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Sandra phase 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

What components makeup neuron

A

Dendrites
Cell body
Axon
Axon terminal/synaptic terminal

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2
Q

What does the axon hillock contain

A

High concentration of voltage gated Na+ channels

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3
Q

Function of dendrites

A

Involved in graded potentials

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4
Q

What are graded potentials?

A

Little changes in the voltage of the cell membrane to try to make the cell have the ability to generate action potentials

This is comprised of the EPSP (depolarisation) and IPSP hyperpolarisation

Takes place within ligand-gated channel of dendrites

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5
Q

Function of cell body

A 
graded potentials
protein synthesis (NT, enzymes, membrane proteins)
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6
Q

What is the name of RER in the neuron

A

Nissl bodies

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7
Q

Function of Axon

A

Conduct Action Potential
Action potential consists of a depolarisation wave followed by a repolarisation wave

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8
Q

Axonal transport

A

Retrograde: Axon terminal to the cell body
Anterograde: Cell body to axon terminal

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9
Q

Function of axon terminal

A 
Secretory region (neurotransmitter released)
Reuptake of neurotransmitter
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10
Q

How to remove neurotransmitters from a synapse (NT termination)

A

Reuptake
Degradation

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11
Q

Structural classification of neuron

A

1 multipolar (3+ dendritic extension).

  1. bipolar (1 dendritic extension). Found in the retina, olfactory epithelium, and inner ear.
  2. pseudo unipolar. Found in dorsal root ganglion + CN5
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12
Q

Functional classification of neurons

A

Sensory (afferent)

Motor (efferent)

interneurons (within CNS)

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13
Q

What is the resting membrane potential

A

The voltage difference across cells when the cell is at rest

It exists in all cells

RMP: -70mV → -90mV

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14
Q

Describe how resting potential is established

A
  1. 3Na+/2K+ ATPase channels: This causes the cell to be slightly negatively. Generate concentration gradient for ions to move
  2. Leaky K+ channels (more permeable than Na+): K+ leaves cells due to concentration gradient. Since it’s bound to an anion, it leaves it behind, increasing the negative charge in the cell.
  3. Leaky Na+ Channel: Na+ moves into the cell due to conc gradient.
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15
Q

Nernst potential

A

Same for Na+

E(K+) =61.5 x log10 (K(out)/K(in))

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16
Q

Where does graded potential occur

A

Postsynaptic neurons

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17
Q

Difference between graded potential and action potential

A

The graded potential is when potential is reached either at threshold potential or slightly above the threshold potential

why?

The ESPS produced may not be enough to reach threshold frequency as they lost their strength.

Graded potential also needs a stimulus

Summation can help to reach threshold potential

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18
Q

What is temporal summation

What is the spatial summation

A

One presynaptic neuron repeatedly stimulates a postsynaptic neuron.

Multiple presynaptic neurones firing simultaneously on one postsynaptic neuron

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19
Q

How do you get to action potential

A

RMP → T.P → Action potential

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20
Q

Describe action potential

A

Depolarisation

  1. Once the action potential reaches -55mV, the Na+ channel opens and allows Na+ to enter the axon. Na+ channels close once action potential reaches +30mV. The action potential travels down to the terminal bulb
  2. Calcium channels open when the action potential reaches +30mV. Causes the synaptic vesicles to fuse with the cell membrane. Releases contents

Repolarisation

  1. At +30mV opens up voltage-gated K+ channel. Allow for potassium to exit the cell.
  2. +30mV → -90mV
  3. The repolarisation of the K+ channels closes the Ca+ channel
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21
Q

Where can you find glial cells

A

PNS & CNS

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22
Q

What makes up nervous tissue

A

Glial cells and neurons

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23
Q

Where do you find astrocytes

A

CNS

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24
Q

What is the blood-brain barrier

A

3 layer innermost→ outermost

  1. Endothelial cells, lots of tight junctions (control permeability)
  2. Basal lamina
  3. foot processes of astrocytes

Also contains pericytes

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25
Q

What is it called when parts of the brain lack blood-brain barrier

A

Circumventricular organs e.g posterior pituitary, need to be in contact with blood for the sensory role

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26
Q

What do glial cells do?

A

Blood-brain barrier- makes tight junctions

Potassium buffer

Removes excess neurotransmitter

Glycogen reserve

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27
Q

Oligodendrocytes function

A
  1. Myelinate axons in CNS + CN2
  2. Myelinate 30-60 axons
  3. When there is damage there is no ability to regenerate
  4. Demyelination = multiple sclerosis
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28
Q

Schwann cells function

A
  1. Myelinates axons in PNS + CN 3-12
  2. Myelinate segments of one axon
  3. If damaged can regenerate
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29
Q

What are spaces between Schwann cells called?

A

Nodes of Ranvier- concentrated with voltage-gated ion channel

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30
Q

Why does myelination increase action potential speed (permeability)

A

Nodes of Ranvier contain voltage-gated sodium channels allowing sodium to enter. There are no Na+ channels present where there is myelination.

This means that there are periods where no depolarisation occurs until the action potential reaches another node of Ranvier to become stimulated.

The same occurs with K+ leaving the axons.

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31
Q

How does myelination speed up action potential speed?

A

Decrease permeability at the myelin sheaths

Myelination also decreases membrane capacitance

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32
Q

What increases conduction velocity

A

Diameter

Myelination

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33
Q

What is the blood CSF barrier made up of?

A

1: Fenestrated Endothelial cells
2: Basal lamina
3: Ependymal cells (tight junctions)

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34
Q

Ependymal cells function

A

Controls the movement of substances across the blood CSF barrier

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35
Q

Microglia cells

A

Acts as an immune system cell

Specialised macrophage cell

Phagocytosis

Can secrete toxins that could potentially affect neural tissue

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36
Q

Boundaries of frontal lobe

A

Central sulcus

Lateral sulcus

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37
Q

What does the front lobe contain

A

Motor Cortex

Broca’s Area

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38
Q

Another name for primary motor cortex

A

Broadman area 4

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39
Q

Broca’s area

A

Stimulating muscles of speech

Right-handed → left Broca

Communicates with Wernicke’s area

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40
Q

Boundaries of parietal lobe

A

Central sulcus (ant)

Lateral sulcus (inf)

Parieto-occipital sulcus (post)

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41
Q

What does the parietal lobe contain

A

Primary somatosensory cortex

Consciousness, awareness of somatic sensations

Somatosensory association cortex

Analysing sensations, recognition of sensations, memory storage

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42
Q

Temporal lobe boundaries

A

Lateral sulcus

Pre occipital notch

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43
Q

The cortexes of temporal lobe

A

auditory cortex

Wernicke’s area

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44
Q

Boundaries of the occipital lobe

A

Parieto-occipital sulcus

Pre-occipital notch

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45
Q

Occipital cortex

A

Primary Visual cortex

Conscious awareness of visual stimuli

Visual association cortex

Visual stimuli → meaning + understanding

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46
Q

Components of basal ganglia

A

Caudate nucleus

Putamen

Globus pallidus (internal + external)

Thalamus (VA nucleus + VL nuceus)

Subthalamic nuclei

Substantia nigra

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47
Q

Striatum composition

A

Caudate nucleus + putamen

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48
Q

Lentiform nucleus

A

Putamen

Globus pallidus

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49
Q

Basal Ganglia function

A

Involved with movements:

Stop

Start

Modulation

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50
Q

What is the purpose of direct pathway of basal ganglia

A

increase motor activity

Neurons from the cortex move down to the striatum (Glutamate)

→ Globus pallidus internus (GABA) → Thalamus (GABA) → Cortex

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51
Q

Glutamate is what kind of neurotransmitter

A

stimulatory neurotransmitter

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52
Q

What kind of neurotransmitter is GABA

A

inhibitory transmitter

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53
Q

Indirect pathway of basal ganglia

A

Decrease unwanted motor activity

Cortex → (Glutamate) Striatum → (GABA) Globulus pallidus externus → (GABA) Subthalamic nucleus → (Glutamate) Globus pallidus internus → (GABA) Thalamus VA + VL → Cortex

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54
Q

Nigrostriatal pathway

A

Modulation (amplify) of activity

Direct pathway: neurons attach from the zona compacta of substantia nigra to the striatum nucleus via the D1 receptor (stimulatory receptor) and release dopamine.

Indirect pathway: neurons from zona compacta of substantia nigra attach to the striatum via D2 receptors (inhibitory receptors)

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55
Q

What is diencephalon

A

A grey matter substance deep within the cerebrum

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56
Q

What makes up the diencephalon

A

Hypothalamus

Epithalamus (Pineal gland, habenula, post commissure)

Sub-thalamus

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57
Q

Hypothalamus function

A

Limbic system

Endocrine system

Autonomic NS

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58
Q

What is the limbic system involved?

A

Emotions and behaviours

olfaction

Memory and learning

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59
Q

What is the function of the mammillary bodies

A

Reflex with olfaction

Formation of new memories

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60
Q

What kind of memory is the hypothalamus involved in

A

Long term memory

Explicit: Conscious memory

Episodic

Semantic

Implicit: Unconscious memory

Skills and habits

Conditioned reflex

Emotion

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61
Q

What is the thalamus

A

Paired midline structure in the brain

Contains multiple nuclei: Relay + Association function

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62
Q

What sensations pass through the thalamus?

