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IDC School > Neuro > Flashcards

Neuro Flashcards

1
Q

what is the network of nerves located in the gastrointestinal tract?

A

Enteric Motor Neurons (involuntary) in enteric plexuses

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2
Q

how many spinal nerve pairs do we have and name each category?

A

31 spinal nerve pairs

  • 8 pairs in the cervical
  • 12 pairs in the thoracic
  • 5 pairs in the lumbar
  • 5 pairs in the sacral
  • 1 in the coccygeal
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3
Q

what are the motor neurons that carry neural impulses away from the CNS and toward muscle to cause contraction?

A

efferent

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4
Q

what is the name of the sensory neurons that carry impulses from the sensory stimuli toward the CNS?

A

afferent

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5
Q

structural classes of a neuron

A

unipolar
bipolar - special senses
multipolar- most common in the body

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6
Q

what supports, nourishes, and protect neuron and is critical for homeostasis?

A

neuroglia

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7
Q

what cell produces myelin around the pns neuron

A

schwann cells

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8
Q

what cells produce myelin around the CNS neuron?

A

oligodendrdrocytes

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9
Q

what cell produces CSF?

A

ependymal cells

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10
Q

What cell forms the blood brain barrier

A

astrocytes

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11
Q

what is the bundle of axons in the PNS called?

A

Nerve

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12
Q

what is a bundle of axons in the CNS called?

A

Tract

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13
Q

what nervous system includes cranial nerves, spinal nerves and sensory nerves??

A

PNS

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14
Q

what nervous system controls thoughts emotions and memories

A

central nervous system

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15
Q

what nervous system conveys information from sensory receptors in the head, body wall and limbs and from the receptors for special senses (vision, hearing, taste and smell) to CNS and conduct motor impulses from the CNS to skeletal muscles

A

somatic nervous system

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16
Q

what nervous system conveys sensory information in visceral organs (stomach/lungs) to CNS and conduct motor impulses from CNS to smooth muscle, cardiac muscles and glands?

A

autonomic nervous system

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17
Q

what nervous system is called brain of the gut, monitors chemical changes in the GI tract, stretching walls, regulate acid secretion and endocrine cell secretions?

A

enteric nervous system

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18
Q

what are the meningeal layers?

A

dura mater
arachnoid mater
pia mater

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19
Q

what is the most outer meningeal layer?

A

dura mater

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20
Q

what is the middle meningeal layer and resembles spider web?

A

arachnoid layer

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21
Q

what is the inner, thin and delicate and adheres to surface of the spinal cord and brain?

A

pia mater

it also contains numerous blood vessels(

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22
Q

what is the name of the space cerebral spinal fluid travels?

A

subarachnoid space

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23
Q

what space helps protect and cushion and is between the vertebrae and dura mater?

A

epidural space

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24
Q

what is the name of the two spinal cord grooves?

A

anterior median fissure

posterior median sulcus

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25
Q

what axons does the posterior (dorsal) root contain?

A

sensory axons (afferent)

(which conduct nerve impulses from sensory receptors in the skin, muscle and internal organs into the central nervous system)

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26
Q

what axons does the Anterior (ventral) root contain?

A

motor neurons (efferent)

which conduct nerve impulses from the CNS to effectors

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27
Q

what axons does the posterior grey horn contain?

A

sensory neurons

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28
Q

what axons does the anterior(ventral) grey horn contain?

A

somatic motor neurons that provide impulses for contraction of muscles

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29
Q

what axons does the lateral gray horn contain?

A

autonomic motor neurons that regulate the cardiac muscle, smooth muscle and glands

only present in the thoracic and upper lumbar segments

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30
Q

what tract conducts nerve impulses toward the brain?

A

sensory tract

Example: spinothalamic

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31
Q

what tract conducts nerve impulses away from the brain

A

motor tracts

example: corticospinal tract

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32
Q

what are the two types of reflexes?

A

spinal - simple reflex arc - patellar reflex

cranial - occurs in brainstem - gag reflex

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33
Q

what plexus supplies the upper limbs, some neck and shoulder muscles?

