Survey of Anatomy Final Review Flashcards by Brashe Webster

CN VIII travels to the brainstem where it is relayed to the___ via ____

Vestibulocochlear
Cerebellum via vestibular nuclei

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Vestibular nuclei sends signals to the

Spinal cord via vestibulospinal tracts
Extraocular motor nuclei
Thalamus
Cerebellum

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motor function to maintain upright posture, balance, head position

Spinal cord via vestibulospinal tracts

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coordinating eye movements, extraocular reflex

Extraocular motor nuclei

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relays to somatosensory and motor cortex (spatial orientation of the body)

Thalamus 

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coordinated input from CN VIII and from visual cortex (balance and smooth eye movements)

Cerebellum

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Identify the consequences of this lesion

Total Right Eye Visual loss

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Identify the consequences of this lesion (2)

Bitemporal Hemi-anopia

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Identify the consequences of this lesion (3)

Left Nasal Hemianopia

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Identify the consequences of this lesion (4)

right homonymous hemianopia

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Identify the consequences of this lesion (5)

Left homonymous hemianopia with macular sparing

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Branches of the trigeminal nerve

V1 Opthalmic
V2 Maxillary
V3 Mandibular

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How is the sense of smell unique?

neurons bypass the thalamus to synapse directly in the olfactory cortex/other limbic structures.

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How are pediatric airways different than adults?

Narrow nasal passages
Obligate nasal breathers until 5 m/o
Obstruct much easier
Consider oral airways but not nasal
Anterior and cephalad larynx (glottis at C4 versus C6)
Longer, floppier, U-shapped epiglottis
Prominent tonsillar tissue
Shorter trachea and neck
Cricoid is narrowest portion of airway until 5 y/o
Post-extubation laryngospasm more common than in adults
Post-intubation croup

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CO formula

CO= HRx SV

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Pediatric renal function

Approaches normal by 6 m/o but could take until 2 y/o

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4:2:1 Rule

First 10 kg: 4 ml/kg/hour.
Next 10 kg (11-20 kg): 2 ml/kg/hour.
Remaining weight (over 20 kg): 1 ml/kg/hour.

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Identify the lesion

Tracheoesophageal fistula

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Most common TEF type

Most common is esophagus with a blind pouch and lower esophagus that attaches to trachea (Type C)

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Symptoms of Type C TEF

Breathing leads to gastric distension and feeding results in coughing, choking and cyanosis

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TEF is associated with

congenital anomalies (VACTERL syndrome: vertebral defects, anal atresia, cardiac defects, TEF, renal abnormalities and limb dysplasia)

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Anesthetic concerns for TEF

Copious pharyngeal secretions
PPV avoided
Low intravascular volume and malnourished
Retraction during ligation of the esophagus can obstruct mainstem bronchus

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Pyloric stenosis metabolic abnormality

Hypokalemic, hypochloremic metabolic alkalosis

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Anesthetic considerations for pyloric stenosis

Correct metabolic abnormalities first
NG to decompress
Increased risk for aspiration

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Viral URI in 3 m/o – 3 y/o Barking cough

Infectious Croup

Haemophilus influenzae infection 2-6 y/o Sore throat to complete obstruction quickly

Acute Epiglottitis

6 m/o – 5 y/o Peanuts, coins, batteries Stridor or wheezing

Foreign body aspiration

Prechiasmic visual field deficit

Glaucoma, optic neuritis

Chiasmic visual field deficit

Bitemporal hemianopsia (pituitary adenoma)

Post-chiasmic visual field deficit

Homonymous hemianopsias (parietal stroke, trauma, tumor

Papilledema

– optic nerve swelling due to increased ICP Bulging optic disc

Snellen chart

Visual acuity

(color matching Ishihara charts, red/green) Visual fields

Color vision

(confrontation test)

Visual Fields

Fundoscopic exam

(optic disc)

Cranial nerve VII Pathology

Facial nerve Physical exam: Assess changes to taste, salivation or lacrimation

Facial nerve palsy thought to be caused by viral infection/edema with rapid onset

Bell's Palsy

Chronic inflammatory disease of the axial skeleton, w/ progressive stiffness of the spine Young adults, more common in males (peak at 20 & 30 years old) Back pain (improves w/ exercise), buttock, hip, or shoulder pain Systemic complaints (fever, malaise, fatigue, weight loss, myalgias) Restrictive pulmonary failure due to costovertebral rigidity, ILD Renal impairment Asymptomatic ileal & colonic mucosal ulcerations Secondary amyloidosis

Ankylosing Spondylitis

Complications of Ankylosing Spondylitis

Acute spinal cord or nerve compression, subluxation of the atlantoaxial joint, aortic regurgitation