A

All sensation except olfactory pass through it

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63
Q

Anatomy of the limbic system

A

Limbic lobe (Cingulate gyrus, parahippocampal gyrus)

Hippocampus (Memory)

Amygdala (Emotions and behaviours)

Hypothalamus

Thalamus

Septal area

Habenula

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64
Q

What is the hippocampus involved in

A

Memory

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65
Q

What is the amygdala responsible for

A

Emotions and behaviour

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66
Q

What is the fornix

A

Connection from hippocampus to septal area and hypothalamus

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67
Q

What is the papez circuit responsible for and how does it work?

A

Part of the limbic system involved in-memory processing and learning

  1. Hippocampus
  2. Fornix
  3. Mammillary bodies
  4. Mammilothalmic
  5. The anterior nucleus of the thalamus
  6. Internal capsule
  7. Cingulate gyrus
  8. Parahippocampal gyrus
  9. Dentate gyrus
  10. Subiculum
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68
Q

What is the midbrain consist of?

A

Tectum (inferior + superior colliculi)

Cerebral peduncle (tegmentum + crus cerebri)

Surrounds cerebral aqueduct

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69
Q

What is the medulla oblongata continuous with?

A

Spinal cord

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70
Q

What is pons

A

Bridge to cerebellum

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71
Q

Functions of cerebellum

A

Balance

Equilibrium

Motor learning

coordination

muscle tone

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72
Q

The internal circuitry of the cerebellum

A

Sensory pathway → mossy fibres → granule cells → Purkinje fibres

Inferior Olives→ climbing fibres

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73
Q

Meninges

A

Pia mater (innermost)

Subarachnoid space

Arachnoid mater

Subdural space

Dura matter (inner: meningeal & outer: periosteal)

Epidural space

Skullbone

Scalp

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74
Q

Dural septa

A

Falx cerebri

Tentorium cerebelli

Falx cerebelli

Diaphragm sellae

Important to surround and protect dural sinuses

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75
Q

Epidural hematoma

A

Location: Epidural space (Temporal bone fracture)

Cause: Temporal bone fracture affecting middle meningeal artery

Symptoms: Headache, nausea/vomiting, CN3 palsy

Management: Evacuate hematoma, Maintain intracranial pressure

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76
Q

Subdural Hematoma

A

Location: Subdural space

Cause: Motor vehicle accident, Trauma, falls

Symptoms: vary, headaches, high BP, Low pulse, Confusion

Management: Evacuate hematoma

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77
Q

Subarachnoid hematoma

A

Location: Subarachnoid space

Cause: Berry (saccular) aneurysm, Ruptures

Symptoms: Thunderclap headache, nausea, vomiting, neck stiffness, photophobia, delirium

Management: Supportive care

Decrease BP

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78
Q

Intracerebral hematoma

A

Location: Thalamus, Basal ganglia, Cerebellum, Pons

Cause: Hypertension, amyloid deposits

Symptoms: Nausea, vomiting, headache, hemiplegia

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79
Q

What are the component of CNS

A

Brain

Spinal cord

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80
Q

What are the component of PNS

A

Sensory component

Motor component

=spinal nerves

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81
Q

Spinal cord where does it terminate

A

L1/L2

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82
Q

Segments of spinal cord + spinal nerves

A

Cervical (8 pairs of spinal nerves)

Thoracic (12 pairs of spinal nerves)

Lumbar (5 pairs of spinal nerves)

Sacral (5 pairs of spinal nerves)

Coccygeal (1 pair of spinal nerves)

To remember: You have breakfast at 7, lunch at 12, dinner at 5 and a big drink and a small dessert.

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83
Q

White matter: cervical → coccygeal

A

Decrease in white matter

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84
Q

Grey matter: cervical → coccygeal

A

Increase in grey matter

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85
Q

What part of the spinal cord contains sensory neurons

A

Posterior/Dorsal grey horn

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86
Q

What part of the spinal cord contains motor neurons

A

Anterior/Ventral grey horn

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87
Q

What are group of cell bodies (axons) in CNS + PNS called

A

CNS: nucleus

PNS: ganglia

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88
Q

What is the grey matter?

A

Grey matter containing unmyelinated dendrites

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89
Q

Divisions of grey matter

A

Posterior grey horn -Most posterior is somatic sensations, and anterior to that is visceral sensations.

Lateral grey zone- Visceral motor

Anterior grey horn - Somatic motor

A Gray commissure connects two sides of the horn

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90
Q

Rexed laminae

A

10 in grey matter

Laminae I-III: Substania gelatinosa

Laminae VII: Clarkes Column (C8-L3)

Laminae IX: motor supply

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91
Q

What is white matter

A

Structure of spinal cord containing myelinated axons

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92
Q

Parts of white matter

A

Dorsal white column

Lateral white column

Anterior white column

Anterior white commisure

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93
Q

The tracts of the white column

A

Ascending tract (Sensory)

Descending (motor)

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94
Q

Dorsal Column Medial Leminiscal pathway carries what sensations?

A

Discriminative touch

Pressure & Stretch & Vibrations

Proprioception

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95
Q

What tract is the DCML

A

Sensory Ascending tract

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96
Q

Receptors in DCML

A

Meissner’s Corpuscles

Merkel’s discs

Pacinian corpuscles

Peritrichial nerve endings

Ruffini corpuscles

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97
Q

DCML Pathway

A

Stimulus → Receptors → afferent neurons →Dorsal root ganglia →

Either:

Fasciculus gracilis (Below T6)→ Nucleus gracilis (2nd order neurons- medulla)

Fasciculus cuneatus (Above T6) → Nucleus cuneatus (2nd order neurons)

Medial leminiscus→ VPL nucleus of the thalamus → Posterior ⅓ Internal capsule → corona Radiata → Somatosensory cortex

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98
Q

DCML contralateral/ipsilateral

A

Ipsilateral at the level of spinal cord

Contralateral once you get to internal arcuate fibres

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99
Q

Spinothalamic Tract Division

A

Ant: crude touch, pressure

Lat: pain, temp

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100
Q

Receptors of Spinothalamic Tract

A

Nociceptors: tissue damage and extreme temp

Fast pain (A-delta fibres), stimulated my mechanical stimuli, and cold temp

Slow pain (C fibres), stimulated by mechanical stimuli, hot temp, chemical factors

Merkel’s disc stimulated by crude touch and pressure

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101
Q

Where do neurons from the spinothalamic tract enter the spinal cord

A

Rexed laminae

crosses to contralateralside of the spinal cord to anterior white commissure

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102
Q

Spinothalamic lesions

A

Has ascending and descending tracts (Tract of Lisshauer)

A lesion will result in 2 segments down and on the contralateral side being injured

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103
Q

Crude touch and pressure spinothalamic tract

A

Stimulus → Receptor → Dorsal root ganglia (1st order neuron) → Rex lemniscus (dorsal grey horn + 2nd order neuron) cross over anterior commissure ventral white column→ ventral posterior inferior thalamic nucleus → Internal capsule → corona Radiata → cortex

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104
Q

Pain and temp pathway spinothalamic tract

A

Stimulus → Receptor → Dorsal root ganglia → Rex lemniscus .. → Lateral Spinothalamic Tract → Ventral posterior lateral nucleus in the thalamus → internal capsule → corona Radiata → cortex

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105
Q

Pain modulation systems

A

Gate control theory (Melzack-wall pain gate)

Descending analgesic system

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106
Q

What is the regulatory for slow pain

A

C fibres unmyelinated, short axon.

Secrete Substance P

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107
Q

What is the regulatory for fast pain

A

A Delta fibre - myelinated long axon

Glutamate

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108
Q

Gate control theory

A

Touch receptors are stimulated and travel via DCML giving off collateral stimulating inhibitory receptors to prevent inhibit pain and temp action potential

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109
Q

Spino cerebellar Tract subdivided

A

Dorsal Spinocerebellar Tract

Ventral Spinocerebellar Tract

Cuneo cerebellar Tract

Spino-olivary tract

(Dirty Virgins Cant Spit)

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110
Q

Spinocerebellar tract stimulus

A

Proprioception:

Muscle spindles: Type 1a (faster) type 1b

Golgi tendon organ

Touch + Pressure

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111
Q

Dorsal Spinocerebellar Tract

A

Ipsilateral. Below L2

Stimulus → Receptor → Dorsal root ganglia → Clarke’s nucleus (dorsal grey horn) → Lateral white column → Inferior cerebellar peduncle

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112
Q

Ventral Spinocerebellar Tract

A

Contralateral. Upper limbs (head + neck)

Stimulus → Receptor → Dorsal Root ganglion → Dorsal grey horn → Cross over via anterior white commissure → Superior cerebellar peduncle → Crosses over AGAIN!!!!!