A

brachial plexus

examples: radial nerve, ulnar nerve and axillary nerve

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34
Q

what plexus supplies posterior head, neck, upper part of the shoulders and the diaphragm

A

cervical plexus

example: phrenic nerve (C3, 4, 5)

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35
Q

what plexus supplies abdominal wall, external genitals, and parts of the lower limbs

A

lumbar plexus

example: femoral nerve (L2-L4)

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36
Q

what plexus supplies buttocks, perineum and most of the lower limbs?

A

sacral plexus

example: sciatic nerve (L4 -S3)

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37
Q

what percentage of oxygen does the brain require?

A

requires 20% of the bodies oxygen supply

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38
Q

what major vessels compose the circle of willis?

A

internal carotid arteries

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39
Q

where is CSF produced?

A

choroid plexuses located in the brain

Choroid plexus which is specialized networks of capillaries in the walls of ventricles

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40
Q

what are the components of the brain stem?

A

medulla oblongata (inferior part of the brain stem; continuation of the spinal cord)

pons (“bridge that connects the medulla to the midbrain and above)

Midbrain (connects pons to diencephalon)

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41
Q

what are the components of the diencephalon?

A

thalamus (major sensory relay center)

Hypothalamus (important for homeostasis)

Pineal Gland (part of the endocrine system)

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42
Q

what is called “little brain”

A

cerebellum

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43
Q

what regulates breathing, heart rate and force and contains cranial nerves VIII-XII

A

medulla

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44
Q

what is called the “bridge” and connects the left and right side of the cerebellum and contains CN V-VIII

A

pons

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45
Q

what coordinates reflex center for the eye, head movement and auditory relay?

A

midbrain

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46
Q

what controls relay center, motor functions and consciousness

A

Thalamus

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47
Q

what controls homeostasis, pituitary gland, hormone production, body temperature, circadian rhythm?

A

hypothalamus

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48
Q

what secretes melatonin and promotes sleep?

A

pineal gland

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49
Q

what controls smooth/coordinate skeletal muscle contraction, skilled motor activities, posture and balance

A

cerebellum

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50
Q

what is called the emotional brain, plays a roll in pain, pleasure, anger, and affection?

A

the limbic system of the cerebrum

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51
Q

name all the CN that only have sensory function

A

CN I, II, VIII

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52
Q

name the CN that only have motor functions

A

CN III, IV, VI, XI, XII

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53
Q

what CN tests for superficial pain and touch sensation of the face and ability to clench the teeth

A

CN V : trigeminal

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54
Q

what cn test for hearing and lateralization of sound?

A

CN VIII, Vestibulocochlear

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55
Q

what three neurons are in the somatic sensory pathway?

A

cell body #1 is in the dorsal root ganglion
cell body #2 is in the spinal cord or the brain stem
cell body # 3 is in the thalamus

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56
Q

what are the two examples of the somatic sensory pathway?

A

pain stimuli

mechanical stimuli

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57
Q

what spinal tract pathway test for superficial pain and temperature

A

lateral spinothalamic tract

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58
Q

what spinal tract pathway test for superficial touch and deep pressure

A

anterior spinothalamic tract

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59
Q

what spinal tract pathway tests for vibration, deep pressure, position sense, stereognosis, point location and two point discrimination?

A

posterior column- medial lemniscus pathway

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60
Q

what spinal tract pathway tests for rapid rhythmic, alternating movements, voluntary movements, DTR and Plantar reflex?

A

corticospinal tract

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61
Q

what spinal tract pathway test for posture, romburg, gait and instinctual motor reactions

A

Reticulospinal (descending tract)

62
Q

what reflex controls spinal nerve T8, T9, and T10

A

upper abdominal

63
Q

what reflex controls spinal nerve T10, 11 and 12

A

lower abdominal

64
Q

what reflex controls spinal nerve T12, L1 and L2

A

Cremasteric

65
Q

what reflex controls spinal nerve C5 and 6

A

Bicep (DTR)

Brachioradial (DTR)

66
Q

what reflex controls spinal nerves L5, S1 and S2

A

Plantar

67
Q

what reflex controls spinal nerve C6, 7 and 8

A

Triceps

68
Q

what reflex controls spinal nerve L2, 3 and 4

A

Patellar

69
Q

What reflex controls spinal nerve S1 and S2

A

Achilles

70
Q

What does a DTR score of 1+ mean

A

minimal (sluggish or diminished)

71
Q

What does a DTR score of 2+ mean

A

Normal (active/ expected response)

72
Q

What does a DTR score of 3+ mean

A

Brisk (More than expected, slightly active)

73
Q

what does a DTR score of 4+ mean

A

Very Brisk (Hyperactive, with intermittent or transient clonus)

74
Q

What does a DTR score of 0 mean

A

Absent

75
Q

what are the two neurons in the somatic motor pathway

A

upper and lower motor neurons

76
Q

what are the subdivisions of the autonomic nervous system

A

sympathetic

parasympathetic

77
Q

name the two neurons in the sympathetic division pathway?

