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Flashcards in Neuro Phys Deck (176):
1

Gag reflex

Ipsilateral glossopharyngeal (afferent) -> bilateral vagus (efferent)

2

Spinothalamic tract

Carries?
1st order neuron?

pain and temperature sensation

peripheral nerves to posterior horn , cell body in DRG

3

Dorsal column medial lemniscus

Carries?
1st order neuron?

pressure, touch vibration, proprioception

peripheral nerves to medulla via dorsal column, cell body in DRG

4

lateral corticospinal

Carries?
1st order neuron?

voluntary movement

Pyramidal neurons in the cortex descent, cross in medullary pyramids,
Synapse on the anterior motor horn of the cord (UMN)

5

hypothalamospinal

carries?
1st order neuron?

sympathetic input to the face

Arrises from hypothalamus and synapses on lateral horn at T1

6

2nd order spinothalmic tract

arises from posterior horn, IMMEDIATELY CROSS, in anterior white commissure and ascend in spinothalmic tract to thalamus

3rd order - thalamus to cortex

7

2nd order dorsal column medial lemniscus

arises from the medulla, crosses LATE and ascends via the medial lemniscus to thalamus

3rd order - thalamus to cortes

8

2nd order corticospinal

Arises from the anterior motor horn and synapses on muscle (LMN)

9

2nd order hypothalamospinal

arises from the lateral horn at T1 and synapses on the superior cervical ganglion (sympathetic)

3rd order - superior cervical ganglion to eyelids, pupil and skin of face

10

Microglial origin

mesoderm - like macrophages

11

Neural crest cells -> what neural structures?

PNS (CN, DRG, celiac ganglia, ANS) and Schwann Cells

there are other ones....

12

Neuroectoderm leads -.

CNS neurons, epndymal cells, oligodendrocytes, astrocytes

13

Blood brain barrier made of

foot process of astrocytes
BM
non fenestrated endothelia

No BBB where hypothalamus releases ADH or measures osmolarity

14

Histiologic feature defining neurons

Nissl cebstances in the dendrocytes

15

HIV infected multinucleate giant cells formed by

microglia

16

Reactive gliosis preformed by

astrocytes
~fibroblasts in the brain
-ID'ed by GFAP

17

Cell destroyed in MS

Oligodendrocyte

18

Cell destroyed in Gulliene Barrie

Schwann Cell

19

Fried Egg apperance on Hand E (3)

Oligodendrocyte
koliocyte w/ HPV
seminoma

20

Acustic nurima is

type of schannoma -. internal acoustic meatus of CNVIII

21

Pathways associated w/ Schizophrenia +/-

mesocortical pathway

mesolimbic pathway

Dopamine

22

Pathway implicated Parkinsons

Nigrostriatal path (substantial nigra-> neostriatum)

Dopamine

23

Tuberoinfundibular Pathway

Dopamine path from arcuate nucleus in hypothalamus -> Pituitary leading regulation of prolactin levels

24

What passes the BBB (4)

Lipophilic substance
- small non polar

Glucose and AA w/ carrier transport

25

Nucleus accumbens

uses what Vitamin and AA

Creates GABA
-LOW in huntintons

Using glutamate and Vit B6

26

Locus ceruleus creates?

NE
-high in anxiety
-low in depression

Also reticular formation and solitary tract

27

Ventral tegmentum of midbrain creates?

Dopamine
Also SNc

Decreased dopamine in parkinsons and depression

28

Raphe nucleus in the pons makes?

5HT

29

Basal nucleus of meynert makes?

ACh

increased in REM sleep and parkinsons

30

Glycine?

inhibitory NT of the Spinal Cord

31

Glutamate?

excitatory NT of CNS

32

Arcuate nucleus
Hypothalamus

releases dopamine and GnRh

33

Lateral nucleus
hypothalamus

Hunger
-inhibited by leptin
Destruction -> anorexia

34

Ventromedial nucleus
hypothalamus

Satiety
-stimulated by leptin
Destruction -> hyperphagia - >excessive eating

35

Anterior hypothalamus(2)
hypothalamus

Cooling (A/C)
parasympathetic stim

36

Posterior hypothalamus(2)
hypothalamus

Heating
sympathetic stim

37

Dorsal medial nucleus
hypothalamus

Stimulates the GI
works w/ VMN

38

Suprachiasmatic nucleus
hypothalamus

master clock
circadium rhythm

39

Preoptic nucleus
hypothalamus

Secreted GnRH -> FSH and LH

40

Supraotic nucleus
hypothalamus

ADH release

41

Paraventricular nucleus
hypothalamus

Oxytocin
- give synthetic ptocin for Uterine contraction and clamping down the uterus after birth to control bleeding