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113
Q

Cuneocerebellar tract

A

Ipsilateral

Stimulus → Receptor → Dorsal Root Ganglia → Posterior grey horn → accessory cuneate nucleus → External arcuate fibres → Cerebellum

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114
Q

Inferior Olivary nuclei

A

Contralateral

Stimulus → Receptor → Dorsal root ganglion → Posterior grey horn → Crosses over via anterior white commissure → Inferior Olivary nucleus → Inferior cerebellar peduncle via climbing fibres → cerebellum

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115
Q

Corticobulbar Tract

A

Bilateral

Origin: motor cortex

Destination: CN5, CN7, CN12

Nucleus ambiguous (CN9, 10, 11)

Function:

CN5-Muscles of mastication

CN7- Muscles of Facial expression

Nucleus ambiguous- Soft palate, Uvula, Pharynx, Larynx

CN12-muscles of tongue

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116
Q

Corticospinal tract

A

control of voluntary muscles

Lateral (75%): pyramidal (medulla) decussation - limb muscles

Medial (25%): decussates as it leaves via the anterior white commissure (

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117
Q

Reticulospinal tract

A

Descending

Spinal reflexes

Medial pathway: Pons controls extensors to increase muscle tone thereby facilitatory voluntary movement

Lateral pathway: The medulla controls flexors acting to decrease muscle tone thereby inhibiting voluntary movement

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118
Q

What is the extrapyramidal tract responsible for?

A

Involuntary autonomic movement

Descending pathway

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119
Q

What vertebrae should a lumbar puncture be performed

A

L3/L4

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120
Q

What is the filum terminale

A

Extension of pia mater attaches onto the coccyx prevents the spinal cord from moving

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121
Q

Denticulate nucleus

A

When pia mater extends onto the outer dura forms these ligaments

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122
Q

Extrafusal fibres functions

A

Connect with tendons

Generate movement

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123
Q

Intrafusal fibres function

A

Proprioceptors

Length and velocity

Consist of:

Nuclear bag fibres

Nuclear chain fibres

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124
Q

Nuclear bag fibres

A

More sensitive than nuclear chain fibers to :

Length and velocity

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125
Q

Nuclear chain fibers

A

More specific to length

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126
Q

Nuclear bag fibres vs nuclear chain fibres

A

Type 1a fibres + gamma motor neurons in nuclear bag fibres

type 1a + 2 fibres + gamma motor neurons in nuclear chain fibres

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127
Q

Type 1a muscle fibres sensory or motor

A

Sensory

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128
Q

Type 2 muscle fibres sensory or motor

A

Sensory

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129
Q

Gamma motor neurons sensory or motor

A

Motor

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130
Q

What reflex is the stretch reflex

A

Monosynaptic

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131
Q

Stretch receptor reflex

A

Ipsilateral

Stimulus → type 1a + 2 fibres (sensory) → ventral grey horn → Synapses with motor neuron

It also synapses with interneurons to inhibit opposite muscles (reciprocal inhibition)

Both receptors act on the extra-fusal muscles

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132
Q

What do the gamma motor neurons stimulate

A

Muscle spindle fibres contract where the stimulus is detected

Inhibits the opposite muscle spindle fibres

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133
Q

Upper motor neuron lesion leads to

A
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134
Q

What innervates the Golgi tendon organ

A

Type 1b muscle fibres

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135
Q

What does tendon connect

A

muscle -> bone

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136
Q

What does the golgi tendon organ detect

A

Tension due to muscle contraction

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137
Q

Golgi tendon organ reflex

A

Muscle contraction → type 1b fibres → Dorsal root ganglia → posterior grey horn →

Reciprocal Activation: Interneuron inhibitory (Glycine)→ gamma motor neuron → inhibits muscle that is experiencing contraction

Autogenic Inhibition: Interneuron stimulatory (Glutamate) → Gamma motor neuron → stimulates the opposing muscle that isn’t experiencing contraction

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138
Q

UMN lesions condition examples

A

Stroke

Multiple sclerosis

ALS

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139
Q

LMN lesions conditions called?

A

Polio

Spinal muscular atrophy

Cauda Equina syndrome

ALS

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140
Q

Clasp knife reflex

A

A spasticity test

A physical exam to assess the passive flexion movement. If there is spasticity there will be a lot of resistance during flexion until it does a sudden flexion movement

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141
Q

UMN lesion characteristics

A

Mass: ⇣15-20%

Strength: Spastic paralysis

Tone: ⇡ hypertonia

Deep tendon reflexes: ⇡ hyperreflexia

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142
Q

LMN lesion characteristics

A

Mass: ⇣80%

Strength: flaccid paralysis

Tone: ⇣hypotonia

Deep Tendon Reflexes: ⇣hyporeflexia

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143
Q

5 facial branches of the facial nerve

A

Temporal

Zygomatic

Buccal

Marginal Mandibular

Cervical

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144
Q

Bells palsy

A

The unilateral facial droop in at least lower ⅔ of face

The forehead has both contralateral and ipsilateral innervation

The face has only contralateral innervation

LMN means paralysis of all the sides of that face, the ipsilateral side as a lesion.

UMN lesions mean that lower ⅔ of the contralateral side

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145
Q

How can PNS be subdivided

A

Sensory

Motor

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146
Q

How can motor PNS be further subdivided?

A

Autonomic and Somatic

Autonomic is further subdivided: into SNS, PSNS, Enteric

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147
Q

What chemical does the somatic NS secrete

A

Ach

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148
Q

Difference between the autonomic and somatic NS

A

Somatic: one motor neuron to reach the effector organ

Autonomic: Takes two motor neurons (preganglionic + postganglionic) to reach the effector organ

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149
Q

What is the thoracolumbar outflow

A

T1-L2

Contains the preganglionic fibres of the autonomic sympathetic nervous system

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150
Q

PSNS vs SNS diff in ganglion

A

PSNS: Long preganglionic Short postganglionic

SNS: Short preganglionic, Long postganglionic

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151
Q

Fibers that release Ach are called

A

Cholinergic fibres

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152
Q

What chemical does SNS secrete?

A

Norepinephrine therefore adrenergic fibers

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153
Q

What fibres are presynaptic ganglion

A

Cholinergic therefore secrete Ach

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154
Q

What fibres are postsynaptic ganglion

A

Adrenergic → NE

There are 5 subtypes of adrenergic

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155
Q

SNS on heart

A

Increase heart rate

Increase CO

Increase BP

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156
Q

Autonomic SNS effect on oesophagus + bronchioles+ lungs

A

Oesophagus: Decrease peristalsis

Bronchioles: dilate bronchioles. Decrease secretions and vasoconstriction of brachial arteries

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157
Q

SNS effect on the stomach

A

Inhibit peristalsis

decrease absorption and secretions

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158
Q

SNS on liver + gallbladder

A

Liver : Increase Glycogenolysis

Gall bladder: Decrease Biliary Tree flow

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159
Q

SNS effect on the pancreas + spleen

A

Pancreas: Decrease insulin production

Increase Glucagon production

Spleen: Decrease splenic contraction

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160
Q

SNS on stomach

A

Decrease peristalsis

Decrease absorption

Decrease secretion

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161
Q

SNS effect on kidney

A

Decrease urine production

Decrease blood flow

Increase in renin release

Decrease peristalsis

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162
Q

SNS on large + small intestine

A

Inhibit peristalsis

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163
Q

SNS on urinary bladder

A

Detrusor muscle: decrease contractions

Internal urethral spincter: increase contractions/constriction

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164
Q

SNS on gonads

A

Male: Ejaculation

Female: Uterine contraction (nonpregnant)

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165
Q

What parts affect SNS control

A

Limbic nuclei

Hypothalamus

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166
Q

PNS effect on lungs (bronchi)

A

Bronchoconstriction

Increase secretions

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167
Q

PNS on heart

A

SA/AV node: Decrease heart rate

Decrease blood pressure

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168
Q

PNS on oesophagus

A

Increase peristlasis

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169
Q

PNS effect on the stomach

A

Increase in motility

Increase secretions

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170
Q

Where would you find cholinergic receptors

A

PNS

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171
Q

How many subtypes of cholinergic fibres do you have?

A

Nicotinic: Ach + nicotine

-Ion channels are ligand-gated

Muscarinic: Muscarine + Ach

-G protein-coupled receptors

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172
Q

What role Ach do in the brain

A

Increase memory

Arousal

Analgesia

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173
Q

Olfactory CN 1

A
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174
Q

Optic nerve 2

A
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175
Q

Oculomotor CNIII

A

Origin: Midbrain

Structure supplying: S.Rectus, Levator palpebrae sp, I rectus, I oblique, medial rectus, pupil, ciliaris

Fibres: GSE, GVE

Function: Eye movement, eyelid movement, accommodation of pupil size

Exit skull: Superior orbital fissure

Motor

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176
Q

Trochlear nerve

A
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177
Q

What C1 of the cervical plexus run alongside with

A

CN12

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178
Q

Superficial Cervical plexus nerves

A
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179
Q

Brachial plexus

A
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180
Q

Lumbar plexus

A
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181
Q

Left eye visual field

A

Temporal - left

Nasal - right

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182
Q

Right eye visual field

A

Nasal - left

Temporal - right

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183
Q

Superior retinal fibres?

A

Go to parietal lobe (Baums loop)

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184
Q

Inferior Retinal fibres?

