Neurophys final Review Flashcards by Brashe Webster

the PNS arises from which cranial nerves?

III, VII, IX and X

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What is the primary nerve for PNS innervation?

Vagus -X
75%

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CN III

Oculomotor

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CN VII

Facial

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CN IX

Glossopharyngeal

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CN X

Vagus

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CN I

Olfactory

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CN II

Optic

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CN IV

Trochlear

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CN V

Trigeminal

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CN VI

Abducens

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CN VIII

Vestibulocochlear

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CN XII

Hypoglossal

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CN III nucleus

edinger-westphal nucleus of the oculomotor nerve

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CN III parasympathetic function

ciliary ganglion → pupil dilation

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CN VII Nucleus

superior salivary nucleus (aka lacrimal nucleus) of the facial nerve

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CN VII Parasympathetic function

greater petrosal nerve → pterygopalatine (aka sphenopalatine) ganglion → lacrimal and nasal glands
chorda tympani and lingual nerves → submandibular ganglion → submandibular and sublingual salivary glands
Injury can result in Xerostomia or dry mouth

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Neurotransmitters are packaged into secretory vesicles by which organelle?
*Endoplasmic reticulum
*Golgi apparatus
*Nucleus
*Mitochondria

Golgi apparatus-Warehouse

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The ATP required to provide energy for cellular function is synthesized in the

Golgi apparatus
Endoplasmic reticulum
Mitochondria
Nucleus

Mitochondria

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A patient with increased intracranial pressure and impending herniation is treated with hypertonic saline. Which of the following statements explains how this treatment improves cerebral edema?

The cells shrink because the extracellular fluid is hypertonic relative to intracellular fluid

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A substance that requires a protein channel to cross a cell membrane is undergoing:

Exocytosis
Simple diffusion
Osmosis
Carrier-mediated diffusion

Carrier-mediated diffusion

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The sodium-potassium ATPase system maintains a resting transmembrane potential by which of the following mechanisms?

Creating net movement of positive ions out of the cell
Allowing passive movement of sodium ions down the concentration gradient
Moving 2 Na+ ions out of the cell for every 3 K+ ions moved into the cell
Maintaining a higher concentration of Na+ ions inside the cell than outside the cell

Creating net movement of positive ions out of the cell

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Activation of these ion channels/receptors will INCREASE neuronal excitability:
Potassium channels and GABA receptors-decrease-hyperpolarize the cell, harder to achieve an AP
Sodium and potassium channels
Potassium channels and glutamate receptors
Sodium channels and glutamate receptors

Sodium channels and glutamate receptors

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Propofol reduces neuronal excitability by:

Activating glutamate receptors
Inhibiting glutamate receptors
Activating GABA receptors
Inhibiting GABA receptors

Activating GABA receptors

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Release of synaptic vesicles is triggered by: Myelination of axons Influx of calcium into the nerve terminal Chloride influx through GABA receptors Cleavage of SNARE proteins- important part,but would be the release of vesicle itself as opposed to the contents (exocytosis)

Influx of calcium into the nerve terminal

This drug works primarily by blocking voltage-dependent sodium channels Ketamine Lidocaine Dexmedetomidine Nitrous oxide

Lidocaine

The most abundant excitatory neurotransmitter in the central nervous system is: Dopamine Epinephrine Acetylcholine Glutamate

Glutamate-1 Acetylcholine-2

A patient is able to produce speech, but has difficulty understanding language and conveying coherent thoughts. He likely has an injury to: Primary motor cortex Broca’s area Auditory cortex Wernicke’s area

Wernicke’s area

Which of the following structures is NOT part of the motor system? Hippocampus Cerebellum Basal ganglia Brain stem

Hippocampus-Memory and attention, emotional regulation

Which of the following visual fields defects is likely to be present in a patient with a pituitary tumor compressing the optic chiasm? Loss of peripheral vision bilaterally Loss of central vision Loss of one hemifield Loss of the superior visual field

Loss of peripheral vision bilaterally- Bi-temporal hemianopsia

Inferior occipital cortex Lateral pre-central gyrus Medial post-central gyrus Superior insular cortex

Sensory information from the lower extremities is transmitted to which part of the cerebral cortex? *You move before you feel! Lateral pre-central gyrus- Motor Medial is sensory

Lateral Pre-central gyrus (Motor or sensory)

Motor

Medial post-central gyrus (Motor or sensory)

Sensory

Cerebellar degeneration is likely to produce: Aphasia Difficulty initiation movements Difficulty coordinating movements Autonomic dysfunction

Difficulty coordinating movements

Which of the following neurotransmitters induces sleep by suppressing the reticular activating system? Histamine- involved in deep sleep Gama-amino-Butyric Acid (GABA)-REM Sleep Acetylcholine Norepinephrine

Gama-amino-Butyric Acid (GABA)-

Which of the following conditions is NOT a cause of coma? Central nervous system infection Seizures Hypothermia Glycopyrrolate-