__ % of our body weight is water

50-60%

ECF is made up of

The interstitial compartment The intravascular compartment

2/3 of body fluid is

ICF

1/3 of the body fluid is

ECF

The interstitial compartment contains __ of the ECF

80%

20% of the ECF is in the intravascular compartment as ____

Plasma

ICF most abundant ion

K+

ECF Most abundant Ion

Na+

Peptide hormone -> its main role is to regulate fluid balance in the body

ADH

ADH is produced in the ______ by osmoreceptors and the hormone is stored in the posterior pituitary gland

Hypothalamus

Osmoreceptors are sensitive to plasma osmolality and a decrease in _____ _____

Blood Volume

Target organ for ADH

Kidneys

ADH acts on the distal convoluted tubule and collecting ducts, making the tubules more permeable to water and thus

increasing reabsorption of water

During dehydration, what happens with ADH?

more ADH is released, thus increasing water reabsorption and resulting in less fluid loss

Secretion of ADH is decreased by

a drop in plasma osmotic pressure, increased ECF volume, and increased alcohol intake

They are produced in the bone marrow from fragments of megakaryocytes

Platelets

Lifespan of platelets

life span of approximately 5-9 days

How are old and dead platelets removed from the body?

by macrophages in the spleen & Kupffer cells in the liver

What role do platelets play in blood loss?

the formation of platelet plugs that seals holes in vessels & release chemicals that aid in blood clotting

Sperm production occurs in

in the seminiferous tubules of the testes and is called spermatogenesis

How long does spermatogenesis take in humans?

~74 days in humans

What organ produces estrogen and progesterone?

Ovaries

Monthly, follicles are stimulated by two hormones,___ & ___, which stimulate the follicle to mature, leading to the release of a mature ovum at ovulation

FSH LH

FSH and LH are produced where?

Anterior pituitary

What stimulates the release of FSH and LH

GnRH

Corpus leuteum secretes

Progesterone Oestrogens Relaxin Inhibitin

The uterine cycle begins w/ the ____ _____ which lasts from days 1 to 5

Menstrual Phase During this time the inner functionalis layer of the endometrium is released as menstrual fluid

As the growing follicle in the ovary begins to produce the hormone estrogen (days 6 – 14)

The proliferative Phase

The final phase of the uterine cycle, lasting from days 14 to 28 The corpus luteum produces progesterone resulting in an increased vascularity, changing the inner layer of secretory mucosa. If fertilization does not occur, hormone levels fall & the endometrial cells degenerate and slough off

The Secretory Phase

Contractions intensify & the amniotic membrane ruptures

Stage 1 of Labor

Contractions continue at a now regular pace (60-90 seconds every 3-5 minutes)

Stage 2 of Labor

After delivery of the baby, uterine contractions continue so that the placenta separates from the uterine wall

Stage 3 of Labor

process of maintaining a stable internal environment

Homeostasis

hormones that are secreted into the blood and have an effect on cells distant from those that released the hormone (can also act locally, even on the cells that secrete them)

Endocrine

refers to hormones that act locally and diffuse to the cells in the immediate neighborhood to produce their action

Paracrine

refers to hormones that act on the cells that produce it

Autocrine

refers to glands and organs that secrete substances into ducts that eventually lead to the outside of the body (sweat glands)

Exocrine

Chemical messengers that are secreted into the blood or the extracellular fluid by one cell & have an effect on the function of other cells

Hormones

cannot cross the cell membrane. Their receptors are found on the cell wall and exert their influence via signal transduction

Peptide Hormones

are lipid soluble and small, allowing them to freely cross the cell membrane

Steroid hormones Receptors are found within the cell itself Normally exert their effect by stimulating transcription and translation

Not a steroid hormone but is lipid soluble and small, allowing it to diffuse easily across the cell membrane

Thyroid Hormone

Hormone concentration at the target cell is determined by

the rate of hormone production the rate of hormone delivery the half life of the hormone

 Translation/expression of more cellular receptors in response to low circulating levels of a hormone the cell becomes more responsive to the presence of the hormone

Upregulation

reduction (involution) of the number of cellular receptors often in response to prolonged periods of high circulating levels of a hormone the cell becomes less responsive to the hormone (desensitized)

Downregulation

Two portal circulations in the human body

The connection between the hypothalamus and the anterior pituitary gland Hepatic portal circulation that merges to form the portal vein entering the liver

The influence of a stimulus leads to hormone release. There are three types

Humeral Neural Hormonal

# Define type of response response to changing levels of ions and/or nutrients in the blood (ex: parathyroid hormone release is stimulated by decreased serum concentration of calcium ions)

Humeral

direct nervous stimulation (ex: the release of catecholamines from the adrenal medulla)