A

Go to temporal loop

(Myers loop)

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185
Q

Monocular Blindness

A

Lesion to optic nerve

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186
Q

Bitemporal Hemianopia

A

Lesion to the optic chiasm

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187
Q

Binasal kemianopia

A

Affects ipsilateral fibres

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188
Q

Visual eye fields

A
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189
Q

Left/Right homonymous hemianopia

A
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190
Q

Left inferior quadrant hemianopia

A

If the right superior retinal fibres are damaged you are losing vision of the inferior visual field of the left side

We know that anything coming from the right side damages the left eye/visual field. But superior retinal fibres only pick up information from the inferior visual field.

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191
Q

Right superior quadrant hemianopia

A

Inferior retinal fibres only pick up information from the superior visual field.

Therefore wont be able to see on the Superior right visual field

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192
Q

optic radiation

A

Parietal - inferior retinal fibres (Baum’s loop)

Temporal- superior retinal fibres (Meyer’s loop)

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193
Q

Left homonymous hemianopia

A

Damage to right optic radiation

There is visual field loss of the right visual field

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194
Q

Cochlear pathway

A

Sound wave → Oracle → External acoustic meatus → Sound wave hits the tympanic membrane (vibrates-compresses + decompresses) → ossicles (malleus → incus → stapes) → oval window → scala vestibuli → scala media → scala tympani → round window → cochlear branch of CN VIII

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195
Q

Ascending auditory pathway

A

Cochlear branch of CN VIII → Internal acoustic meatus → Cochlei nucleus →

Cochlea nuclei

→ Dorsal cochlear nuclei + Posterior ventral cochlear nuclei: Cross over and ascend to the nucleus of the lateral lemniscus

→Anterior Ventral nuclei Contralateral (area know as trapezoid body) + Ipsilateral → Superior Olivary Nuclei

Tract joins (lateral lemniscus) → Inferior colliculus → medial geniculate nucleus → Primary auditory cortex →

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196
Q

Hearing is

A

Bilateral

Nucleus of the lateral lemniscus cross over + inferior colliculus

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197
Q

Give 3 functions of the cranial meninges.

A
  1. Protects the brain and spinal cord form injury.
  2. Provides a framework for cerebral and cranial vasculature.
  3. Provides a space for the flow of CSF.
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198
Q

What are the 3 meningeal layers?

A
  1. Dura mater (outermost).
  2. Arachnoid mater.
  3. Pia mater (innermost).
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199
Q

What are the 2 connective tissue sheets of dura mater?

A
  1. Endosteal layer - lines the cranium.
  2. Meningeal layer.
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200
Q

Where are the dural venous sinuses located?

A

Between the endosteal layer of dura and the meningeal layer.

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201
Q

What vein do the dural venous sinuses drain into?

A

The internal jugular veins.

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202
Q

Name 3 locations where the dura mater folds inwards as dural reflections?

A
  1. Falx cerebri.
  2. Tentorium cerebelli.
  3. Falx cerebelli.
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203
Q

Where is the falx cerebri located?

A

It lies in the longitudinal fissure between the cerebral hemispheres.

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204
Q

Where is the tentorium cerebelli located?

A

The tentorium cerebelli is a thick fibrous roof lying over the posterior cranial fossa and the cerebellum.

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205
Q

Where is the falx cerebelli located?

A

Between the 2 lobes of the cerebellum.

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206
Q

What lies beneath the arachnoid mater?

A

The subarachnoid space containing CSF and arteries.

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207
Q

What is the function of the blood-brain barrier?

A

It protects the brain by preventing the passage of some substances from circulation into the nervous tissue.

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208
Q

Which meningeal layers are highly vascularised?

A

The dura and pia mater. The arachnoid mater is avascular.

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209
Q

What are the 2 main arteries that supply blood to the brain?

A
  1. Vertebral arteries.
  2. Internal carotid arteries.
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210
Q

Which arteries supply about 80% of blood to the brain?

A

The internal carotid arteries.

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211
Q

What are the vertebral arteries a branch of?

A

The subclavian arteries.

212
Q

Where do the vertebral arteries enter the skull?

A

Through the foramen magnum.

213
Q

What are the internal carotid arteries branches?

A

The common carotids. Arise from bifurcation at the same level as the upper border of the thyroid cartilage (T4)

214
Q

What do the vertebral arteries supply?

A

The posterior cerebrum and the
contents of the posterior cranial fossa.

215
Q

What do the internal carotid arteries supply?

A

The anterior and middle parts of the cerebrum and the diencephalon.

216
Q

Where do the internal carotid arteries enter the skull?

A

Through the carotid foramina.

217
Q

What are the terminal branches of the internal carotid arteries?

A

The middle and anterior cerebral arteries.

218
Q

What does the middle cerebral artery supply?

A

The lateral surface of the hemispheres.

219
Q

What does the anterior cerebral artery supply?

A

The medial aspect of the hemispheres and the corpus callosum.

220
Q

What does the posterior cerebral artery supply?

A

The occipital lobe.

221
Q

What artery passes through the foramen spinosum?

A

The middle meningeal artery.

222
Q

What do the two vertebral arteries form?

A

The basilar artery.

223
Q

Where is a berry aneurysm likely to occur?

A

At branching points in the circle of willis, especially at the anterior communicating artery.

224
Q

What is a berry aneurysm?

A

A sac-like out pouching that will progressively enlarge until it ruptures resulting in haemorrhage.

225
Q

What are the two types of stroke?

A
  1. Ischaemic.
  2. Haemorrhagic (intracerebral or subarachnoid).
226
Q

Where are dural venous sinuses located?

A

In between the endosteal and meningeal layers of dura.

227
Q

Where do cerebral veins drain into?

A

Into dural venous sinuses.

228
Q

What does the great cerebral vein drain?

A

Deep brain structures.

229
Q

What sinus does the great cerebral vein drain into?

A

The straight sinus.

230
Q

Where is the straight sinus located?

A

In the midline of the tentorium cerebelli.

231
Q

What vessels lie in the cavernous sinus?

A
  • Cn 3, 4, 5(1), 5(2) and 6.
  • Internal carotid artery.
232
Q

Why is the cavernous sinus of clinical importance?

A

If this sinus is infected Cn 3, 4, 5(1), 5(2) and 6 and the internal carotid artery could be affected.

233
Q

How do dural venous sinuses and veins outside the skull communicate?

A

Via emissary veins.

234
Q

What is the clinical significance of emissary veins?

A

They represent a possible route for infection to spread into the cranial cavity.

235
Q

Briefly describe the pathway of venous drainage starting at the great cerebral vein.

A

Great cerebral vein -> straight sinus -> transverse sinus -> sigmoid sinus -> internal jugular vein -> jugular vein -> brachiocephalic vein -> SVC.

236
Q

What sinuses form the confluence of sinuses?

A

The straight sinus and the superior sagittal sinus.

237
Q

Where is the largest aggregation of choroid plexus?

A

In the lateral ventricles.

238
Q

Where is the majority of CSF produced?

A

In the lateral ventricles (greatest amount of choroid plexus here`).

239
Q

What is ependyma?

A

A thin-epithelial like structure lining the ventricles.

240
Q

Tight junctions prevent the passage of fluid into the ventricles. Why is this important?

A

It means that the volume and composition of CSF can be closely controlled.

241
Q

What embryonic part of the brain is the midbrain formed from?

A

Mesencephalon.

242
Q

What embryonic part of the brain is the pons formed from?

A

Metencephalon of Rhombencephalon.

243
Q

What embryonic part of the brain is the medulla oblongata formed from?

A

Myelencephalon of Rhombencephalon.

244
Q
  • What is the name of Cn1?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Olfactory.
  • Cribriform plate of ethmoid bone.
  • Sensory.
245
Q
  • What is the name of Cn2?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Optic.
  • Optic canal.
  • Sensory.
246
Q
  • What is the name of Cn3?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Occulomotor.
  • Superior orbital fissure.
  • Motor and parasympathetic.
247
Q
  • What is the name of Cn4?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Trochlear.
  • Superior orbital fissure.
  • Motor.
248
Q
  • What is the name of Cn5?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Trigeminal.
  • V(1)-superior orbital fissure. V(2)-foramen rotundum. V(3)-foramen ovale.
  • Both: sensory and motor.
249
Q
  • What is the name of Cn6?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Abducens.
  • Superior orbital fissure.
  • Motor.
250
Q
  • What is the name of Cn7?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Facial.
  • Internal acoustic meatus.
  • Both: sensory and motor and parasympathetic.
251
Q
  • What is the name of Cn8?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Vestibulocochlear.
  • Internal acoustic meatus.
  • Sensory.
252
Q
  • What is the name of Cn9?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Glossopharyngeal.
  • Jugular foramen.
  • Both: sensory and motor and parasympathetic.
253
Q
  • What is the name of Cn10?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Vagus.
  • Jugular foramen.
  • Both: sensory and motor and parasympathetic.
254
Q
  • What is the name of Cn11?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Accessory.
  • Jugular foramen.
  • Motor.
255
Q
  • What is the name of Cn12?
  • Where does it exit the skull?
  • Sensory, motor or both?
A
  • Hypoglossal.
  • Hypoglossal canal.
  • Motor.
256
Q
  • What does Cn1 innervate?
  • What are it’s functions?
A
  • Innervates: olfactory epithelium.
  • Function: olfaction.
257
Q
  • What does Cn2 innervate?
  • What are it’s functions?
A
  • Innervates: retina.
  • Function: vision.
258
Q
  • What does Cn3 innervate?
  • What are it’s functions?
A
  • Innervates: medial, superior and inferior rectus muscles and inferior oblique and levator palpebrae superioris.
  • Motor function: movement of eyeball.
  • Parasympathetic function: constriction and accommodation.
259
Q
  • What does Cn4 innervate?
  • What are it’s functions?
A
  • Innervates: superior oblique.
  • Functions: movement of eyeball.
260
Q
  • What does Cn5 innervate?
  • What are it’s functions?
A