A

preganglionic

postganglionic

78
Q

what autonomic nervous system division increases HR, BP, dilate pupils, dilate airway, dilate vessels of the skeletal muscles, heart, liver and adipose tissue

A

fight or flight (sympathetic)

79
Q

What does the acronym SLUDD mean?

A 
Salivation
Lacrimation
Urination
Digestion
Defecation

(Mainly the parasympathetic)

80
Q

Diagnosis for:
Pain on the right side of the head with some lacrimation.
Neuro exam in unremarkable

A

Cluster headache (Due to the lacrimation)

TX: Inhaled 100% oxygen fir 15 minute

  • sumatriptan SubQ initial 6 mg do not exceed two 6mg injections in 24 hours
  • Zolmitriptan Oral 2.5 mg no more than 10mg in 24hours may repeat every 2 hours as needed for pain
81
Q

Sailor immediately falls to the floor and goes rigid. Right after he starts experiencing jerking, which lasts about 90 seconds, then he remains unresponsive and goes flaccid.

When he gains consciousness, he complains of fatigue and a headache. What condition did this sailor more than likely experience

A

Generalized Seizure- Tonic-clonic (AKA grand mal)

Treatment for active seizure:
Clear the room and maintain airway
Diazepam 5mg iv/im every 5-10 minutes do not exceed 30 mg

82
Q

Suspicion of a drunk sailor due to slurred speech, difficulty understanding others and imbalance.

  • unremarkable neuro exam
  • HPI: patient takes HCTZ QD and states he felt weird and not him self this morning but went into work anyways. What is most likely the diagnosis for this patient
A

ischemic stroke

  • do not lower blood pressure acutely as it may be the only thing maintaining adequate perfusion. UNLESS PRESSURE IS ABOVE 220/120

TX: Medication - Aspirin 325 mg and medevac

83
Q

Sailor presents with 9/10 headache

  • around the head and squeezing
  • going through divorce and extremely tired with work
  • unremarkable neuro exam
  • neck and back of head tender to palpation
A

tension headache

-Treatment: NSAID ibuprofen 400-800 mg po q 4-6 hours max 2400mg or naproxen 250-500 mg po q12hrs

Tylenol 325-1000 mg po q 4-6 hours, max 4 grams

84
Q

Sailor drunkenly fell, witness states he had alot to drink and got into a fight then was knocked unconscious.

  • Woke: couldnt remember what happened and was confused
  • Neuro exam: inability to focus, slurred speech, stare and disorientation
A

Concussion

TX: MACE within 48 hours
- 24 hours mandatory rest with 2 hour checks

85
Q

Patient reports with headache.

  • Worst headache of my life
  • neck pain
  • N/V x2
  • focal deficits noted
A

Subarachnoid hemorrhage

TX plan: MEDEVAC

  • bedrest
  • analgesic = Tylenol
  • no drugs that can lead to anticoagulation
86
Q

Tackled during a soccer game and audible scream after falling on neck.

  • neck pain
  • numbness spreading down arms and legs
  • step off at C5 and swelling
A
  • spinal cord injury
TX plan: MEDEVAC
ABC's first
-C-collar ASAP
- insert a foley catheter 
- maintain oxygenation and B/P
- may require intubation if resp compromise

MO PERMISSION = Methylprednisolone 125 mg im/iv q 4-6 hours

86
Q

Patient reports feeling ill
- sister feels the same
- headache, light sensitivity, neck pain, chills, skin rash, generalized pain.
- Exam reveals: Nuchal rigidity, neuro deficits, burdzinkis sign and kernigs is postive
- Temp: 103.5F
What is the treatment and prophylaxis of this?