Neural

response to hormones released by other organs, normally in a rhythmical pattern (ex: release of TSH from the anterior pituitary directly stimulating the release of T4 from the thyroid gland)

Hormonal

Initial stimulus leads to release of hormone Hormone exerts effect on target organ Some aspect of organ function feeds back into the system

Negative Feedback inhibiting further hormone release/ Negative feedback loop

The hypothalamus is directly connected to the pituitary gland via

the pituitary stalk (infundibulum)

The hypothalamus connects the nervous system to the endocrine system via

The Pituitary Gland

Increased serum hormone levels are detected by hypothalamic hormone receptors, which in turn

downregulates release of that hormone

Neurohypophysis

(posterior lobe) of pituitary gland

Adenohypophysis

(anterior lobe) of Pituitary gland

The Posterior Lobe (Neurohypophysis) releases 2 hormones that it receives directly from the hypothalamus

Oxytocin ADH

 effects uterine contraction in childbirth & is responsible for the release of breast milk in response to suckling. In men and non-pregnant women, it plays a role in sexual arousal and orgasm

Oxytocin

increases water retention by the kidneys by increasing the permeability (aquaporin channels) of the collecting ducts in the kidneys

ADH

The ____ Lobe of the pituitary gland is much larger and is composed of glandular tissue to produce and release several hormones

Anterior Lobe of Pituitary

Control of the anterior pituitary is affected by

releasing or inhibiting factors from the hypothalamus

There are 5 types of pituitary cells in the anterior pituitary

Somatotropes Lactotropes Thyrotropes Gonadotropes Corticotropes

Release Growth hormone (GH)

Somatotropes

secrete prolactin (PRL)

Lactotropes

: secrete thyroid stimulating hormone (TSH)

Thyrotropes

secrete luteinizing hormone (LH) & follicle-stimulating hormone (FSH)

Gonadotropes

secrete adrenocorticotropic hormone (ACTH)

Corticotropes

released from the hypothalamus to stimulate the release of growth hormone from the anterior pituitary

Growth hormone releasing factor

Growth hormone releasing factor is inhibited by

the release of somatostatin by the hypothalamus, producing a negative feedback loop

Growth hormone promotes the growth of bone, cartilage and soft tissue by stimulating the production and release of

insulin-like growth factor (IGF)

stimulates the secretion of milk from the breast

Prolactin

Secretion of prolactin is inhibited by

the release of dopamine from the hypothalamus

FSH Function in Males

FSH stimulates sperm production

FSH Function in Females

FSH leads to the early maturation of ovarian follicles and estrogen secretion

LH Function in Males

stimulation of testosterone secretion in males

LH Function in Females

responsible for the final maturation of the ovarian follicles and estrogen secretion in females

In males and females, LH and FSH production are regulated by the release of

gonadotrophin-releasing hormone (GnRH) from the hypothalamus

Testosterone and estrogen exert a negative feedback effect on release

gonadotrophin-releasing hormone (GnRH) from the hypothalamus

TSH is produced & released in response to

the release of thyroid-releasing hormone (TRH) from the hypothalamus

The release of TRH from the hypothalamus is inhibited by

somatostatin

TSH stimulates thyroid gland cells to increase the production and secretion

of T4 and T3 (thyroid hormones)

stimulates the production of cortisol & androgens from the adrenal cortex2

ACTH

leads to the production of aldosterone in response to: increased serum concentration of potassium ions increased angiotensin levels decreased total body sodium

ACTH

ACTH is secreted from the anterior pituitary in response to

the secretion of corticotropin-releasing hormone (CRH) from the hypothalamus

Excitation of the hypothalamus by any form of stress leads to the release of CRH &

the subsequent release of ACTH, then cortisol

the amount of energy expended while at rest in a temperate environment

Basal metabolic rate (BMR

As the BMR increases energy requirements

oxygen consumption is also increased

C cells found between thyroid follicles secrete

calcitonin which is involved in the metabolism of calcium and phosphorus.

Calcitonin decreases calcium levels in the blood by

reducing the activity of osteoclasts (cells that digest bone and release calcium and phosphorus into the blood) and inhibiting the reabsorption of calcium from urine

the single most important hormone for the control of calcium balance in the body

Parathyroid Hormone (PTH)

_______ hormone has the following functions: Increasing intestinal calcium absorption Stimulating renal calcium absorption Stimulating osteoclast activity, thereby increasing reabsorption of calcium from the bones

Parathyroid

is involved in muscle contraction, transmission of nervous impulses, & is required for the creation of clotting factors in the blood

Calcium

Reduced blood calcium level leads to

an increase in the synthesis & secretion of parathyroid hormone

a hormone released by the kidneys in response to decreases in calcium ions in the blood & inhibits calcitonin release from the thyroid gland