- Sensory innervation: face, scalp, cornea, nasal and oral cavities, anterior 2/3 of the tongue, dura mater. (FONDSAC)

- Motor innervation: muscles of mastication and tensor tympani.(MOMTT)

  • *- Sensory function:** general sensation.
  • *- Motor functions:** open and close the mouth. Tenses tympanic membrane.
261
Q
  • What does Cn6 innervate?
  • What are it’s functions?
A
  • Innervates: lateral rectus.
  • Function: eye movement, abduction.
262
Q
  • What does Cn7 innervate?
A
  • Special sensory innervation: anterior 2/3 of tongue - taste. (SAT)
  • Motor innervation: muscles of facial expression and stapedius.
  • Parasympathetic innervation: submandibular and sublingual and lacrimal glands.
263
Q
  • What does Cn8 innervate?
  • What are it’s functions?
A
  • Innervation: cochlea and vestibular apparatus.
  • Functions: hearing and proprioception of head and balance.
264
Q
  • What does Cn9 innervate?
A
  • Sensory innervation: posterior 1/3 of the tongue, middle ear, pharynx, carotid bodies. (PEPC)
  • Motor innervation: stylopharyngeus.
  • Parasympathetic innervation: parotid gland.
265
Q
  • What does Cn10 innervate?
A
  • Sensory innervation: pharynx, larynx, oesophagus, external ear, aortic bodies, thoracic and abdominal viscera.

(O PALATE)

- Motor innervation: soft palate, larynx, pharynx.

(SLP)

  • Parasympathetic innervation: CV, respiratory and GI systems.
266
Q
  • What are the functions of Cn10?
A
  • Sensory functions: general sensation.
  • Motor functions: speech and swallowing.
  • Parasympathetic functions: control over CV, respiratory and GI systems.
267
Q
  • What are the functions of Cn9?
A
  • Sensory functions: general sensation, taste, chemo/baroreceptor.
  • Motor functions: Swallowing (larynx and pharynx are elevated).
  • Parasympathetic function: salivation.
268
Q
  • What are the functions of Cn7?
A
  • Sensory function: taste.
  • Motor function: facial movement and tension of ossicles.
  • Parasympathetic function: salivation and lacrimation.
269
Q
  • What does Cn11 innervate?
  • What are it’s functions?
A
  • Innervation: trapezius and sternocleidomastoid.
  • Functions: movement of head and shoulders.
270
Q
  • What does Cn12 innervate?
  • What are it’s functions?
A
  • Innervation: intrinsic and extrinsic muscles of the tongue.
  • Function: movement of the tongue.
271
Q

What are the characteristic features of a cervical vertebra?

A
  • Small vertebral body.
  • Transverse foramen for vertebral arteries.
  • Bifurcation of spinous processes (except C7).
  • Triangular intervertebral foramen.
272
Q

What region of the vertebral column has the greatest capacity for rotation?

A

The thoracic region.

273
Q

What region of the vertebral column has the least capacity for flexion?

A

The thoracic region; this is due to the presence of the ribcage.

274
Q

What are the 2 components of an intervertebral disc?

A
  1. Nucleus pulposus.
  2. Annulus fibrosus: concentric layers of collagen surrounding the nucleus pulposus.
275
Q

What does the ligamentum flavum connect?

A

Connects the laminae of adjacent vertebrae.

276
Q

Where does the spinal cord end?
a) in an adult.

b) at birth.
c) in the embryo.

A

a) L2.
b) L3.

c) runs the entire length of the vertebral column.

277
Q

Where would you insert an epidural needle?

A

Between the dura mater and vertebrae in order to inject anaesthesia.

278
Q

Where would you insert a lumbar puncture needle?

A

At the L3/L4 level in the sub-arachnoid space in order to take CSF.

279
Q

What is the conus medullaris?

A

The tapered, lower end of the spinal cord.

280
Q

What is the filum terminale?

A

A fibrous strand that proceeds downwards from the apex of the conus medullaris.

281
Q

What is the cauda equina?

A

Spinal nerves from the lower spinal cord that hang obliquely downwards.

282
Q

Define dermatome.

A

An area of skin with a sensory nerve supply from a single root of the spinal cord.

283
Q

What is the dermatome for the thumb?

A

C6.

284
Q

What is the dermatome for the knee?

A

L3.

285
Q

What is the dermatome for the big toe?

A

L5.

286
Q

Name 4 ascending spinal pathways.

A
  1. DCML.
  2. Spinothalamic.
  3. Spinocerebellar.
  4. Spinoreticular.
287
Q

Which dorsal column would an afferent signal from the lower limb use?

A

The gracile fasciculus (medial part of dorsal column). They then synapse at the gracile nucleus of the medulla.

288
Q

Which dorsal column would an afferent signal from the upper limb use?

A

The cuneate fasciculus (lateral part of dorsal column). They then synapse at the cuneate nucleus of the medulla.

289
Q

Where is the somatosensory cortex located?

A

Post-central gyrus in parietal lobe.

290
Q

What sensations is the lateral spinothalamic tract responsible for?

A

Pain and temperature.

291
Q

What sensation is the anterior spinothalamic tract responsible for?

A

Crude touch + pressure

292
Q

What is the function of the spinocerebellar tracts?

A

They carry unconscious proprioceptive information to the ipsilateral cerebellum.

293
Q

Do the fibres decussate in the spinocerebellar tracts?

A

No! They go to the ipsilateral cerebellum.

294
Q

What sensation does the spinoreticular tract convey?

A

Deep/chronic pain.

295
Q

Name 5 descending pathways.

A
  1. Corticospinal.
  2. Vestibulospinal.
  3. Rubrospinal.
  4. Tectospinal.
  5. Reticulospinal.
296
Q

Where in the thalamus do the DCML and spinothalamic tracts synapse?

A

In the ventral posterio-lateral division (VPL) of the nucleus of thalamus

297
Q

What descending pathways are described as pyramidal?

A

Corticospinal and corticobulbar tracts - responsible for voluntary control.

298
Q

What descending pathways are described as extrapyramidal?

A

Vestibulospinal, rubrospinal, tectospinal, reticulospinal - responsible for involuntary and automatic control of all musculature, such as muscle tone, balance, posture and locomotion.

299
Q

Are there any synapses within the descending pathways?

A

No. At the termination of the descending tracts, the neurones synapse with a lower motor neurone. (All the neurones within the descending motor system are UMNs).

300
Q

What are the corticospinal tracts responsible for?

A

The control of voluntary muscles. Anterior - axial muscles. Lateral - limb muscles.

301
Q

Describe the corticospinal tracts.

A

Originate in the primary motor cortex, descends through corona radiata and internal capsule to the medullary pyramids. 90% decussates here and becomes the lateral corticospinal tract; the remaining 10% forms the anterior corticospinal tract. The anterior tract then decussates through the anterior white commissure. Both tracts terminate in the ventral horn.

302
Q

Describe the corticobulbar tracts.

A

Originate in the primary motor cortex, descends through corona radiata and internal capsule to the brainstem. The fibres terminate on motor nuclei of cranial nerves. They synapse with LMN’s which carry motor signals to the face and neck.

303
Q

Where do the extrapyramidal tracts originate?

A

The brainstem.

304
Q

Where do the vestibulospinal tracts originate and what are they responsible for?

A
  1. Originate from vestibular nucleus.
  2. Responsible for muscle tone and postural control.
  • Remains ipsilateral.
305
Q

Where do the reticulospinal tracts originate and what are they responsible for?

A
  1. Originate from reticular formation.
  2. Responsible for spinal reflexes.
306
Q

Where do the tectospinal tracts originate and what are they responsible for?

A
  1. Originate from tectum nuclei (superior and inferior colliculi).
  2. Responsible for head turning in response to visual and auditory stimuli.
307
Q

Where do the rubrospinal tracts originate and what are they responsible for?

A
  1. Originate from red nucleus.
  2. Responsible for assisting motor functions.
  • Contralateral.
308
Q

What tracts are known as the ventrolateral/anterolateral system?

A

Spinothalamic tracts.

309
Q

Damage to the anterolateral system will present with what symptoms?

A

Contralateral loss of pain and temperature sensation.

310
Q

What tracts are known as the dorsomedial system?

A

DCML.

311
Q

What would be the signs of a complete spinal cord lesion?

A
  • Weakness in all muscle groups below the lesion.
  • Complete sensory loss below lesion.
  • Spasticity and hyperreflexia.
312
Q

What is Brown-Sequard syndrome?

A

Hemi-section of the spinal cord.

313
Q

What would be the signs of Brown-Sequard syndrome?

