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Flashcards in Week 1 Deck (135):

Neurons have various classifications, name them

1) A single axon emerges from the cell body, and on the other side of the cell body a single dendrite emerges

** These are found in the retina, olfactory epithelium, and vestibular and auditory systems

2) No dendrites present, instead there is a single axon that divides into two branches (aka signal goes out in both directions)

** These cells are found in the sensory ganglia of the cranial and spinal nerves

3) Many dendrites and a single long axon emerge from the cell body and examples include pyramidal cells of the ____ cortex and the purkinje cells of the ____ cortex

1) Bipolar neurons

2) Pseudounipolar neurons

3) Multipolar

Cerebral, Cerebellar


For pseudounipolar neurons, the peripheral branch carries info from the periphery and the central branch ends in the ___

Spinal cord


For the brain, unlike the spinal cord, the gray matter is on the ___ and the white is on the ____ (which is white because it is myelinated by ___ cells)

Name the layers of the cerebrum starting from the outermost layer

Name the layers of the cerebellum starting from the outermost layer

Outside, Inside, Schwann

Molecular layer, External Granular layer, External Pyramidal cell layer, Internal granular layer, Internal pyramidal cell layer, Mutliform cell layer, White matter

(MEgEp IM White)
^*** So everything is gray matter, except for the white matter

Molecular layer, Purkinje cell layer, Granular layer, White matter

(Miles Per Gallon, White)

^** So everything is gray matter, except for the white matter


Once the signal transfers down to the presynaptic cleft, an influx of ___ through voltage sensitive channels cause release of the neurotransmitter into the synaptic cleft, where it binds to a receptor of the postsynaptic membrane and stimulates or inhibits it



___ are a main component for producing the blood brain barrier and they prevent things from where they should not go

**They are present in the CNS and are branching cells with cytoplasmic processes ending in expansions called ___




Astrocytes cover ___ (dendrites and cell bodies), the inner surface of the ___, and every ___ of the CNS

In the CNS, capillaries are lined by continuous ___ cells linked by ___ (the main component of the blood-brain barrier) and 2 additional components to the endothelial cells that form the barrier include the ____ of the endothelial capillaries and the perivascular ___ end-feet

Neurons, pia matter, blood vessel

Endothelial, tight, basal lamina, astrocyte


In the PNS, axons are myelinated by ___ cells and in the CNS they are myelinated by ___

Each oligodendrocyte can myelinate ___ axons and each Schwann cell forms a myelin sheath around a ___ axon

Schwan, Oligodendrocytes

Multiple, single


In the ___, there are voltage gated Na+ channels located at the Node of Ranviers along the axon (and the Schwann cells interdigitate), where as in the ___ the are astrocyte end-feet located in the Node of Ranviers (and the Oligodendrocytes do not interdigitate)



Macrophages inside the CNS are called ____, which are phagocytic cells aka basically monocytes



The brain ventricles (like the 3rd ventricle) and central canal of the spinal cord are lined by simple cuboidal epithelium called ____, which has two types

____ have cilia and microvillia on the apical domain, along with lots of mitochondria and are attached by ___

____ have basal processes that extend through the astrocytic processes layer to form the end-feet on a blood vessel and also are attached via ___ junctions

**The reason why the tanycytes have an end foot that goes to the blood capillaries is because it is most responsible for producing ___, which helps supply the fluid needed for it

** Also as a side note, in the brainstem (aka the central canal) there are only ___ cells, no tanycytes


Ependymal cells, Desmosomes

Tanycytes, Tight junctions




CSF should ALWAYS circulate and be deep to the ___, which is called the ____ space between the arachnoid matter and pia matter

Arachnoid matter

Subarachnoid space


The ____ is where almost all the CSF is made and it is wrapped by ependyma around fenestrated blood vessels (in the lateral ventricles)

Choroid plexus


The reason why we have arachnoid mater is to line the inside of the ___ mater, and you DO NOT want a space between the arachnoid matter and dura mater (aka a ___ space) so the ____ barrier keeps the CSF off of the dura