Calcitrol

the inner portion of the adrenal gland & comprises 30% of the total mass of the adrenal gland

Adrenal medulla

The function of the ____ ____ the secretion of catecholamines: epinephrine, norepinephrine, & dopamine

Adrenal medulla

Secetion of ___ and ____ is actively controlled by the hypothalamus and occurs in response to: pain, anxiety, excitement, hypovolemia, & hypoglycemia

epi and Norepi

have a very short half-life in blood of less than 2 minutes as they undergo rapid enzymatic degradation

Catecholamines

produces the mineralocorticoids

Zona Glomerulosa

produces the glucocorticoids

Zona Fasciulata

this zone is also involved in the production of glucocorticoids but also produces small amounts of adrenal sex hormones (the gonadocorticoids)

Zona Reticularis

A group of hormones whose main function is the regulation of the concentration of electrolytes in the blood

Mineralcorticoids

accounts for 95% of all the mineralocorticoids & is the most potent

Aldosterone

Reduces the excretion of sodium in the urine by regulating the reabsorption of sodium in the distal renal tubules. Sodium is exchanged for potassium & hydrogen which are excreted in urine

Aldosterone

Aldosterone secretion is primarily induced by _________ ___ in response to: Increased serum potassium Decreased serum sodium Decreased blood pressure Hypovolemia

Angiotensin II

Influence the metabolism of most body cells Promote glycogen storage in the liver Stimulate the generation of glucose during fasting Involved in providing resistance to stressors Potentiate the vasoconstrictor effect of catecholamines Decrease the permeability of vascular endothelium Promote the repair of damaged tissues Suppress the immune system Suppress the inflammatory response

Glucocorticoid effects

normally released in a rhythmical pattern, with most being released shortly after rising from sleep & the lowest released after sleep commences

cortisol

release is stimulated by ACTH from the anterior pituitary gland. ACTH secretion is regulated by release of CRH from the hypothalamus

Cortisol

Increasing levels of cortisol have a negative feedback effect on the hypothalamus & the pituitary gland, inhibiting further release of

both CRH and ACTH

the site of the endocrine cells of the pancreas

islets of Langerhans

Major cell types of Islets

Alpha Beta Delta

Cells that secrete somatostatin

Delta Cells

Cells that secrete insulin

Beta Cells

Cells that secrete glucagon

Alpha Cells

How are islet cells arranged in the pancreas?

The different cell types w/in each islet are distributed in a set pattern, w/ beta cells being the central portion of the islet, surrounded by alpha & delta cells

What inhbits insulin secretion?

Alpha-adrenergic agonists & somatostatin

facilitates glucose & potassium transport across cell membranes, increases glycogen synthesis, & inhibits lipolysis

Insulin

the result of insulin deficiency, resistance to insulin during stress, or medications. Treatment of DKA is with volume replacement, correction of electrolyte abnormalities (replete potassium), identification & treatment of underlying stressors or precipitants, &supportive care.

DKA Diabetic ketoacidosis

reduces blood glucose levels by: Facilitating the entry of glucose into muscle, adipose tissue & several other tissues The brain and liver do not require insulin to facilitate the uptake of glucose Stimulating the liver to store glucose in the form of glycogen

Insulin

The half-life of insulin is approximately

5 Mins Broken down in the liver

has an important role in maintaining normal blood glucose levels

Glucagon

secretion is stimulated in response to a reduction in blood glucose concentration & elevated blood levels of amino acids (after a protein-rich meal)

glucagon

Stimulates the breakdown of glycogen stored in the liver Activates hepatic gluconeogenesis (creation of glucose from substances such as amino acids)

Glucagon

has the opposite effect on blood glucose levels to insulin

Glucagon

autoimmune destruction of the pancreatic beta cells resulting in an absolute insulin deficiency Patients are generally thin, diagnosed at an early age, sensitive to small amounts of insulin, & prone to ketoacidosis.

Type I Diabetes Mellitus

insufficient blood insulin concentration due to either impaired insulin production or insulin resistance Patients require high insulin levels to a maintain euglycemia

Type II Diabetes Mellitus

inability of the hypothalamus to produce adequate amounts of antidiuretic hormone (ADH)

Diabetes Insipidus

high blood glucose that develops at any time during pregnancy in a woman who doesn’t have diabetes. May predispose to development of type II diabetes later in life

Gestational Diabetes

due to other causes of absolute or relative insulin insufficiency. Insulin hyposecretion is seen with pancreatic destruction due to cystic fibrosis, pancreatitis, hemochromatosis, cancer, & after pancreatic surgery

Secondary Diabetes

Caused by the secretion of vasoactive substances (serotonin, histamine) from enterochromaffin tumors (carcinoid tumors)