A
  • Ipsilateral weakness and loss of motor function below the lesion.
  • Ipsilateral loss of proprioception, 2-point discrimination and fine touch.
  • Contralateral loss of pain and temperature sensation 2-3 spinal segments below the lesion.
314
Q

What are the 3 primary vesicles?

A
  • Prosencephalon (forebrain).
  • Mesencephalon (midbrain).
  • Rhombencephalon (hindbrain).
315
Q

What are the sub-divisions of the prosencephalon?

A
  • Telencephalon.
  • Diencephalon.
316
Q

What does the telencephalon form?

A
  • The cerebral hemispheres.
317
Q

What does the mesencehpalon form?

A
  • Midbrain.
  • Colliculi.
318
Q

What are the sub-divisions of the rhombencephalon?

A
  • Metencephalon.
  • Myelencephalon.
319
Q

What does the metencephalon form?

A
  • Cerebellum.
  • Pons.
320
Q

What does the myelencephalon form?

A
  • Medulla oblangata.
321
Q

Where are the lateral ventricles formed in the embryo?

A

Telencephalon.

322
Q

Where is the 3rd ventricle formed in the embryo?

A

Diencephalon.

323
Q

Where is the 4th ventricle formed in the embryo?

A

Rhombencephalon.

324
Q

What are the pluripotent stem cells that lie within the neural folds?

A

Neural crest cells.

325
Q

What do neural crest cells develop into?

A

Schwann cells, pigment cells, adrenal medulla, dorsal root ganglia, Cn 5, 7, 9 and 10.

326
Q

How is the neural tube formed?

A

Notochord in mesoderm signals the ectoderm to form a thickened neural plate. Mitosis forms a neural groove. There are neural folds on either side of the groove. These fuse at the midline forming the neural tube.

327
Q

When should the neural tube fuse?

A

By the end of the 4th week.

328
Q

What vitamins are needed to ensure the neural tube fuses?

A

B9 (folic acid) and B12.

329
Q

Approximately how much CSF do we have?

A

120ml.

330
Q

What is hydrocephalus?

A

An accumulation of CSF in the ventricular system. Often due to a blockage in the cerebral aqueduct.

331
Q

Name 4 substances contained within the CSF.

A
  1. Protein.
  2. Urea.
  3. Glucose.
  4. Salts.
332
Q

Define axonal transmission.

A

Transmitting information from A to B.

333
Q

Define synaptic transmission.

A

Integration/processing of information.

334
Q

What are the 5 fundamental processes of neurotransmission?

A
  1. Manufacture.
  2. Storage.
  3. Release.
  4. Interaction with post-synaptic receptor.
  5. Inactivation.
335
Q

Give 2 examples of fast neurotransmitters. Do fast neurotransmitters have short or long-lasting effects?

A
  • Ach, GABA.
  • Short lasting effects.
336
Q

Give 3 examples of neuromodulators. Do neuromodulators have short or long-lasting effects?

A
  • Dopamine, serotonin, noradrenaline.
  • Long lasting effects.
337
Q

What is an endorphin?

A

A peptide with opiate-like effects. They inhibit the release of substance P.

338
Q

How long does the refractory period last?

A

5-10ms.

339
Q

What is the relative refractory period?

A

It follows the absolute refractory period. Reploarisation occurs as Na+ channels are close and K+ channels are open. A 2nd stimulus that is stronger than the first is needed to produce another AP in this case.

340
Q

What are the 2 components of a refractory period?

A

The absolute refractory period which is followed by the relative refractory period.

341
Q

What is the neuronal resting potential?

A

-70mV.

342
Q

Define nociceptive pain.

A

Pain derived from actual damage to non-neural tissue, it is due to the activation of nociceptors.

343
Q

Define neuropathic pain.

A

Pain caused by a primary lesion or dysfunction of the nervous system.

344
Q

Describe C fibres.

A
  • They are the smallest nerve fibres.
  • Unmyelinated and so have slow conduction speeds.
  • They have a high activation threshold meaning they detect selectively nociceptive stimuli.
345
Q

Describe A-delta fibres.

A
  • Small nerve fibres but larger than C fibres.
  • Thinly myelinated.
  • They have a high activation threshold.
346
Q

What type of pain are A delta fibres responsible for?

A

The sensation of a quick, sharp, localised pain; ‘first pain’.

347
Q

What type of pain are C fibres responsible for?

A

C fibres respond to high-intensity stimuli. They are responsible for a slow, deep, spread-out pain; ‘second pain’.

348
Q

What is voluntary motor control?

A

Goal directed (conscious) or habitual (unconscious/automatic). E.g. running, walking talking etc.

349
Q

Involuntary motor control examples?

A

Eye movements, facial expressions, posture, diaphragm etc.

350
Q

Define motor unit.

A

A single alpha motor neurone and all the muscle fibres it innervates.

351
Q

Do the finger tips have lots of muscle fibres or few muscle fibres?

A

Few muscle fibres. This allows for greater movement resolution.

352
Q

Does function of a muscle affect how many muscle fibres there are?

A

Yes! The finger tips have few muscle fibres because they require greater movement resolution.

353
Q

What are spinal reflexes?

A
  • Involuntary, physiological responses to stimuli e.g. withdrawing your hand when you touch something hot.
  • Unlearned and instinctive: unconditioned responses.
354
Q

Withdrawal reflex: what does reciprocal innervation of antagonistic muscles explain?

A

It explains why the contraction of one muscle induces the relaxation of the other; this permits the execution of smooth movements.

355
Q

What nerve fibres innervate golgi tendon organs?

A

Afferent type 1b sensory nerve fibres (inhibitory).

356
Q

What is a UMN?

A

A neurone that is located entirely in the CNS. Its cell body is located in the primary motor cortex.

357
Q

What is a LMN?

A

A neurone that carries signals to effectors. The cell body is located in the brain stem or spinal cord.

358
Q

What are the characteristic features of MS?

A

MS comes and goes and its symptoms are exacerbated after having a shower.

359
Q

What is myasthenia gravis?

A

An autoimmune disease; antibodies destroy Ach receptors.

360
Q

What are the signs of myasthenia gravis?

A

Weakness and tiredness. Actions like chewing become progressively much harder.

361
Q

What does myasthenia gravis affect: LMN, UMN, neuromuscular junctions?

A

Neuromuscular junctions.

362
Q

Where do the two optic nerves meet?

A

At the optic chiasm. The images from the two eyes are fused here.

363
Q

Where do the optic tracts terminate?

A

Lateral geniculate body in the thalamus.

364
Q

What is the dorsal stream?

A

The ‘where’ stream. It is thought to determine the objects spatial location. It travels through the parietal lobe.

365
Q

What is the ventral stream?

A

The ‘what’ stream. It is thought to be involved in identification and recognition. It travels through the temporal lobe.

366
Q

What occular muscles does the superior branch of Cn 3 innervate?

A
  • Levator palpebrae superioris.
  • Superior rectus.
367
Q

What occular muscles does the inferior branch of Cn 3 innervate?

A
  • Medial rectus.
  • Inferior rectus.
  • Inferior oblique.
368
Q

What occular muscle does Cn 4 innervate?

A

Superior oblique.

369
Q

What occular muscle does Cn 6 innervate?

A

Lateral rectus.

370
Q

What is the origin and insertion of levator palpebrae superioris?

A

Origin: common tendinous ring.
Insertion: Upper eyelid.

371
Q

What is the action(s) of the superior oblique on the eyeball?

A
  • Intorsion.
  • Depression.
  • Abduction.

(SODAbI)

372
Q

What is the action(s) of the inferior rectus on the eyeball?

A
  • Depression.
  • Extorsion.
  • Adduction.

(IRA ED)

373
Q

What is the action(s) of medial rectus on the eyeball?

A
  • Adduction.

(MR. A)

374
Q

What is the action(s) of the superior rectus on the eyeball?

A
  • Elevation.
  • Intorsion.
  • Adduction.

(SIRAE)

375
Q

What is the action(s) of inferior oblique on the eyeball?

A
  • Extorsion.
  • Elevation.
  • Abduction.
376
Q

What is the action(s) of lateral rectus on the eyeball?

A
  • Abduction.
377
Q

What is the function of the outer ear?

A

It gathers sound energy and focuses it on the tympanic membrane; this vibrates the tympanic membrane. The outer ear also amplifies sound.

378
Q

What nerve provides general sensation to the outer ear?

A

Cn 10.

379
Q

What 3 bones make up the ossicular chain?

A

Malleus, incus and stapes.

380
Q

What is the smallest bone in the human body?

A

The stapes.

381
Q

What is the function of the ossicles?

A

To transmit vibrations from the tympanic membrane to the oval window.

382
Q

What nerve provides general sensation to the middle ear?

A

Cn 9.

383
Q

What muscles can change the stiffness of the ossicular chain?

A

Stapedius and tensor tympani.

384
Q

What nerve innervates stapedius?

A

Cn 7.

385
Q

What nerve innervates tensor tympani?

A

Cn 5.

386
Q

How do stapedius and tensor tympani change the stiffness of the ossicular chain?

A

They control the mobility of malleus and stapes and so protect the inner ear from loud noises.

387
Q

What is the function of the round window?