Dura, subdural



Remember, we need the ependyma cells (aka the tanycytes) to be in contact with the capillaries in order to make CSF, however we don't want those mixing, so there is the ___ barrier (so it's taken care of by the cells that line the ____)

Blood-CSF barrier, Choroid plexus


The meninges consists of three membranes that envelop the brain and spinal cord

The ___ is a single layer of flat cells on the brain surface (aka in direct contact with neural tissue)

___ is tough and collagenous and surrounds the brain and spinal cord

Pia mater

Dura mater


The ___ villi poke up into the Dura mater, where they protrude into the lumen of ___ sinuses and the CSF permeates between or through the endothelial cells lining the venous sinus

**Blood does not flow from the venous sinus to the subarachnoid space (due to the blood CSF barrier) and a blockage of CSF movement results in the accumulation of CSF in the ventricles and around the brain called ___

**So in other words, arachnoid villi reabsorb CSF

Arachnoid, venous



"Neck lifts" for wattles can be performed as cosmetic surgery by tightening the _____ muscle via abducting the midline portions of it, which could have separated with age

It is innervated by the __ nerve


VII (Cervical branch of the facial nerve)


What are the three landmarks of the neck?

1) Upper neck
2) Lower neck
3) Root of the neck (muscular landmark)

1) Hyoid bone
2) Six cervical vertebra
3) Anterior scalene muscle


The SCM (Sternocleidomaatoid) is innervated by the ___ nerve, along with small cervical contributions from C2-C3

The trapezius is innervated by the ___ nerve, along with small cervical contributions from C3-C4

Spinal accessory nerve (XI)

Spinal accessory nerve (XI)


Name if the structure is located in the 1st, 2nd, or 3rd layer of the lateral neck?

1) Sternohyoid
2) EJV
3) Inferior Omohyoid m.
4) Platysma
5) Ansa Cervicalis
6) SCM
7) Superior Omohyoid m.
8) Superior and inferior roots
9) Spinal Accessory Nerve (XI)

1) 3
2) 1
3) 3
4) 1
5) 3
6) 2
7) 3
8) 3
9) 2


The boundaries for the posterior triangle of the neck (aka the lateral region) are the ___ and ___

You will find the EJV, Spinal accessory nerve (XI), superficial cervical plexus C1-C4 (aka sensory nerves to the skin), etc.

SCM and trapezius


The subclavian vein and phrenic nerve are ___ to the anterior scalene muscle and ___ to the clavicle

The ___ is pressed between the subclavian vein and anterior scalene muscle

The subclavian artery and brachial plexus are ___ to the anterior scalene muscle in the interscalene triangle

^** So if you were to put in a subclavian line and go to deep, you could injure the brachial plexus

Anterior, posterior

Phrenic nerve



******************When the second brachial cleft fails to obliterate, ____s can occur along the length of the ___ muscle*********************

Brachial Fistulas, SCM


1/6th of the time, the ___ artery comes off of the transverse cervical or some other artery instead of the thyrocervical trunk (from the subclavian artery)



During removal of the thyroid gland, as in a ____, it is important to know how the root of the neck is divided (such as medial vs lateral) etc so you don't cut anything you shouldn't like the ____ nerve or ___ artery

The Parathyroid glands get their blood supply from the ___ artery

^** If you lose blood supply to parathyroid glands your patient will end up with tetany


Recurrent laryngeal N, Inferior Thyroid A.

Inferior Thyroid A.