42

Mammary body

in hypothalamus
contains hemorhagicc lesion of Wernicke encephalopathy

43

Melatonin

secreted by pineal gland during period of darkness

also follows circadian rhythm

44

Limbic system and at the 5 Fs

Feeding
Fleeing
fighting
Fucking
Feeling

45

Anxiety is due to these changes in NTs (3)

increased NE
decreased 5Ht
decreased GABA

46

Stages of Sleep and EEG (6)

awake-beta
relaxing- alpha
NI- Theta
NII - Sleep spindle and K complexes
NIII- Delta
REM - Beta

47

Night terrors and bed wetting found in

NIII

Rx w/ benzos or imiprimine

48

Bruxism is what and where is it found

Teeth grinding in stage II sleep

49

Sleep enuresis can be treated w/

imiprimine (TCA)
Desmopressin - ADH

50

paramedian pontine reticular formation is important in sleep when?

rapid eye movement in REM

51

Depressed sleep changes (4)

decreased REM latency and increased REM early in sleep cycle
repeated nighttime awakenings and early morning awakening
low slow sleep

52

Narcolepsy characterized by what sleep cycle



Rx:

Awake -> REM
- Cateplexy and Hallucinations

Tx w/ modafinil
-nightime sodium oxybate

53

Insomina Rx

1st line

Benzo alternative Rx? (3)

antihistamines

Zolpidem
Zaleplon
eszopiclone - long term

54

Tounge nerves
Anterior 2/3 taste?
Anterior 2/3 sensation
Posterior taste?
posterior sensation

Facial nerve
trigeminal - mandibular branch
glossopharyngeal
glossopharyngeal

Vagus is taste in epiglotic

55

Olfactory nerve exits

cribiform plate

56

Lesions of the olfactory nerve (2)

cribiform plate frature
Kallman syndrom e9infertile as well)

57

Exits the superior orbital fissure (4)

Occulomotor
Trochlear
trigeminal opthalmic branch
abducens

58

Trigeminal maxillary branch exits

foramen rotundum

59

Trigeminal mandibular branch exits

foramen ovale

60

2 nerves exiting internal acoustic meatus

facial
vestibularcochlear nerve

61

3 nerves exiting the jugular foramen

glossopharyngeal
vagus
spinal accessory nerve

62

Hypoglosseal nerve exits the

hypoglosseal canal

63

Cranial nuclei of midbrain

3 occulomotor
4 trochlear

64

Cranial nuclei of the pons

5 trigeminal
6 abducens
7 facial
8 vestibularchochlear

65

Cranial nuclei of the medulla

9 Glossopharyngeal
10 Vagus
12 hypoglosseal

66

Cranial nuclei of spinal cord

11 accessory

67

Muscles of mastication
- open
-close
-nerve

open - lateral petrygoid
close - temporal is, masseter, medial pterygoid

V3 - mandibular branch of trigeninal

68

5 branches of facial nerve

To Zanzibar By Motor Car

Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical

69

Parotid gland innervation

glossopharyngeal

70

Submandibular and sublingual innervation

facial nerve

71

Lesions of the hypoglosseal see?

tounge pointing toward the lesion

72

lessons of vagus nerve see?

Uvula points away from lesion

73

Pupillary reflex

II shine in light
III constricts

74

Corneal reflex

V1 senses touch
VII temporal branch shuts

75

CNIII damage

Down and out pupil

76

CN IV damage

eyes gazes upward, hard with stairs

77

CN VI damage

medially directed eye

78

Nucleus Solitaris(3)

Vagus nuclei- Visceral sensory
taste
baroreceptors
gut distension

79

Nucleus ambiguous (3)

Vagus nuclei -Motor
pharynx
larynx
upper esophagus (swallowing, plate elevation)

80

Dorsal motor nucleus

Parasympathetic control of vagus

heart
lungs
Upper Gi

81

Infection of cavernous sinus leads to what neuro defects

Ophthalmoplegia (CN 3, 4 ,6)

Upper and middle face sensation change (V1 and 2)

82

Marcus gunn pupil

afferent pupillary defect - damage or retina detachment ->

Bilateral constriction when light is shown in unaffected eye

Neither constrict in affected

83

Bitemporal hemanopia

optic tract lesion

84

Left homonymous hemianopia

R optic tract lesion

85

Right anopia

Right optic nerve lesion

86

central scotomata - loss of central vision

macular degeneration

87

Left hemanopia w/ macular sparing

Posterior cerebral artery infarct- collateral from middle cerebral spares the macula

88

Increased AFP seen in maternal serum and amniotic (3)

Down in ?

anterior abdominal wall defect
Spina bifida
Anencephaly

Down in Down syndrome

89

Anencephaly

Clues(2)?

malformation of anterior neural tube-> no forebrain, low folate of DM type 1 risk

polyhydramnios - no swallowing reflex
Increase AFP

90

Holoprosencephaly is ?