A

It vibrates in the opposite phase to vibrations entering the inner ear through the oval window. This moves the fluid in the cochlea which means that hair cells of the basilar membrane will be stimulated and that audition will occur.

388
Q

What is the function of the vestibular system?

A

Balance and spatial orientation.

389
Q

What is the vestibular apparatus?

A
  1. Otolithic organs: utricle and saccule.
  2. 3 Semi-circular canals.
390
Q

What do the semi-circular canals detect?

A

Angular acceleration.

391
Q

What do the otolithic organs detect?

A
  • Linear acceleration.
  • Changes in head position relative to gravity.
392
Q

Where are vestibular hair cells located?

A

In the utricle and saccule and in 3 ampullae at the base of the semi-circular canals.

393
Q

What is the function of the vestibular hair cells?

A

They detect changes in motion and position of the head by stereocilia transduction.

394
Q

What are the 3 cavities of the cochlea?

A
  1. Scala vestibuli.
  2. Scala media.
  3. Scala tympani.
395
Q

Which of the cavities of the cochlea are filled with perilymph?

A

Scala vestibuli and scala tympani.

396
Q

What is the helicotrema?

A

Where the scala vestibuli and scala media meet.

397
Q

What is the scala media filled with?

A

Endolymph.

398
Q

Which cavity of the cochlea houses the organ of corti?

A

The scala media.

399
Q

What does the organ of corti sit on?

A

The basilar membrane.

400
Q

What is the stria vascularis?

A

A structure involved in the active transport of K+ into the scala media.

401
Q

What is the potential of the scala media?

A

+80mV.

402
Q

What are the 3 structures that make up the organ of corti?

A
  1. Hair cells.
  2. Supporting cells.
  3. Auditory nerve fibres.
403
Q

How many rows are there of:
a) Inner hair cells?

b) Outer hair cells?

A

a) 1 row of IHC’s.
b) 3 rows of OHC’s.

404
Q

Which hair cells have 95% afferent nerve fibres?

A

Inner hair cell’s (OHC’s - efferent).

405
Q

Is the base or the apex of the basilar membrane wider?

A

The apex.

406
Q

Is the base or the apex of the basilar membrane more sensitive to high-frequency sounds?

A

The base.

407
Q

What structures are present on the IHC’s and OHC’s?

A

Stereocilia.

408
Q

What structures connect adjacent stereocilia?

A

Tip links.

409
Q

What happens to the stereocilia when the basilar membrane vibrates?

A

They bend. This opens the hair cells’ ion channels and there is an increase in auditory nerve firing.

410
Q

True or False; antibiotics can damage stereocilia.

A

True!

411
Q

Describe the I’MAuditory pathway.

A

Inferior colliculi -> inferior brachium -> medial geniculate body.
- Concerned with the reflex of looking towards a loud noise.

412
Q

What is the function of the basal ganglia?

A

It is connected and configured to serve as a specialised action selection mechanism. It determines WHAT you do via a system of inhibition and disinhibition.

413
Q

Name 4 disorders associated with basal ganglia dysfunction.

A
  1. Huntington’s disease.
  2. Parkinson’s disease.
  3. ADHD.
  4. OCD.
414
Q

What is the reason behind the signs of PD?

A

Not enough dopamine.

415
Q

What are the signs of parkinson’s disease?

A
  1. Tremor.
  2. Bradykinesia.
  3. Rigidity.
416
Q

What is the reason behind the signs of HD?

A

Too much dopamine.

417
Q

What are the signs of Huntington’s disease?

A
  1. Chorea (jerky, involuntary movements).
  2. Dementia.
  3. Personality change.
418
Q

Briefly describe how dopamine is produced.

A

Tyrosine -> L-dopa -> dopamine.

419
Q

What is the function of the limbic system?

A

The limbic system is involved with emotion, behaviour, long-term memory, olfaction and motivation. It is also thought to have a role in learning.

420
Q

What is the papez circuit?

A

A circuit that connects the main structures of the limbic system. It is involved in memory and emotions.

421
Q

How would the eye appear to the examiner if a patient is diagnosed with a lesion to Cn 3?

A

down and out’ due to unopposed action of lateral rectus and superior oblique.

422
Q

Why would ptosis (drooping of the eyelid) occur?

A

If there was a loss of innervation to levator palpebrae superioris.

423
Q

Where are Cn 1 nuclei located?

A

Olfactory bulb.

424
Q

Where are Cn 2 nuclei located?

A

Lateral geniculate body.

425
Q

What structures lie anteriorly to the cerebellum?

A

The pons and medulla. The 4th ventricle lies in between these and the cerebellum.

426
Q

What is the midline of the cerebellum called

A

The vermis.

427
Q

What are the two fissures of the cerebellum called?

A
  • The primary fissure.
  • The horizontal fissure.
428
Q

What are the lobes of the cerebellum hemispheres called?

A

The anterior and posterior lobes.

429
Q

How does the cerebellum control coordination, precision and timing of movements?

A

It compares the brain’s intentions with actual actions and makes any necessary modifications.

430
Q

What are the 3 layers of the cerebellar cortex?

A
  • Molecular (outermost).
  • Purkinje.
  • Granular.
431
Q

What are the 2 inputs into the cerebellum?

A
  • Climbing fibres.
  • Mossy fibres.
432
Q

Where do the mossy fibres come from?

A

They come from the pons via the middle cerebellar peduncle.

433
Q

Where do the climbing fibres come from?

A

The come from the olivocerebellar nuclei via the inferior cerebellar peduncle.

434
Q

What do the inferior cerebellar peduncles do?

A

They connect the medulla and the cerebellum and convey muscle proprioception and vestibular inputs.

435
Q

What do the middle cerebellar peduncles do?

A

They connect the pons and the cerebellum and they ‘tell’ the cerebellum about voluntary motor outputs.

436
Q

What is the output from the cerebellum?

A

Purkinje cell axons.

437
Q

Where do the purkinje cell axons go to?

A

Most go to the dentate nucleus. They then pass into the superior cerebellar peduncle to decussate, and then travel to the thalamus and the red nucleus.

438
Q

What do the superior cerebellar peduncles do?

A

They connect the midbrain and the cerebellum and carry mostly efferent fibres.

439
Q

Name 4 cerebellar nuclei.

A
  1. Dentate.
  2. Emboliform.
  3. Globose.
  4. Fastigial.
440
Q

What is the affect on movement in cerebellar injury?

A

Movements are slow and uncoordinated.

441
Q

What are some symptoms of the cerebellar injury?

A
  • Loss of coordination.
  • Inability to judge distances.
  • Intention tremor.
  • Staggering, wide-based walking.
  • Weak muscles.
442
Q

What is the peripheral nervous system?

A

The nervous system outside the brain and spinal cord. It includes the cranial nerves (except 1 and 2) and the spinal nerves.

443
Q

Is the CNS or the PNS protected by the blood-brain barrier?

A

The CNS.

444
Q

What spinal nerves innervate the biceps reflex?

A

C5/6.

445
Q

What spinal nerves innervate the ankle reflex?

A

S1/2.

446
Q

A 30-year-old man presents with increased muscle tone, brisk reflexes and fasciculations. Which spinal tract is likely to be affected?

A

Corticospinal (UMN and LMN weakness).

447
Q

Where does the spinothalamic tract decussate?

A

Within the spinal cord, 2-3 spinal segments above.

448
Q

A patient can understand what you’re saying but is unable to construct sentences in response. What part of the brain is affected?

A

Broca’s area in the dominant frontal lobe.

449
Q

A man is feeling very distressed as he woke up being unable to feel the right side of his face and his right arm and leg. What lobe is affected?

A

The parietal lobe (somatosensory cortex). Feel is the keyword here.

450
Q

A woman presents to the stroke unit being unable to move/feel her left leg/foot. Which artery has been affected?

A

Right anterior cerebral artery.

451
Q

A man presents to the stroke unit being unable to move/feel his right arm, with right-sided facial drooping and slurred speech. Which artery has been affected?

A

Left middle cerebral artery.

452
Q

A woman presents to the stroke unit with complete right sided visual field loss. Which artery has been affected?

A

Left posterior cerebral artery.

453
Q

A 40-year-old removal man felt immediate back pain and a popping sensation after lifting a heavy box. The next day he noticed he was tripping over his right foot as it was dragging along the floor. What is affected?

A

Lower motor neurones (he has a slipped disc. The LMN nerve roots coming out of the spinal cord have been damaged).

454
Q

An elderly patient presents with a stiff flexed arm, and a stiff extended leg (both on the left) which the patient finds difficult to bend. What is affected?

A

Upper motor neurone – this patient has had a stroke and so the UMN’s are affected.

455
Q

A 42-year-old female has presented with weakness in her left leg. She has been seen previously in your clinic two years ago for visual disturbance and sensory loss over the left forearm. These symptoms persisted for several weeks but then gradually resolved. Her symptoms are exacerbated following a shower. What is the problem?

A

Multiple Sclerosis (characterised by the fact it comes and goes. Exacerbated after a shower is also a key feature of this disease).

456
Q

A 30-year-old woman noticed that her face had become progressively droopier whilst putting her make-up on in the mornings. Weeks later she began to experience double vision, and found it progressively more tiring and difficult to chew all the food in her mouth when eating. What is the problem?