The trachea is ____ to the esophagus and in the longitudinal vertical groove between the two is the ___ nerve (aka posterior and lateral to the trachea) and it innervates all of the muscles of the larynx except the cricothyroid

Also the ___ crosses the anterior surface of tracheal rings 2-4

____ are an emergency airway that is cut through the tracheal rings 2-4, ___ is a similar procedure that cuts through the cricothyroid membrane, and ___ is a procedure used to open a long term airway through tracheal rings 2-4 (usually for a ventilator)

Anterior, recurrent laryngeal nerve

Thyroid Isthmus

Tracheotomy, Cricothyrotomy, Tracheostomy


The thoracic duct is located on the __ side and dumps into the ___

Left, Subclavian Vein


Name the nerve that innervates the structures located in the submandibular triangle

1) Anterior Digastric
2) Posterior Digastric
3) Stylohyoid
4) Mylohyoid
5) Geniohyoid
6) Hyoglossus

1) Mylohyoid N
2) VII
3) VII
4) Mylohyoid N (V3)
5) C1
6) XII


The major nerve that can be cut in the submandibular triangle area is the ___ nerve

Marginal mandibular branch of facial nerve (VII)


The submandibular salivary gland is drained by the ____ duct and this empties into the floor of the mouth at the apex of the ____, which is adjacent to the lingual frenulum.

The ___ nerve spirals around the duct in a superior-lateral to inferior-medial direction

Submandibular duct (aka Wharton's duct), Sublingual caruncle

Lingual nerve


*********************Submandibular gland is innervated by both para and sympathetic fibers

Preganglionic parasympathetic fibers originate in the _____ and exit the brainstem with the ____ nerve, then they travel thorough the ____ nerve and join with the ___ nerve, before terminating in the submandibular ganglion.

^Postganglionic fibers from the submandibular ganglion distribute as numerous short branches to the parenchyma of the gland (aka innervate the submandibular and sublingual salivary glands)

Postganglionic sympathetic fibers originate from the ____ ganglion and reach the gland by going in the ___ and ____ plexuses (often get there off the surface of their corresponding artery)

^** (So in other words, the facial plexus of the facial artery distributes postganglionic sympathetic fibers to the submandibular and sublingual salivary glands) ***********************

Superior salivatory nucleus, facial nerve, chorda tympani, lingual

Superior cervical, external carotid and facial


Proximally the lingual nerve contains ___ fibers that distribute to the anterior 2/3 of the tongue

Superiorly in the infratemporal fossa, a branch of the facial nerve called the ____ merges with the lingual nerve and adds ____ fibers the supplies taste buds on the anterior 2/3 of the tongue and ____ fibers that terminate in the submandibular ganglion (preganglionic)

GSA (sensory)

Chora tympani, SVA (taste), GVE parasympathetic


The ___ nerve supplies GSE fibers to all of the intrinsic muscles of the tongue and has a small vena commitans that accompanies the nerve

The "strap" muscles (aka the infrahyoid muscles which include the sternohyoid, omohyoid, sternothyroid, and thyrohyoid muscles) are innervated by the first ___ cervical nerves via the ___ root of the ___ nerve

Hypoglossal (XII)

3 (C1-C3), Superior, Ansa Cervicalis


The _____ of the lung is a portion of the thoracic cavity that extends into the base (root) of the neck between the scalenes and longus colli muscles above the medial third of the clavicle

A penetrating wound to the base of the neck may puncture the pleural cavity and/or lung and collapse the lung resulting in a ___

Cupula of pleura



For the thyroid gland, there are two lobes adjacent to the trachea and connected by the ____, which overlies the tracheal rings ___-___

Also the anterior arch for the cricoid cartilage is at the level of the ___ cervical vertebra

Isthmus, 2-4



The Superior and Middle thyroid veins drain into the ___ and the Inferior thyroid vein drains into the ____

The ___ thyroid artery arises from the common or external carotid arteries, the ___ thyroid artery arises from the thyrocervical trunk, and the ___ thyroid artery can arise from the brachiocephalic, aorta, or let common caroitd

IJV, Brachiocephalic vein

Superior, Inferior, Lowest


*************The thyroid glands drain into lymph nodes adjacent to it including pretracheal and paratracheal nodes, which then eventually all dumps into ___ lymph nodes, which are scattered along the course of the ___ vein********************

***^This is why in radical neck dissections the object is to remove the IJV***

Deep cervical, Internal Jugular Vein


There are two parts to a neuron, the cell body and its projection (dendrites or axons)