Carcinoid syndrome

products of ___-_____ _____ _____(pulmonary, hepatic & ovarian) bypass the portal circulation, causing systemic manifestations Cutaneous flushing, bronchospasm, profuse diarrhea, blood pressure lability, & supraventricular arrhythmias

Non-Intestinal Carcinoid Tumors

Patients with glucocorticoid deficiency require

adequate steroid replacement therapy during the perioperative period

A vascular tumor of chromaffin tissue (most commonly in the adrenal medulla) that produces and secretes norepinephrine, epinephrine, & dopamine 10% are bilateral, 10% are metastatic, & 25% are familial. The classic presentation includes palpitations, headache, diaphoresis, & HTN

Pheochromacytoma

Maintenance of homeostasis (esp. electrolyte levels and fluid balance) Metabolism Growth and development Response to stress

Major functions of the endocrine system

Composed of the brain and spinal cord Only 2% of our body weight Receives 20% of oxygenated blood Most protected organ in the body

Central nervous system

Cerebral cortex, white matter, basal ganglia, hippocampus, amygdala

Cerebrum

Thalamus, hypothalamus

Diencephalon

Midbrain, pons, medulla oblongata

Brain Stem

Interhemispheric fissure

Falx Cerebri

Hemispheres are connected by a large C-shaped fiber bundle, the____ _____, which carries information between the two hemispheres

corpus Callosum

horizontal fissure that separates the temporal lobe

Lateral fissure (of Sylvian

transverse fissure that separates the frontal and parietal lobes

Central sulcus of Rolando

Folds of the cortex

Gyrus

Motor of the frontal Lobe

Precentral gyrus Premotor Supplementary motor area

higher level thinking, personality, insight, foresight, reward, problem solving

Prefrontal cortex

– motor mechanisms of speech Left hemisphere

Broca's area

controls voluntary movement of the eyes

Frontal Eye field

Where is Wernicke's area located in the brain

(parietal vs temporal) – generally described as near the Sylvian fissure

Primary auditory cortex location

Temporal lobe

Occipital lobe function

Vision Primary and secondary visual cortexes orientation, spatial-frequency, color

Plays role in motivation, emotion, learning, consciousness, memory and much more

Limbic system

Parkinson’s, Depression, PTSD, ADD, Autism Schizophrenia, Alzheimer’s, Narcolepsy

Diseases of the limbic system

Series of nuclei within the motor, limbic, and sensory systems Process info to aid in fine-tuning motor response/coordination, movement generation Parkinson’s disease is an example of pathology within this system

Basal Ganglia

Formation of episodic memories and long-term storage; association of memories with various senses Neural plasticity and learning new things; new neurons can be made here Spatial orientation

Hippocampus

acts as a relay station for sensory impulses going to the cerebral cortex and integrates motor responses

Thalamus

closely associated with the posterior pituitary gland and produces two hormones: Antidiuretic hormone (ADH) and Oxytocin

Hypothalamus

Controls body temperature, autonomic responses, fluid balance and thirst, appetite control, emotional reactions in concert with the limbic system, and control of sexual behaviors

Hypothalamus

linked to the pineal gland, which secretes the hormone melatonin responsible for sleep/wake cycles

Epithalamus

Regulates motor control via input from the sensory system, the spinal cord and other parts of the brain

Cerebellum

a lack of balance, slowed movements, loss of equilibrium and tremors. May also affect motor learning in humans

Damage to the Cerebellum

allows you to maintain your gaze fixed on an object even when your head moves

Vestibuloocular reflex

Associated with cranial nerves 3-12 and essential life functions

Brainstem

conduction pathway that connects the cerebrum with lower brain structures and the spinal cord Visual and auditory data, consciousness

Midbrain

conduction pathway that communicates with the cerebellum Subconscious somatic and visceral motor functions Works with the medulla oblongata to control rate and depth of respiration

Pons

relays to thalamus coordinating visceral autonomic areas that control the cardiac, respiratory, and vasomotor centers Controls coughing, sneezing, and vomiting

Medulla Oblongata

demyelination of neurons in the pons caused by alcoholism, malnutrition, or rapid correction of hyponatremia paralysis, dysphagia, dysarthria

Central Pontine myelinolysis (CPM

Locked-in Syndrome can be caused by

a ventral pontine stroke  complete loss of voluntary muscle function except for some eye-movements and blinking, but no damage to cortical structures (intact comprehension, cognition, and reasoning = awake and aware)

Purely sensory Cranial nerves

(I, II, VIII) Have ganglia in the periphery CN I – Olfactory CN II – Optic CN VIII – Vestibulocochlear

Purely Motor Cranial nerves

(III, IV, VI, XI, XII) Cell bodies are in their respective nuclei in the brainstem