A

Meningitis

This is a Medical emergency, almost 100% fatal
TX: Ceftriazone 2mg IV q12hrs (antibiotic that can cross blood brain barrier)

Prophylaxis:

  • Treat the exposed crew with Ciprofloxacin 500mg PO x1
  • ensure vaccinations are current (meningococcal, s. penimonieae and H influenza)
  • mask patient and close medical personnel
87
Q

CC: Feeling sick
PmedHX: Ear infection about a week ago
Sx: numbness in face, drooling, tearing of eye, blinking and inability to drink water
PE: CN VII deficit and unable to raise eyebrows or make forehead folds.

What is the dx? and what is the best treatment?

A

Bells palsy

  • eye protective measures (if inadequate closure of eye)
    -MEDICATION: Prednisone 60mg PO daily for 7 days then 5 day taper
    severe is treated with: Valacyclovir 1000 mg 3 times daily for 7 days
88
Q

what is the treatment for psychogenic nonepileptic seizures?

A

Cognitive behavioral therapy

89
Q

what is a hemorrhagic stroke?

A

Bleeding INTO the brain

90
Q

What is an Ischemic stroke?

A

BLOCKAGE of a blood vessel causing lack of cerbral blood flow leading to ischemia

91
Q

What are the two subtypes of ischemic stroke?

A

Transient ischemic attack

Cerebral Vascular accident

92
Q

what is the most common type of stroke

A

ischemic

93
Q

what is the difference between TIA and CVA

A

Transient = transient episode of neurologic disfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction

CVA = Neurological dysfunction WITH infarction (tissue death) of the central nervous system tissue

94
Q

What occurs within the precentral gyrus?

A

Primary motor area, skeletal muscle (somatic), all intended movements

95
Q

Where does learned sequences of movements occur

A

Frontal lobe (somatic sensory)

96
Q

what is an efferent tract

A

corticospinal

97
Q

what is an afferent tract

A

spinothalamic (axons go from spinal cord to thalamus)

posterior column- medial lemniscus is also an afferent tract

98
Q

Conscious proprioception occurs where?

A

PCML (posterior column - medial lemniscus )

99
Q

Pain and temperature is controlled where

A

lateral spinal thalamic tract

100
Q

Which cranial nerves have pons nuclei?

A

CN V- VIII

101
Q

What is the definition of a seizure?

A

an abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons

102
Q

nuclei in the medulla cranial nerves

A

CN VIII- XII

103
Q

what is a focal seizure without impaired consciousness or formally known as complex partial seizure

A

does not involve the whole brain

i.e. only one part of the brain is affected

104
Q

what is status eplilepticus

A

when a single seizure last more than or equal to 5 minutes or 2 or more seizures occur causing an incomplete recovery time

105
Q

How is the only way to truly diagnose a seizure

A

video EEG

106
Q

if an EEG shows no changes in electrical activity, what type of seizure is this?

A

Psychogenic nonepileptic seizure

107
Q

Where do disk herniations usually occur

A

L5 through s1

108
Q

What type of hemorrhage is this? immediate loss of consciousness after a significant head trauma, “lucid interval” with recovery of conciousness

A

Epidural hemorrhage

between the dura mater and the skull

109
Q

what is more common than an epidural hemorrhage, often occurring in the elderly, ETOH abusers and those on anticoagulants? It may sometimes occur with impact

A

Subdural hemorrhage

between the dura mater and arachnoid mater

110
Q

A patient reports hearing a “thunder clap” and then immediately having the worst headache of his life.
Past social history includes heavy alcohol use, cocaine and smokes a pack of cigarettes a day.

A

Subarachnoid hemorrhage
(bleeding is high pressure and into subarachnoid space which normally carries CSF)
(Usually rupture of blood vessel aneurysm)

111
Q

If a patient reports to medical following a severe blow to the head and during the MACE exam reports that this is her second mTBI/Concussion in 12 months, what is the rest period

A

RTD delayed for an additional 7 days following symptom resolution

112
Q

what can be caused from severe compression of the spinal cord and is considered a surgical emergency

A

Cauda Equina syndrome

113
Q

define sciatica

A

Electrical shock like pain radiating down the posterior aspect of the leg, often below the knee

114
Q

What is the most common level of herniation causing decreased strength in foot dorsiflexion, toe extension, foot inversion or eversion

A

L5

115
Q

what is carpal tunnel syndrome

A

an entrapment neuropathy caused by compression of the median nerve between the carpal ligament and other structures within the carpal tunnel