Nissl bodies are NOT found in the ____, which means it is the start of the axon

^** So there are nissl bodies in the cell body and/or dendrites

Axon Hillock


For ____ receptors, when the NT binds a conformation change occurs that opens up the channel and allows ions for which the receptor is selective to flow through

^** Composed of subunits coded for by different genes

For ___ receptors, the NT binds and causes a secondary messenger system to open up the channel for the ions to flow across

^** Composed of a single, large protein (one gene codes entire receptor)

Ionotropic (Ligand gated ion channels)

Metabotropic (aka serpentine receptors)
^** Associated with G-proteins (Gs-Stimulatory PKA; Gi-Inhibitory PKA; Gq-IP3/DAG) and Jak-Stat (growth factors)

^** When you hear Gq is activated, immediately jump to "release of intracellular calcium stores"


___ axonal transport carries neurotransmitter vesicles from the cell body to the synapse and ____ axonal transport carries cytostructural components (like mitochondria) or ion channels/receptors

Fast, Slow


There are 5 important monoamines that we discuss, three are catecholamines (Dopamine, Norepinephrine, and Epinephrine) and the other two are Serotonin and Histamine.

Name where each is produced

1) Dopamine (name all 4 Pathways)
2) Norepinephrine
3) Epinephrine
4) Serotonin
5) Histamine

1) Substantia nigra, Mesolimbic, Mesocortical, and Tuberinfundibular (**aka the basal ganglia)
2) Locus Ceruleus
3) Brain stem to Adrenal Medulla
4) Midline raphe nuclei in brainstem
5) Tuberomammillary body (nucleus) in the hypothalamus
^** Along with its presence in mast cells


All three catecholamines are created by modifying the amino acid ___

Tyrosine is converted to ___ via the enzyme ___, next it is converted to ___ and then ____ via the enzyme dopamine beta-hydroxylase (this conversion step takes place inside the vesicles).

Then NE leaves the vesicles and the enzyme ___ converts it to its final form of ____


DOPA, Tyrosine-hydroxylase, Dopamine, Norepinephrine

PNMT (Phenylethanolamine-N-methyl-transferase), Epinephrine


Name the dopaminergic pathway

1) Runs from the ventral tegmental area to the nucleus accumbens and associated with the pleasure/reward pathways in the brain
^** Alterations associated with addiction

2) Runs from the hypothalamus to the anterior pituitary and release of dopamine from here suppresses prolactins release from the anterior pituitary

3) Runs from the ventral tegmental area to the cortex (frontal) and is associated with higher levels of consciousness
^** Alterations associated with changes in cognition/consciousness and some links to schizophrenia

4) Involved in motor control and damage can result in Parkinson's disease
^**D1 receptor activation is permissive to voluntary motion and D2 receptor activation inhibits motion

1) Mesolimbic

2) Tuberinfundibular

3) Mesocortical

4) Substantia nigra


___ is found in the adrenal medulla and moves both dopamine into the vesicles for its conversion to NE and Epi that was created in the cytoplasm back into the vesicles

___ is the neuronal form of the VMATs and moves all monoamines into vesicles for NE synthesis or storage prior to release




NE and Epi bind to catecholamine receptors that mediate secondary messenger systems (Gq - Alpha1, Gi- Alpha2, and Gs-Beta adrenergic)

Dopamine binds to its own set of receptors and there are 5 of them. D1 and D5 are classified as D1-like and activate G__-proteins. D2, D3, and D4 are classified as D2-like and activate G__-proteins

Gs, Gi


Catecholamines are removed from the synaptic cleft via a high affinity uptake protein back into the cell OR enzymatic destruction via ___ or ___s

Serotonin is removed from the synaptic cleft via ___

Histamine is removed from the synaptic cleft via



Diamine oxidase


Serotonin is derived from the amino acid ___ and the enzyme ___ converts the tryptophan into 5-HTP, which is then converted to serotonin (5-HT) via the enzyme 5-HTP decarboxylase