Due to

failure of L and R hemispheres to separate

sonic hedgehog signaling mutation

91

Proencephalon/Forebrain -> (2)
embryology

telencephalon -> cerebral hemispheres
Diencephalon -> thalamus

92

Mesenecephalon/Midbrain ->
embryology

mesencephalon -> midbrain

93

rhombencephalon/hindbrain -> (2)

metencephalon (Pons and cerebellum)
Myelencephalon (medulla)

94

Chiari One is at risk for?

Characterized by

syringomelia
- can be connected to trauma as well

mild cerebellar tonsils herniate

95

Chiari type II is what ?

Leads to (3)

Significant cerebellar tonsillar/vermian herniation through foramen magnum

aquaductal stenosis,
hydrocephalus,
thoraco-lumbar myelomeningocele

96

cystic enlargement of the 4th ventricle w/ enlarged posterior fossa
- Agenesis of cerebellar vermis is called

Dandy walker

97

C8-T1 lesion w/ loss of pain and temp sensation is at further risk for what neuro defects?

What tract is affected 1st

Syringomyelia


can have additional weakness of arms w/ progressive anterior horn involvement

spinothalamic tract

98

Brachial cleft derived from

ectoderm

99

Brachial pouches derived from

Endoderm

100

Brachial arches derived from

mesoderm

101

Branchial cleft cyst characterized by

Other major cleft derivative?

lateral neck location that does not move w/ swallowing

-vs thyoglossal cyst(midline and moves)

Cleft 1 -> external auditory meatus

102

1st brachial arch derivatives think

Muscles(3)

Nerves(2)

Ms and Ts

Muscles of mastication(Temporalis, Maseter, lateral and medial pterygoid)
Mylohyloid
Tensor Tympani
Tensor veli palatini

Mandibular and Maxilliary branch of trigeminal

103

2nd brachial arch derivatives think

Muscles(4)

Nerve(1)

S's

Facial expression (CN Seven)
Stapedius
Stylohyoid
posterior belly of digastric

CN VII

104

3rd brachial arch derivatives think

Muscle (1)

Nerve (1)

pharyngeal

Stylopharyngeous

glossopharyngeal

105

4-6th brachial arch derivative think

Muscle(2)

Nerve (1 w/ 2 branches)

thyroid and cricoid

4th
swallowing muscles - cricothyroid, levator palatine and pharyngeal constrictors

--enervated by superior laryngeal branch

6th
Larynx/voice box (EXCEPT cricothyroid)
--enervated by recurrent laryngeal branch

106

Inferior parathyroids and thymus come from

3rd brachial pouch

107

superior parathyroids come from

4th brachial pouch

108

middle ear cavity comes from

1st brachial pouch

109

palatine tonsils develop from

2nd brachial pouch

110

monitors carotid body and sinus chemoreceptors

CN 9 - glossopharyngeal

111

Unilateral lower extremity sensory and or motor loss

contra-lateral lesion of the anterior cerebral artery

112

Unilateral facial and arm sensory and/or motor loss

contra-lateral lesion of middle cerebral artery

113

vision defects

poterior cerebral artery

114

hypersexulaty, hyperorality and disinhibited behavior found in

Kluver Bucy syndrome
Bilateral amygdala lesion

115

Disinhibited behavior and problems with judgement and concentration

Lesion in the frontal lobe

116

Views/pays attention to only half the world -

contrallateral lesion of the parietal lobe (non dominant)
- usually the R ignoring the L

hemineglect syndrome

117

Agraphia, acalcula, finger agnosia and can't from R from L -> lesion in

Dominant parietal lobe. usually the Left in a Right handed person

Gestman syndrome

118

Lesion in the reticular activating system leads to

decreased levels of arousal

in the midbrain

119

Common lesion of the mammalary bodies due to

Thiamin - B1 deficiency - seen in alcoholics

120

Wenicke Korsakoff syndrome characterized by(5)

confusion
opthalmoplegia
ataxia
memory loss
confabulation
personality changes

121

Basal ganglia lesions you may see

tremor at rest
chorea
athetosis

Anything coordinating voluntary movement from the cortex

122

Intention tremor and limb ataxia seen in
may fall towards the lesion

cerebellar hemisphere lesion

123

truncal ataxia and dysarthia (muscles of the mouth)