Glycopyrrolate- doesn't cross the BBB

In the ICU setting, seizures are the second most common cause of neurologic complications and can result from all of the following EXCEPT: Anoxic brain injury Head trauma Benzodiazepine overdose- potentiating GABA- Anti-epileptic drug withdrawal

Benzodiazepine overdose

What is the LOWEST composite score for all three items a patient may be given using the Glasgow Coma Scale (GCS) to assess their level of neurologic function? 3 0 8-Airway intervention/intubation 15

Cerebral perfusion pressure is calculated as: Diastolic blood pressure plus 1/3 pulse pressure Mean arterial pressure minus intracranial pressure OR central venous pressure, whichever is HIGHER Mean arterial pressure minus intracranial pressure OR central venous pressure, whichever is LOWER Stroke volume times heart rate

Mean arterial pressure minus intracranial pressure OR central venous pressure, whichever is HIGHER

Administration of propofol will cause which of the following effects? A decrease in cerebral metabolic requirement for oxygen (CMRO2)-> Decrease in CBF An increase in cerebral blood flow (CBF) An increase in intracranial pressure (ICP) Cerebral vasodilation

A decrease in cerebral metabolic requirement for oxygen (CMRO2)-> Decrease in CBF

Which of the statements regarding the blood brain barrier (BBB) is FALSE? Small lipophilic drugs can pass the BBB by passive diffusion The BBB may be compromised by severe hypertension and/or ischemia It is formed by tight junctions on the endothelial cells Large ionized drugs can pass the BBB by passive diffusion

Large ionized drugs can pass the BBB by passive diffusion-Needs carrier mediated diffusion or cotransporters

Which of the following statements regarding the relationship between PaCO2 and cerebral blood flow (CBF) is TRUE? Gradual changes in cerebrospinal fluid bicarbonate offset the effect of hyperventilation on cerebral vascular tone over time- Hypoventilation causes an increase in CSF pH, leading to cerebral vasoconstriction CBF in inversely proportional to PaCO2 between 20-80mmHg-uncoupling, directly proportional PaCO2 <20mmHg provides the most beneficial effects on cerebral oxygen delivery and confers no risk for cerebral ischemia regardless of patient age

Gradual changes in cerebrospinal fluid bicarbonate offset the effect of hyperventilation on cerebral vascular tone over time-Redistribution of Bicarbonate

Which statement regarding the Circle of Willis is TRUE? The MCA supplies the lateral frontal, parietal and temporal cortex It is an anastomosis within the cerebral venous system The vertebral artery contributes directly to the anterior circulation- would be true if it was Posterior circulation. Anterior is taken care of by Internal carotid/Carotid It provides arterial blood supply to the spinal cord

The MCA supplies the lateral frontal, parietal and temporal cortex

Which of the following does NOT reduce intracranial pressure? Mannitol Transient hyperventilation Mild hypoxia Hypothermia-Reduce CMRO2-> CBF-> potential Decrease in ICP

Mild hypoxia

Elevated intracranial pressure, when severe, can result in brain herniation syndromes. All of the following are alarming signs of worsening intracranial pressure EXCEPT: Abnormal respirations Tachycardia- Headache Hypertension

Tachycardia

Cushing's Triad

Hypertension Bradycardia Abnormal Breathing pattern

Which of the following anesthetics is most likely to worsen ICP in a patient with impending brain herniation? Muscle relaxants (Transient increase in ICP w/Sux, not clinically relevant) Opioids Propofol Sevoflurane-

Sevoflurane-

Which of the following intraoperative maneuvers are appropriate for REDUCING intracranial pressure? Increasing PaCO2 Conversion from inhalational to intravenous anesthesia Administration of mannitol and Lasix with no consideration of concurrent or potential electrolyte Administration of high does steroids to a patient with closed head injury and intracranial hemorrhage

Conversion from inhalational to intravenous anesthesia

Activation of the sympathetic nervous system will cause which of the following responses? Bronchoconstriction Bradycardia Pupil constriction Decreased intestinal motility

Decreased intestinal motility

Which one of the following adrenergic receptor function relationships is correct? Beta 1 activation causes decreased inotropy and chronotropy Alpha 1 activation causes vasodilation Beta 2 blockade causes bronchodilation Alpha 2 activation causes decreased neurotransmitter release from the nerve terminal-Sedation

Alpha 2 activation causes decreased neurotransmitter release from the nerve terminal-Sedation

Which enzyme plays a role in the metabolism of acetylcholine Catechol-O-methyltransferase Tyrosine hydroxylase Monoamine oxidase Acetylcholinesterase

Acetylcholinesterase

Catechol-O-methyltransferase function

Metabolism of Norepinephrine

Tyrosine hydroxylase function

Norepi to Dopamine

Monoamine Oxidase function

Norepinephrine Uptake

The pathway for sympathetic output to the head and neck includes which of the following structures? Low thoracic spinal cord Cervical ganglia Celiac ganglion- found in the abdomen-next to celiac artery Prevertebral ganglia-sympathetic chain and can pass low thoracic spinal cord