Both Sensory and motor cranial nerves

V, VII, IX, X) CN V – Trigeminal CN VII – Facial CN IX – Glossopharyngeal CN X - Vagus

# Afferent/Efferent Somatic sensory (body wall) Visceral sensory (internal organs) Special sensory Smell Vision Taste Hearing Equilibrium

Afferent

# Afferent/Efferent Somatic motor Visceral motor (parasympathetic)

Efferent

when a sensory stimulus is sent to the spinal cord, which immediately sends a motor response back to the same location, bypassing higher level processing in the brain

reflex arc

Sensory Gag reflex

Glossopharyngeal nerve (CN XI) Sensory stimulus to the posterior/base of tongue and walls of oropharynx

Motor Gag Reflex

Vagus nerve (CN X) Motor stimulus involving brisk elevation of the soft palate and bilateral contraction of pharyngeal muscles May evoke retching and vomiting in some, more sensitive patients

A protective reflex that is in place to prevent gastric contents from entering the trachea and pulmonary tree

Glottic closure reflex

Glottic closure reflex-Sensory

Superior laryngeal nerve (branch of Vagus nerve, CN X) Sensory stimulus around and above the level of the vocal cords Recurrent laryngeal nerve (branch of Vagus nerve, CN X) Sensory stimulus below the vocal cords and upper part of trachea

Glottic closure reflex- Motor

Recurrent laryngeal nerve (branch of Vagus nerve, CN X) Supplies all of the intrinsic muscles of the larynx except for the cricothyroid muscle, which contract and close the glottis Exaggerated response can lead to Laryngospasm

Paired internal carotid arteries and Paired vertebral arteries form an anastamotic circle

Circle of Willis

of pairs of spinal nerves

Caudal end of spinal cord

Conus medullaris L1-2

extends to coccyx and anchors the cord

Filum terminale

What meningeal space contains the CSF

Subarachnoid space

the cell bodies/synapses occur in

the grey matter

axons occur in the

White matter

medial lemniscus tract (fasciculus gracilis and cuneatus)  deep touch, conscious proprioception, vibration

Dorsal Column

anterior and posterior)  unconscious proprioception

Spinocerebellar tracts

Lateral Spinothalamic tract

pain, temperature)

Anterior Spinothalamic tract

light touch

Pyramidal (Anterior and lateral corticospinal

voluntary movement, finalization of movement

Extrapyramidal

involuntary movement, initiation of movement

Branches from the left side of the descending aorta somewhere around T8-L2 via lumbar or intercostal arteries Important supply for the watershed area in the thoracolumbar region of the SC

Artery of Adamkewicz

Vertebral Arterby branches into

Single Anterior Spinal Artery which supplies the anterior 2/3 of the spinal cord 2 Posterior Spinal Arteries which supplies the posterior 1/3 of the spinal cord

occlusion of A of A leads to anterior cord ischemia-> loss of motor function, pain & temperature

Anterior Spinal Artery syndrome

caused by diminished perfusion of anterior lumbar spinal cord leading to loss of motor function and sensory function carried by the anterior columns including pain and temperature (sparing proprioception within the dorsal column which is supplied by the posterior spinal artery)

Anterior Spinal Cord syndrome

skull fracture, rupture of middle meningeal artery Biconvex shape LOC ->“lucid interval” ->deterioration

Epidural

Deceleration/acceleration injury; shaken-baby; elderly or alcoholics Rupture of bridging vein Crescent shape

Subdural

Trauma or ruptured aneurysm Thunderclap headache

Subarachnoid

Stroke Symptom onset can be minutes to hours

Intracerebral

Flow of CSF

Choroid plexus in the lateral ventricles via interventricular foramen (of Monro) -> third ventricle ->cerebral aqueduct (of Sylvius) -> fourth ventricle -> Foraminae of Magendie and Luschka -> subarachnoid space (brain and SC) ->dural venous sinuses -> absorbed

How much CSF is produced in one day?

500 mL/day

Highly selective semipermeable membrane that separates the circulating blood from the brain due to “tight junctions” between endothelial cells in CNS vessels

BBB

measured in the lateral ventricles or over the cerebral cortex and is Normally 10 mm Hg or less

ICP

headache, nausea/vomiting, seizures, change in consciousness, slow/surred speech, vision changes

Elevated ICP Symptoms

Normal autoregulation of CPP occurs between

50-150 mmHg

pupillary dilation, Cushing’s triad (hypertension/widened pulse pressure, bradycardia, respiratory depression)

Signs of brain herniation

transverse temporal gyrus (of Heschl); upper surface extending into the lateral fissures

Primary Auditory Cortex

caudal part extending towards the parietal cortex; language comprehension

Wernicke's area

This cerebral lobe contains the primary somatosensory cortex: a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe e. Limbic lobe