There are seven 5-HT receptors and the __ receptor is the only ionotropic one (opens a sodium channel) and the others are all metabotropic and associate with G-proteins (5-HT1 = Gi and 5-HT2 = Gq)

Tryptophan, tryptophan hydroxylase

5-HT3 (involved in vomiting)


Histamine is derived from the amino acid ____

There are 3 types of histamine receptors and the H__ receptor is located presynaptically and when activated it decreases the release of histamine from the presynaptic terminal

H1 and H2 mediate the neuronal effects of histamine

**Histamine is most associated with wakefulness




The ___ and ___ has a very large collection of neurons that make ACh

There are also a number of cholinergic axons in the ___

Pons, midbrain



ACh is crucial in producing ___, but NOT awareness (aka brain arousal mechanisms) and it also controls ___ motion and the initiation of ___ sleep

^** AKA its function is wakefulness

Consciousness, voluntary, REM


ACh is transported into the vesicles via ___ and in the synpase ACh is broken down via ___



There are 5 mAChRs (Muscarinic ACh receptors) that ACh binds to and these are ___tropic receptors

M1 is a ___ form aka found in the CNS and is coupled through the G__ protein aka associated with increased IP3/DAG to increase Ca2+ concentrations

M2 is a ___ form and coupled through the G__ protein aka decreases cAMP to increase K+ efflux

M3 is a smooth muscle of bronchi and vasculature (endothelial cells of vasculature aka NO) and is coupled through the __ protein

M4 is found on glands and is coupled through G__ and M5 is coupled through G___


Neuronal, Gq

Cardiac, Gi


Gi, Gq


ACh can also bind to nicotinic receptors at the NMJ, autonomic ganglia and other parts of the CNS

There are 5 subunits and depending on which subunit determines how much ___ (mainly) and Ca2+ can enter

These receptors are ____tropic

Na+, Ionotropic


Name if the amino acid is excitatory or inhibitory

1) Glutamate
3) Aspartate
4) Taurine
5) Glycine

1) Excitatory
2) Inhibitory
3) Excitatory
4) Excitatory
5) Inhibitory


For the two inhibitory NTs

___ is located in the cerebellum, cortex, and retina aka the HIGHER CNS
^** It is critical in producing consciousness/awareness and control of voluntary motion

___ is located in the LOWER CNS aka mostly in the spinal cord
^** It mediates many spinal inhibitions (aka reflexes and their modification)




GABA is derived from ___ and needs the enzyme ___ to make it

**There is a disease called the Stiff Man syndrome, where an autoimmune response occurs to the GAD enzyme and the neurons that normally inhibit motion can't make the GABA so they get severe muscle spasms (a tetanus type)

It's action is limited via ___ into the cell or degradation via ___

Glutamate, GAD (glutamate decarboxylase)

Reuptake, GABA-transaminase


There are two types of GABA receptors,

GABAa is an ____tropic receptor with 5 subunits and allows ___ into the cell (this hyper-polarizes the membrane potential to inhibit excitation)

These GABA receptors have sites for benzodiazepines and this increases the flow of Cl- into the cells and therefore increase inhibition (aka relaxes you)

GABAb is a ___tropic receptor and is a heterodimeric G protein (aka contains Gq AND Gi), which end result is hyperpolarization due to increase K+ efflux and decreased Ca2+ influx





A large number of ___ receptors is the location that general anesthetics is postulated to produce their actions



The glycine receptor is an ___tropic receptor that allows ___ to flow into the cell (hyper-polarize) and can be blocked by strychnine

Ionotropic, Cl-


The subclavian artery is divided into 3 parts via the ___ muscle

Name what part the artery comes off

1) Costocervical trunk (Deep cervical and Superior intercostal artery)
2) Vertebral artery
3) Dorsal scapular A
4) Internal thoracic artery
5) Thyrocervical trunk (Suprascapular, Transverse cervical, and Inferior thyroid arteries)

Anterior scalene

1) Part 2
2) Part 1
3) Part 3
4) Part 1
5) Part 1


Subclavian steal syndrome is when obstruction of the subclavian artery, proximal to the ___ artery occurs

Since no blood is getting into the subclavian artery, blood gets shunt from the ____ circulation into the distal subclavian artery and therefore you loose blood going to the brain (since the pathway of blood switches) and this results in **ischemic necrosis of the spinal cord**

^ Symptoms include dizziness, collapse, etc.