A

Myasthenia Gravis (characterised by progressive weakness and tiredness. Actions like chewing become much harder. It is a neuromuscular junction disease where the Ach receptors are blocked).

457
Q

A man has presented with a history of weakness in both of his hands, he is now unable to open jars. Both of his hands show wasting in the Thenar eminence. He has developed slurred speech and difficultly swallowing over the past 3 weeks. His tongue appears spastic and he is unable to protrude it. What is the disease?

A

Motor neurone disease - both UMN and LMN are affected.

458
Q

What is the only cranial nerve to emerge from the dorsal aspect of the brainstem?

A

Trochlear Cn 4.

459
Q

You are carrying out an eye examination on a patient who is looking at the tip of your nose. Behind you, on your left-hand side, is a tall medical student. What would be the patient’s retinal representation of this student’s face image?

A

The retinal image is converted from right to left and reversed. The student’s face is now in the left lower corner.

(Medical student is standing on your left but that is the patient’s right).

460
Q

What are the functions of cones in the eye?

A

Cones are important for visual acuity and colour vision.

461
Q

What are the functions of rods in the eye?

A

Rods are important for peripheral vision.

462
Q

Define pain.

A

An unpleasant sensory and emotional experience associated with actual tissue damage.

463
Q

Where is the insula located?

A

Deep in the lateral sulcus.

464
Q

What is the role of the insula in pain recognition?

A

The insula contributes to the subjective perception of pain. It is where the degree of pain is judged.

465
Q

What is the role of the cingulate gyrus in pain recognition?

A

It provides an emotional response to pain.

466
Q

What is the Melzack Wall pain gate?

A

The idea that non-painful input can close the ‘gate’ to painful input and so prevent it from reaching the CNS. Non-noxious stimuli can prevent pain as the large fibres can override the small pain fibres. It is a physiological explanation for why ‘rubbing it better’ can help.

467
Q

What is the effect of stimulating opioid receptors?

A

It can reduce neuronal sensitivty and so reduce the pain sensation.

468
Q

How can opioids be used as analgesia?

A

They bind to inhibitory G-protein coupled receptors in the brain/spinal cord.

469
Q

What is a neuromuscular junction?

A

A chemical synapse formed by the contact between a motor neurone and a muscle fibre.

470
Q

Briefly describe the withdrawal reflex.

A

The limb is withdrawn from noxious stimuli. Afferent fibres synapse on motor neurones in spinal cord. The response is ipsilateral flexion (same side as noxious stimuli) and contralateral extension.

471
Q

What would be the affect of damage to the cerebellar vermis?

A

Balance problems due to loss of postural control. Difficulty in sitting and standing up.

472
Q

What would be the affect of damage to the cerebellar hemispheres?

A

Ipsilateral impaired limb coordination.

473
Q

What do the middle cerebellar peduncles convey?

A

They send information from the primary motor cortex about the motor plan to the cerebellum - corticopontocerebellar tract.

474
Q

What do the inferior cerebellar peduncles convey?

A

Ipsilateral muscle proprioception, balance and vestibular inputs - vestibulocerebellar tract and dorsal spinocerebellar tract. Also fibres from inferior olivocerebellar tract.

475
Q

What afferent signals do the superior cerebellar peduncles convey?

A

Ipsilateral information on proprioception and balance from the ventral spinocerebellar tract.

476
Q

What efferent signals do the superior cerebellar peduncles convey?

A

Efferent signals from the dentate nucleus that go to the red nucleus and thalamus.

477
Q

Give 4 treatments for pain.

A
  1. Analgesics.
  2. Acupuncture.
  3. Exercise.
  4. Hypnotherapy.
478
Q

In Huntington’s disease what area of the basal ganglia and what neurotransmitters are affected?

A
  • Striatum (caudate nucleus).
  • GABA.
479
Q

What site does brain stimulation affect?

A

Sub-thalamic nucleus.

480
Q

What neurotransmitter is in deficit in Huntington’s disease?

A

GABA.

481
Q

Give 4 features of pain.

A
  1. Pain is always subjective.
  2. It is a sensation.
  3. It is always unpleasant.
  4. It is an emotional experience.
482
Q

How do men and women differ in their response to pain?

A

Women report pain more readily but can tolerate more pain than men.

483
Q

Where do sympathetic nerves come from?

A

T1 -> L2 spinal nerves.

484
Q

Where do parasympathetic nerves come from?

A

Cn 3, 7, 9 and 10, S2 -> 4.

485
Q

What neurotransmitter do sympathetic and parasympathetic nerves both use at ganglia?

A

Ach.

486
Q

What week does the neural tube fuse?

A

Week 4.

487
Q

What is spina bifida?

A

Failure of the neural tube to close in the spinal cord region.

488
Q

What is the visual pigment in the eye?

A

Rhodopsin.

489
Q

What is the function of hair cells?

A

Through transduction they convert mechanical stimuli into electrochemical activity and they also have a role in amplification.

490
Q

What is the somatic nervous system?

A

A part of the peripheral nervous system that handles voluntary control of body movements.

491
Q

What are the anatomical divisions of the nervous system?

A

The CNS (brain and spinal cord) and the PNS (cranial nerves and spinal nerves).

492
Q

What are the functional divisions of the nervous system?

A

Somatic (voluntary control) and autonomic (involuntary control, further subdivided into sympathetic and parasympathetic).

493
Q

Describe how the brain maintains its blood flow in response to hypovolemia.

A

Cerebral autoregulation. Hypovolemia leads to a decrease in BP and so the cerebral arterioles dilate more so as to maintain blood flow.

494
Q

What nerve provides sensory innervation to the oropharynx?

A

Glossopharyngeal - Cn 9.

495
Q

What nerve provides sensory innervation to the laryngopharynx?

A

Vagus - Cn 10.

496
Q

What nerve provides sensory innervation to the nasopharynx?

A

Maxillary branch of the trigeminal - Cn 5(b).

497
Q

Which part of the brain is activated in acupuncture?

A

Cingulate gyrus.

498
Q

Which part of the brain has a role in addiction?

A

The insular cortex.

499
Q

Stimulation of which part of the brain can result in profound analgesia?

A

PAG

500
Q

Give 3 types of glial cells in the CNS.

A
  1. Astrocytes.
  2. Oligodendrocytes.
  3. Microglia.
501
Q

Neurones communicate via 2 types of synapses. What are they?

A
  1. Chemical - majority.
  2. Electrical.
502
Q

Mutation of what protein can result in duchenne?

A

Dystrophin.

503
Q

What is the function of dystrophin?

A

It provides structural stability to muscle cell membranes.

504
Q

Which cranial nerve can be tested in the unconscious patient by observing pupillary constriction in response to light?

A

Optic - CN2.

505
Q

What would pouring ice cold water in the external auditory meatus cause?

A

Convection currents in the semi-circular canals which results in nystagmus.

506
Q

What is the entry/exit foramina for the ophthalmic artery?

A

Optic canal.

507
Q

What is the entry/exit foramina for the superior ophthalmic vein?

A

Superior orbital fissure.

508
Q

What is the entry/exit foramina for the labyrinthine artery?

A

Internal acoustic meatus.

509
Q

What are the two types of deafness?

A
  1. Conductive - sound is blocked from getting through.
  2. Sensory neural - the problems are with the nerves.
510
Q

Where does the substantial nigra project to?

A

The striatum.

511
Q

What are the three branches of the trigeminal nerve

A

V1- Ophthalmic

V2- Maxillary

V3- Mandibular

512
Q

What is the brain stem responsible for?

A

basic vital functions (breathing heart rate)

513
Q

What is the corpus callosum

A

fibre bundle connecting left and right cerebral hemispheres

514
Q

% of neurones present in the cerbellum

A

70%

515
Q

How are structures connected to the cerebellum

A

Re-entrant loops

516
Q

Neurons + stain

A

H&E: Haemotoxylin stain Nucleic acids are stained blue

Eosin stains proteins red

Luxor fast blue (LFB) stains myelin

Cresol violet stain Nissl

517
Q

CSF Outflow

A

Lateral Ventricles → interventricular Foramina (Monro) → Third ventricle → Cerebral Aqueduct → Fourth Ventricle → Apertures → Subarachnoid Space → Sinuses

Liquid Inside The Cerebrum Flow Around Subarachnoid Space

518
Q

How do local anaesthetics work?

A

Interrupt axonal transmission

Block sodium channels preventing the neurone from depolarising, meaning that threshold frequency isn’t met and therefore, no action potential is produced

This results in pain, and pain isn’t transmitted

519
Q

Blood supply of eye

A

Internal carotid artery: Ophthalmic artery, Lacrimal Artery, Ethmoid Artery, Eyelid artery, Ciliary Artery

External carotid artery: Facial artery

520
Q

Internal rotation

A

Towards midline

521
Q

Extorsion

A

Away from midline

522
Q

Eye muscles (diagram)

A
523
Q

Acute pain

A

Short term pain of fewer than 12 weeks.

Chronic pain is for more than 12 week

524
Q

What is the Periaqueductal grey

A

area of gray matter that surrounds the cerebral aqueduct in the brainstem

525
Q

What is PAG best known for

A

analgesia, or pain reduction

Sandra phase 1 (16 decks)

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