B-Parietal lobe

The area indicated by the blue shading is primarily supplied by which of the following arteries. a. Basilar artery b. Vertebral artery c. Anterior cerebral artery d. Middle cerebral artery e. Posterior cerebral artery

e. Posterior cerebral artery

The unique, direct neuronal connection between the olfactory afferent neurons and this CNS structure are responsible for the strong connection between smell and memory Hypothalmus Hippocampus Olfactory bulb Amygdala Medulla oblongata

Hippocampus

This nerve structure is responsible for transmitting the gustatory information from the anterior 2/3 of the tongue and is easily damaged in by careless ENT surgeons. Lingual nerve Facial nerve (CN VII) Trigeminal nerve (CN V) Chorda tympani Vagus nerve (CN X)

Chorda tympani

This area of the brain is responsible for the oculocephalic reflex (aka the doll’s eyes reflex) that helps stabilize a visual image on the retina when the head is in motion. Primary visual cortex Vestibular nucleus of CN VIII Cerebellum Ciliary ganglion Optic chiasm

Vestibular nucleus of CN VIII

A pituitary tumor is most likely to result in which of the following visual field deficits? Complete unilateral vision loss Bitemporal hemianopia Left nasal hemianopia Right homonymous hemianopia Left homonymous hemianopia with macular sparing

Bitemporal hemianopia

At the olfactory bulbs, efferent fibers from elsewhere allow for potential inhibition of signal progression _____ _____-> Humans tend to habituate to persistent smells to the point where they are no longer perceived

Central Adaptation

Loss of Smell

Anosmia

5 Basic Tastes

Sweet Sour Bitter Salty Umami (savory, taste of protein)

does not contain any taste receptors and is a thread-like structure that helps provide friction to help move food

Filiform Papillae

3 types of papillae involved in taste

Fungiform Circumvallate Foliate

leaf-like papillae found on the sides of the rear of the tongue which contain approximately 100 taste buds.

Foliate Papillae

the largest of the papillae and found in the least numbers. A total of 7-12 are found in an inverted “V” shape at the back of the tongue. They contain approximately 250 taste buds.

Circumvallate aka Vallate papillae

mushroom-shaped papillae, most abundant at the tip and sides. They normally contain between 1-18 taste buds.

Fungiform papillae

: chemoreceptor cells responsible for sensing taste

Gustatory Cells

insulate the receptor cells from each other and from the epithelium of the tongue (most numerous)

Suppporting Cells

: stem cells that mature into new receptor cells to replace those that die

Basal Cells

branch innervates the anterior 2/3 of the tongue (Taste)

Chorda tympani

innervates taste buds in the palate

Greater superficial petrosal

innervates the posterior 2/3 of the tongue and pharynx (Taste)

Lingual Nerve

innervates taste buds in the epiglottis and esophagus

Superior Laryngeal Nerve

responsible for our perception of taste also receives information about the smell and texture of food (in addition

Primary Gustatory complex

contains endolymph filled cohlear duct which contains the organ of corti (which contains the auditory receptors: hair cells)  transmits auditory impulses via the cochlear division of the vestibulocochlear nerve (CN VIII)

Cochlea

consists of a pair of membranous sacs, the saccule and the utricle which provide the sensations of gravity and linear acceleration

Vestibule

enclose 3 slender semicircular ducts (lateral, posterior, anterior) that are stimulated by the rotation of the head

Semicircular Canals

CN VIII travels to the brainstem where it is relayed to the cerebellum via the

Vestibular Nuclei

Decusation of visual signals

left side of the brain receives information from the right visual field of each eye, and the right side of the brain receives information from the left visual field of each eye Matches to the side of needed motor control of the body

an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Pain

refers to a neural response only to traumatic (noxious) stimuli, producing pain But remember, not all pain comes from noxious stimuli

Nocioception

Perception of an ordinarily non-noxious stimulus as pain (Trigeminal Neuralgia)

Allodynia

Diminished response to noxious stimulus (pinprick, e.g.)

Hypoalgesia

Increased response to noxious stimulus

Hyperalgesia

Unpleasant or abnormal sensation with or without a stimulus

Dysesthesia

Increased response to mild stimulus (light touch, e.g.)