*****************So in other words, changes in cerebral blood are autoregulated to a degree, but significant shunting of blood from one region to another (such as in anterior to posterior shunting of the blood) can result in hyperperfusion and therefore ___***************

** Also it is most common on the right side

The circle of Willis is asymmetrical and incomplete



Cerebral edema

^** Hyperperfusion and cerebral edema, remember those two words together


The vertebral artery supplies ___% of blood to the circle of Willis and terminates as the __ artery. This is considered the ___ circulation to the brainstem, cerebellum, and occipital lobes

The internal carotid arteries supply __% of blood to the circle of Willis and is considered the ___ circulation to the cerebral hemispheres and upper brainstem

20, Basilar, posterior

80, Anterior


Of the carotid arteries, the ___ carotid artery does not have any branches in the neck, instead the first branch is the ophthalmic artery, which branches at the level of the carotid siphon

The ___ artery is a good artery that surgeons use to determine that they are looking at the external carotid artery


Superior thyroid A.


The ____ artery is used in neurosurgical procedures to bypass obstructions of the middle cerebral artery by anastomosing that artery with a branch of the MCA to supply blood to the MCA

^** Its pulse can be palpated anterior to the auricle

Superficial temporal


The occipital, lingual, and facial arteries are branching off the external carotid at the level of what landmark structure?

Cornu of Hyoid bone


The ___ artery supplies the infratemporal fossa contents

This artery also supplies the posterior 2/3rds of the ___ cavity and the roof of your mouth (hard palate)

Maxillary A.



The ___ vein drains the brain and some of the face and neck

There is a ____ bulb that does not have a valve and an ___ bulb that has a valve... ***So the importance of this is if you are looking at an ultrasound and see a valve, it is the IJV

^** It empties into the subclavian vein


Superior, Inferior


There are three groups of cervical lymph nodes (aka in the head and neck), name them

1) Around the junction between your skull and neck (aka around the base of the head)
^Surgically they target blocks of fat or veins to get rid of these lymph nodes
2) Adjacent to the EJV or AJV
3) Both of these groups ^ drain into the final group of lymph nodes called the ___
^** 2 groups of deep cervical lymph nodes include the jugulo-digastric and jugulo-omohyoid nodes

1) Pericervical collar lymph nodes
2) Superficial cervical lymph nodes
3) Deep cervical lymph nodes


The thoracic duct is located on the ____ side of the root of the neck and receives lymph from the left side of the head and all the body except the right upper extremity and head (which is drained by the right lymphatic duct)

If it is cut during an operation, you will get major lymphedema



What are the 4 superficial cervical nerves and their spinal cord segment levels

Lesser occipital (C2-C3)
Greater Auricular (C2-C3)
Transverse cervical (C2-C3)
Supraclavicular (C3-C4)


The ___ nerve innervates the strap muscles (aka infrahyoid muscles) and the superior root gets innervation from C__-C__ and the inferior from C__-C___ and it has a close relationship with the __ nerve along with the ___ vein

Ansa Cervicalis, C1-C2, C2-C3, hypoglossal (XII), IJV


The ___ is an important landmark where the hypoglossal nerve, nerve to thyrohyoid, and superior root of ansa cervicalis is located

Tip of hyoid bone


The nerve that runs along the anterior surface of the Anterior Scalene muscle is the ___ nerve, which innervates the diaphragm and gets innervation from C3-C5

^** It is crossed anteriorly by the transverse cervical and suprascapular arteries and goes posterior to the subclavian artery