116
Q

How do you diagnose carpel tunnel

A

tineal or Phalen’s sign is enough to diagnose

also diagnosed with ultrasound and nerve conduction studies

117
Q

What is the clinical presentation of bells palsy

A

abrupt onset of unilateral face paralysis
pain about the ear
face feels stiff and pulled on one side
may be ipsilateral restriction of eye closure and difficulty with eating
bells phenomenon (upward rolling of the eye on attempted lip closure)

118
Q

how will you differentiate between a stroke and bells palsy

A

stroke = no paralysis of the forehead

intake forehead muscle tone suggest a stroke and not bells palsy

119
Q

what are the gaps in myelin along the axon

A

nodes of Ranvier

120
Q

what is the depolarization phase

A

voltage gated Na+ channels open

membrane potential rises and become positive

121
Q

what is the repolarization phase

A

Voltage gated K+ channels open, more K leaves cell

membrane potential is returned to resting value

122
Q

Brain neurons deprived of oxygen for over ____ minutes may lead to permanent damage

A

4 or more minutes

123
Q

Blood brain barrier protect the brain cells from harmful substances and pathogens but what does it allow the passage of?

A

Lipid soluble such as O2, CO2, Alcohol, and anesthesia

124
Q

where is CSF absorbed?

A

slowly reabsorbed into the blood through the ARACHNOID VILLI

125
Q

The fold of the cerebrum are called

A

Gyri (gyrus)

126
Q

the shallow grooves of the cerebrum are called

A

sulci (sulcus)

127
Q

What regulates breathing and speech

A

brocas speech area (in the frontal lobe close to the lateral cerebral sulcus)

128
Q

the autonomic nervous system motor pathway has how many neurons from CNS to the effector?

A

2 neurons (Somatic nervous system motor pathway has one)

129
Q

preganglionic neurons contain what receptors?

A

ACh

130
Q

what supplies abdominal viscera in the prevertebral gangila

A

celiac, superior and inferior mesenteric ganglia

131
Q

what cranial nerve carries 80% of all Parasympathetic division nerve impulses?

A

Vagus CN X

132
Q

sympathetic division releases what

A

epinephrine/ norepinephrine

133
Q

what is the heel to toe gait assessment used for

A

exaggerate any abnormal gait

134
Q

What is the function of Neuroglia?

A

Provide support, nourishment and protection

CRITICAL FOR HOMEOSTASIS OF INTERSISTITAL FLUID AROUND NEURONS

135
Q

Which structural class of neuron is found in the retina of the eye and has one dendrite and one axon?

A

Bipolar (special senses)

136
Q

What structural class of neuron is the most common type in brain and spinal cord?

A

Multipolar

137
Q

What structural class of neuron is sensory neurons of spinal nerves

A

Unipolar (fused dendrite and axon)

138
Q

What is a cluster of cell bodies in the PNS

A

Ganglion

139
Q

What is a cluster of cell bodies in the CNS

A

Nucleus

140
Q

What is a bundle of axons in the PNS

A

Nerves

141
Q

What is a bundle of axons in CNS

A

Tract

142
Q

Which ascending tract is associated with superficial pain and temperature test

A

Lateral spinothalamic

143
Q

Which ascending tract is associated with superficial touch and deep pressure

A

Anterior spinothalamic

144
Q

What ascending tract is associated with vibration, deep pressure, position sense, sterognosis, point location and two point discrimination

A

Posterior column

145
Q

What is associated with proprioception

A

Anterior and dorsal spinocerebellar

146
Q

Which descending tract is associated with rapid rhythmic movement, voluntary movement, DTR, and plantar reflexes

A

Lateral and anterior corticospinal

147
Q

What is associated with posture and Romberg, gait and instinct motor reactions

A

Medial and lateral reticulospinal

148
Q

What are the descending tracts?

A

Corticospinal (lateral) = limbs
Corticospinal (anterior) = Abs (core)
Reticulospinal = reflex

149
Q

What are the ascending tracts?

A

Spinothalamic (lateral) = superficial pain and temperature

Spinothalamic (anterior) = superficial touch and deep pressure

Spinocerebellar = proprioception

Posterior column ( vibration, deep pressure, position sense, sterognosis, point, two point)

IDC School (13 decks)

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