Cerebellar vermis lesion

124

involuntary flailing of the limbs (contralateral hemiballismus ) seen in

lesion subthalamic nucleus

125

Inability to make new memories (anterograde amnesia causing lesion )

hippocampus

126

Lesion of paramaedian pontine reticular formation see

eyes looking away from the lesion

127

paralysis of upward gaze

Parinauds syndrome
superior colliculi lesion

128

Lesion of ? leads to inability to repeat phrases

arcuate fasciulus

129

Wernickes

Fluent aphasia
- speaks but does not comprehend or make sense
word salad

superior temporal gyrus of temporal lobe

130

Brocas

location?

nonfluent aphasia
-can't speak but comprehends, very frustrating

inferior frontal gyrus of frontal lobe

131

Nondominate Brocas lesion?

inability to express emotion (robot talk)
-probably a lesion on the R

132

Nondominate Wernickies lesion ?

inability to comprehend emotion (spock)
- probably a lesion on the R

133

Issue associated w/ inhaled anesthetics

hepatotoxicity

especially halothane

134

Blood solubility and lipid solubility effects on anesthetics

Lipid solubility will determine how quickly it gets into the BBB and also the potency

Blood solubility is the time to effect. Low blood solubility means quicker reaction to effect

ex nitrous oxide is rapid in its effect (low blod solubility) but not very potent- not very lipid soluble

Halothane takes longer to have effect ( more blood soluble) but not more lipid soluble and thus more potent

135

Inhaled anesthetics

(4)

Halothan
enflurane
sevoflurane
nitrous oxide

Used for induction and maintenance of general anesthesia (won't remember)

136

IV anesthetics types and MOA
(4)

Also some sedation seen as well

barbituates - acts on GABA receptor increasing the duration of Cl channels being open (thiopental or phenobarbital)


benzodiazepines- acts on GABA receptor increasing the frequency of Cl channels being open ( Diazapam and lorazepam)

ketamine - dissociative anesthetic- blocking NMDA receptors

Propofol - uses for sedation potentiating GABAa, rapid induction (Michael Jackson)

137

Analgesics used in surgery (2)

Why might you choose one over the other?

Opioids

Morphine -local histamine release side effect

Fentanyl - more potent

Others
Butorphanol
dextromethorphan
tramadol
loeramide and diphoxylate

138

Blood flow concerns during brain surgery which IV anesthetic do you use

Barbituates have decreased blood flow in the brain

NOTE: ketamine causes increased cerebral blood flow

139

Rx for barbituate overdose?

Rx for benzodiazapine overdose

none - supportive

flumazenil

140

High risk of tryglcerides levels w/ continued use of this IV anesthetic

propofol

Used for rapid sedation in the ICU and short procedures

141

Barbituate examples (4)

Thiopental
phenobarbital -> induces liver enzymes (Crigler Najarr Syndrome type II Rx?)
phentobarbiol
secobarbitol

142

Most common drug used in conscious sedation

midazolam

143

Benzodiazabine examples (6)

diazapam
lorazapam
alprazolam
midazolam

tamazapm
chlordiazepoxide

144

Uses of Benzodiazapones (7)

conscious sedation
anesthesia

alcohol withdrawal
anxiety
seizures
night terrors
insomnia

145

2 types of local anesthetics
- both act how?

examples of each (3 each)

esters - procaine, cocaine, tetracaine

amides - lidocaine, mepivacaine, bupivacaine (2 Is)

all act by blocking Na channels on the inner portion of the channel, prefers active channels

does not work as well in acidic environments, like an infection, may need to use more

146

Given w/ local anesthetics to potentiate result

vasoconstrictors like epinephrine

147

3 things needs for general anesthesia

anesthetic
analgesic
immobilization - muscle paralysis

148

MAC - in anesthesia

minimal alveolar concentration which 50% of pop anesthetized -

increased potency = 1/MAC
highly lipid drugs

149

2 types to create neuromuscular blockade and examples of each

Depolarizing - Succinycholine

Nondepolarizing - -curarine; -curium; -curonium

tubocurarine,
atracurium, mivacurium,
pancuronium, vecuronium, rocuronium

150

Succinylcholine MOA
risk?

strong ACH receptor agonist -> fasiculations and eventual paralysis with depolarization
-depolarizing

vc. non depolarizing which is a competitive antagonist

Worry of malignant hypertension

151

Malignant hypertension seen in (2)

Gene?