Cervical ganglia

The primary neurotransmitter released by sympathetic post-ganglionic cells, except for the adrenal medulla and those innervating sweat glands is: Dopamine Norepinephrine Acetylcholine Epinephrine

Norepinephrine

The vagus nerve (CN X) innervates all of the following structures EXCEPT for: Lungs Heart Bladder Stomach

Bladder

Which of the following statements concerning cranial nerves is TRUE? They arise from the ventral surface of the cerebellum They all contain both sensory and motor fibers They are considered part of the central nervous system- Four cranial nerves carry sympathetic innervation-

They are considered part of the central nervous system-exit from brainstem itself

Administration of which of the following can cause central anticholinergic syndrome? Physostigmine Glycopyrrolate Neostigmine Scopolamine

Scopolamine-cross BBB-quaternary amine. Last 24hrs, most cardio-stable induction agent. Not used in the US anymore since 70s

Muscarinic acetylcholine receptors are found in/on all the following organs EXCEPT for: Urinary bladder Blood vessels Eye Heart

Blood vessels-Adrenergic receptors Alpha/Beta

Activation of the parasympathetic nervous system will cause which of the following physiologic responses? Decreased intestinal motility Decreased salivation Bronchoconstriction Tachycardia

Bronchoconstriction

Which of the following statements concerning the parasympathetic nervous system is FALSE? Acetylcholine is the neurotransmitter for both pre and post ganglionic neurons Preganglionic fibers exit the spinal cord at the thoracic and lumbar levels The parasympathetic ganglion is found near or in the wall of the end organ The majority of parasympathetic outflow is carried by the vagus nerve

Preganglionic fibers exit the spinal cord at the thoracic and lumbar levels – exit from nerve associated with- CNs or sacral plexus

Damage to the sensory branch of CN VII results in loss of which of the following on the affected side? Corneal reflex –Trigeminal-ophthalmic branch Hearing Sensation above the eyebrow- Bilateral Taste from the anterior tongue

Taste from the anterior tongue

Which of the following is an early and mechanism to compensate for pressure changes caused by increased intracranial volume? CSF displacement out of the cranial vault Brain tissue displacement Increased CSF production Cerebral vasodilation

CSF displacement out of the cranial vault

Which of the following statements regarding cerebral spinal fluid is FALSE? It flows from the dorsal venous sinus into the ventricles Decreased CSF clearance can result in hydrocephalus It has a lower protein content than plasma It is produced by ependymal cells

It flows from the dorsal venous sinus into the ventricles- flow from ventricles into the dorsal venous sinus

The choroid plexus: Is located in the dorsal sinus Is a nerve bundle arising from the spinal cord Has a smooth lining with minimal surface area Is the main site of CSF production

Is the main site of CSF production

Which statement about seizures is FALSE? Local anesthetic systemic toxicity can lead to seizures Seizures always present with convulsions GABAergic drugs can suppress seizure activity A generalized convulsive seizure lasting for more than 5 minutes is considered status epilepticus

Seizures always present with convulsions

Basic elements of brain death include all of the following EXCEPT: An absence of cranial nerve reflexes An etiology capable of causing neuronal death The absence of spinal cord reflexes-Not part of CNS The patient is apneic

The absence of spinal cord reflexes-Not part of CNS

Which of the following statements is TRUE? Alpha 2 agonists promote wakefulness Histamine from the tuberomammillary nucleus promotes sleep/ unconsciousness –Deep sleep only Gamma-amino-butyric acid (GABA)ergic drugs promote wakefulness The medullary reticular activating system promotes wakefulness-

The medullary reticular activating system promotes wakefulness-

Which of the following structures is a relay station for motor and sensory information in the brain? Putamen- modulating the thalamus Cerebellum Thalamus Globus pallidus-modulating the thalamus

Thalamus

Non-painful sensory information is transmitted to the CNS via: The corticospinal tract- Motor The dorsal column-medial lemniscus pathway The spinothalamic pathway- Pain and Temp The retinogeniculostriate pathway

The dorsal column-medial lemniscus pathway

Corticopsinal tract (S/M)

Motor

Dorsal column

Medial Lemniscus Pathway

Spinothalamic Pathway

Pain and Temp

The main thick protective layer of connective tissue that covers and protects the brain and spinal cord is called: Corpus callosum Subarachnoid space Dura Mater Anterior Commissure

Dura Mater

A lesion in the right lower back at the level of the thoracic spinal cord is likely to produce the following neurological symptoms:

Loss of pain and temperature sensation in the contralateral leg and loss of proprioception and mechanosensation in the ipsilateral leg-decusates immediately after it crosses

- No speech, has understanding

Injury to Broca's Area