Unilateral paralysis of the phrenic nerve causes ____ symptoms, but bilateral causes exertional dyspnea, heaving (aka hyperactivity of the accessory respiratory muscles), and difficulty coughing and sneezing

**Phrenic neuralgia is rare, but can result from various causes and is often characterized by pain radiation down the left side and from the ribs to the root of the neck




Spasms of the ___ muscle can compress the brachial plexus since it is located posterior to the muscle ** also called anterior scalene syndrome

Erb-Duchenne paralysis effects the ___ portion of the brachial plexus and Klumpke paralyses affects the ___ portion of the brachial plexus

Anterior scalene muscle

Upper, Lower


There are 4 functional components of spinal nerves, name them based on the description

1) Convey pain (sharp, highly localized sensations), temperature, tactile, pressure, and proprioception
2) Convey visceral pain (dull, aching, burning, poorly localized sensations) aka stretch or ischemia, and reflexes
3) Innervate muscles of myotomic origin (including neck muscles and 2 muscles in the head which are the tongue and extraocular muscles)
4) Associated with sympathetic and parasympathetic divisions of the ANS
^**There are no preganglionic parasympathetic fibers in any of the spinal nerves

**There are also 3 special components, which include SVAs, SVEs, and SSAs (description provided in notes)

1) GSA
2) GVA
3) GSE
4) GVE


GSAs innervate structures of ____ origin (including skin, anterior 1/3 of nasal cavity, and anterior 2/3 of oral cavities) and GVAs innervate structures of ___ origin (including posterior 1/3 of tongue to the mid portion of the transverse colon aka lungs, heart, everything)

So once again, ___s are dull, aching, burning, or poorly localized sensations and ___s are sharp, highly localized sensations

Ectodermal, endodermal



The trigeminal sensory nuclei has ONLY ___ fibers from the cranial nerves that are coming into the brainstem.

It is the sensory nucleus for all sensations from the ___

There are three nuclei within the trigeminal sensory nucleus and include the ____ nucleus of V which receives proprioception information from the facial muscles, the ____ nucleus of V which recieves precise tactile discrimination information from the face, and the ____ nucleus of V which recieves crude tactile, pain, and temperature informations from the face



Mesencephalic, Main sensory, Descending


The nucleus tractus solitarius (NTS) aka the solitary nucleus has __ and ___ fibers and is the sensory nucleus for ******general sensation from the posterior 1/3 of the tongue to the mid-portion of the transverse colon******

*********************** THIS WILL BE ON THE TEST*****************

GVA and SVA (taste)


So once again, name the part of the brainstem associated with the cranial nerves

1) Sensory nucleus for general sensations from the posterior 1/3 of tongue to mid portion of transverse colon

2) Sensory nucleus for all sensations from the face

Nucleus Tractus Solitarius

Trigeminal sensory nuclei


What nucleus does the vagus nerve go to?

Solitary nucleus


The GSEs that control the extraocular muscles via extraocular nuclei are of ___ origin and include the Oculomotor nucleus, Trochlear nucleus (IV), Abducens nucleus (VI), and Hypoglossal nucleus (XII)

^** Innervations skipped over, not sure if I need to know them? It seems like we will come back to this stuff later in the course**********



There are 4 GVE parasympathetic columns

**#1 is the most important
1) The ____ nucleus (X) sends preganglionic fibers to the scattered ganglion in the larynx, pharynx, thorax, and abdomen and these ganglia send postganglionic fibers to various glands and smooth muscles in the region

2) The ____ nucleus (IX) sends preganglionic fibers to the otic ganglion and these ganglion send postganglionic fibers to the parotic and salivary glands

3) The ___ nucleus (VII) sends preganglionic fibers to the sphenopalatine and submandibular ganglion and the sphenopalatine ganglion send postganglionic fibers to the lacrimal gland and oral cavities and the submandibular ganglion send postganglionic fibers to the submandibular and sublingual salivary glands