Rx

succinylcholine use and neuroleptic malignant syndrome

Ryr1 mutation - rytanidine receptor

Rx Dantrolene - blocks Ca release from sarcoplasmic reticulum

152

Non-depolarizing neuromuscular blocking drugs MOA and examples

Rx?

Competitive antagonists for ACh at the neuromuscular junction

Tubocurarine, atracurium, mivacurium, pancuronium, rocuronium,

Rx w/ neostigmine (cholinestrase inhibitor) - less degradation -> more Ach to overcome

153

2 Types of depolarizing neuromuscular blocking and Rx

Phase I - prolonged depolarization
- normal dose of succinylcholine
- NO antidote, wait 10 min

Phase II - depolarized but blocked
-overdose of succinylcholine
- antidote w/ cholinesterase inhibitors like in non depolarizing blockade (20-30 min)

154

seizure affecting only 1 area of the brain

Usually what lobe?

partial or focal

the temporal

either
simple - consciousness intact
complex - LOC

155

What is the difference between a simple and complex siezure

both are partial seizures usually affecting the temporal lobe

Simple - consciousness intact
complex - LOC

156

Status epileptics is defined by

Rx?

continuous seizure greater then 5 min or recurrent seizure w/o regaining conscious ness for >30 min

Benzodiazapin 1st line - diazepam or lorazepam

157

5 types of diffuse seizures and differences

Absence - blank star
myoclonic - quick repetitive jerk
tonic - stiffening
tonic clonic- gran maul - alters between stiff and moving
atonic- drop seizure (appears to be fainting)

158

Top 3 causes of seizures in kids

congenital, developmental and infection (febrile)

trauma and metabolic

159

Top 3 causes of seizures in adults

tumors, trauma and stroke

maybe infection

160

Top 3 causes of seizures in elderly

stroke, tumor and trauma

Maybe metabolic and infection

161

Rx for trigeminal neuralgia (1 + 3 others)

usually affects which branch

Carbamazepine

phenytoin, gabapentin, topiramate

- maxillary - > touch leads to EXTREME pain

162

See port-wine stains (nevus flames) over the eye (V1 distribution called?

Causes (3)

Sturge Weber syndrome - congenital disease
- worry of ipsilateral leptomeningeal anginoma under the eye

Causes Seizures, glaucoma, and mental retardation

163

Presentation of
Seizures, adenoma sebaceous (cutaneous angiofibromas),mental retardation
due to an autosomal Dom disease?

Which gene?

Associated symptoms (2)

Tumors (3)

Tuberous Sclerosis
- complete penetrance w/ variable expression
(TSC1 or 2 gene; hamartin or tuberin protein)

Ash leaf spots(hypomelaocytic macuoles), , harmatomas in CNS(retina) and skin (cortical tubers),

Tumors:
renal angiomyolipoma,
astrocytomas,
cardiac rhabdomyoma

164

5 Seizure drugs blocking Na Channels

Phenytoin
Carbamazapine
Lomotrigone
topiramate
valproic acid

165

7 seizure drugs that increase GABA activity

gabapentin
phenobarbital
valproic acid
benzodiazapine
tigabine
vigabatrin
levetiracetum

166

3 seizure drugs that block T type Ca channels

gabapentin
ethosuximde
phenytoin - at high doses

167

Rx of choice for absence seizures?

Ethosuximide -> valproic acid

168

Rx for status epilepticus

benzodiazapine - lorazepam and diazepam

169

Rx for eclampsia

Magnesium sulfate

maybe a benzo

170

7 odd Side effects of phenytoin

gingerval hyperplasia
hirsutism
fetal hydrantoin syndrome (cleft lip/palat; mental retardation, congenital heart)
megaloblastic anemia - low folate
peripheral neuropathy
drug induced lupus
Steven johnson syndrome

171

Anti epileptics that are teratogens

phenytoin
carbamazapine
valproic acid - spina bifida worries

172

Hepatotoxic epileptics(2)

valproic acid
carbamazapine

173

Treatment for tonic clonic seizures (3)

Valproic acid
phenytoin
carbamazapine

174

3 receptors and endogenist agonists to opiod receptors

mu - beta endorphin
delta - enkephalin
kappa -dynorphin

175

aneurysm causes the eye to look down and out

posterior communicating artery

176

aneurysm leading to loss of peripheral vision bilaterally

anterior communicating artery