Hyperesthesia

Pain in the distribution of a nerve or a group of nerves

Neuralgia

Abnormal sensation perceived without an apparent stimulus

Parasthesia

Functional abnormality of one or more nerve roots with pain in the corresponding dermatomes

Radiculopathy

noxious stimulus which activates the pain pathway. Carried out by high-threshold receptors and conducted by smaller, lightly myelinated A𝛅 and unmyelinated C fibers

Protopathic

non-noxious stimulus such as light touch, pressure, proprioception, and temperature discrimination. Characterized by low-threshold receptors conducted by large, myelinated Aβ nerve fibers

Epicritic

experience occurs as a result of activation of peripheral nociceptors

Nocioceptive pain

occurs from a dysfunction or injury to the nervous system itself, with or without concurrent tissue damage

Neuropathic pain

Superficial – arising from skin, subcutaneous tissues, mucous membranes (sharp, pricking, throbbing, burning, well-localized) Deep – arising from muscles, tendons, joints, bones (dull, aching, less well-localized)

Somatic Pain

(abnormal function of an internal organ or its surrounding membrane- produced by ischemia, distension, stretching, traction, compression or inflammation of the viscera or linings of body cavities)

Visceral Pain

is a 3-neuron pathway that transmits noxious stimuli from the periphery to the brain to allow localization and perception of pain

Ascending Pathway

serves to modulate pain

Descending Pathway

respond primarily to intense mechanical and thermal stimuli that damage tissues (releasing prostaglandins)

High-Threshold Mechanoreceptors

most prevalent, respond to tissue damage from excessive pressure, temperature (> 42 degrees C & < 18 degrees C), and chemical stimuli (bradykinin, histamine, serotonin, and prostaglandins)

Polymodal Nocioceptors

respond to inflammation, ischemia

Silent Nocioceptors

fast, myelinated, localized sharp

A-Delta fibers

slow, unmyelinated, dull, poorly localized

C FIbers

Sensory afferent axons bring the signal via the dorsal root to the dorsal horn of the spinal cord (cell body lies in the dorsal root ganglion)

First-Order Neuron

Crosses the midline to the the contralateral spinothalamic tract (STT) in the anterolateral white matter of the spinal cord, ascending to the thalamus

Second-Order Neuron

Cortical representation is defined by relative density of cutaneous tactile receptors on that body part, defined as the

Homonculus

# Which pathway does this apply to? Endogenous opioid (enkephalin) are present within the brainstem and interact with opioid receptors

Descending Pathway

Neurogenic inflammation (“triple response” of flushing, local tissue edema, sensitization to noxious stimuli) is due to the release of Substance P from the primary afferent neuron Degranulates serotonin and histamine -> vasodilation, inflammation

Secondary Hyperalgesia

receive noxious and non-noxious input from A beta, A delta, and C-fibers and are the most prevalent cell type in the dorsal horn in lamina

Wide Dynamic Range (WDR) interneurons

activation of large afferent fibers subserving epicritic sensation inhibits WDR neurons and STT activity

Segmental inhibition

Perception of pain in a limb that has been removed Stabbing, throbbing, burning, or cramping pain (more intense in distal portion)

Phantom Limb Pain

occurs following an injury or illness which did not directly affect any nerves surrounding the affected area

CRPS Type I

occurs after a confirmed distinct nerve injury

CRPS Type II

Phase 0 Cardiac AP

Na Influx

Phase 1 Cardiac AP

Slow K efflux

Phase 2 Cardiac AP

Ca influx

Phase 3 Cardiac AP

K Efflux > Ca influx

Phase 4 Cardiac AP

Active Na, K pumping (membrane priming)

CO=

𝑠𝑡𝑟𝑜𝑘𝑒 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑆𝑉) × ℎ𝑒𝑎𝑟𝑡 𝑟𝑎𝑡𝑒 (𝐻𝑅)

70 ml, heart rate of 75 beats/minute

~5 liters/minute

difference between EDV and ESV

Stroke Volume

(𝑀𝐴𝑃 −𝐶𝑉𝑃)/𝐶𝑂

refers to the pressure in the arteries leading from the ventricles (aorta or pulmonary arteries) which must be overcome to eject blood

Afterload

Wall Tension=

(𝑇𝑟𝑎𝑛𝑠𝑚𝑢𝑟𝑎𝑙 𝑝𝑟𝑒𝑠𝑠𝑢𝑟𝑒 (𝑃) × 𝑅𝑎𝑑𝑖𝑢𝑠 (𝑟)) /(2 × 𝑤𝑎𝑙𝑙 𝑡ℎ𝑖𝑐𝑘𝑛𝑒𝑠𝑠 (ℎ))

A Wave- CVP

Atrial contraction

C Wave-CVP

tricuspid valve (TV) elevation during early ventricular Contraction

X-Descent CVP

downward displacement of the TV in systole and atrial relaXation

V-Wave CVP

Venous return against a closed TV

Y Descent CVP

descent is due to the tricuspid valve opening during diastole; atrial emptYing

Occlusion of A of A leads to

anterior cord ischemia-> loss of motor function, pain & temperature

Survey of Anatomy Final Review Flashcards

(324 cards)