4) The ___ nucleus sends preganglionic fibers to the ciliary ganglion via branches of the oculomotor nerve and the ciliary ganglion send postganglionic fibers to the ciliary muscles of the lends and the pupillary constrictor muscles

1) Dorsal motor nucleus

2) Inferior salivatory

3) Superior Salivatory

4) Edinger-Westphal


____ fibers innervate muscles derived from mesenchyme of the brachial arches

Name the nucleus that innervates the muscles

1) Muscles of mastication (tensory palati, tensory tympani, mylohyoid, anterior digastric)
2) Muscles of facial expression (stylohyoid, stapedius, posterior digastric)
3) Stylopharyngeus muscle
4) Pharyngeal and laryngeal muscles
5) SCM and trapezius muscles

The nucleus ambiguous includes the IX, X, and XI nucleuses


1) Trigeminal (V)
2) Facial (VII)
3) Glossopharyngeal (IX)
4) Vagus (X)
5) Spinal accessory (XI)


Name the nerves from I to XII

Mnemonic: Oh, Oh, Oh, To, Touch, And, Feel, A, Girls, Vagina, Such, Heaven

I - Olfactory
II - Optic
III - Occulomotor
IV - Trochlear
V - Trigeminal
VI - Abducen
VII - Facial
VIII - Vestibulo-cochlear
IX - Glossopharyngeal
X - Vagus
XI - Spinal accessory
XII - Hypoglossal


Which nerves exit the jugular foramen at the base of the skull (between the internal jugular vein and internal carotid artery)?

___ syndrome is when there is a fracture to the basilar skull and can damage the jugular foramen, which results in ipsilateral IX, X and XI paralysis

Glossopharyngeal (IX), Vagus (X), and Spinal accessory (XI)

Vernet's syndrome



Name the nerve that is damaged based on the clinical presentation

1) Loss of gag reflex (afferent component)
2)***** Dysphonia (hoarseness) and nasal speech, dysphagia (difficulty swallowing) and dyspnea (difficulty breathing)****
3) Ipsilateral inability to shrug the shoulder and flex and rotate head (due to SCM and traps being paralyzed)
4) Tongue deviates towards the affected side
5) Loss of sensation in the pharynx, tonsils, fauces, and posterior 1/3 of tongue
6) Loss of gag or laryngeal cough reflex
7) Atrophy and fasciculations

1) Glossopharyngeal (IX)
2) Vagus (X)
3) Spinal accessory (XI)
4) Hypoglossal (XII)
5) Glossopharyngeal (IX)
6) Vagus (X)
7) Hypoglossal (XII)


The ____ include endorphins, enkephalins, dynorphins, and nociceptin and are made in the cell bodies of the basal ganglia, hypothalamus, and parabrachial nuclei and raphe nuclei ^** aka hypothalamus and medulla (low in brain)

Their general functions are modification of nociceptive inputs (neurophysiology of pain) and modification of mood/affect



There are 4 precursor molecules for opioids including

1) The proenkephalins, which include __-enkephalin and ___-enkephalin

2) The ____, which gives rise to ACTH, MSH, and most importantly for this section, Beta-endorphins

3) ____, which gives rise to three molecules of ___-enkephalin and 2 different forms of ____ (1-8 and 1-17)

4) Orphanin FQ aka ____

Since opioids are peptides, they are coded and created via DNA/RNA/Protein synthetic machinery

1) Met and leu


3) Prodynorphin, leu-, dynorphins

4) Nociceptin


The opioid receptors are ____tropic and one group is called ___ receptors and the other are ___ receptors or ___ receptors

When Mu receptors are activated, 4 main things happen...these receptors are strongly associated with ____ (aka pain reduction), ____ depression, __phoria, sedation, and ___ (can be used in the gut to control secretions)

When Kappa receptors are activated, 2 things happen, these are strongly associated with ___ (aka pain reduction), diuresis, miosis (pupil dilation) and _____phoria

Delta receptor activation is mostly associated with ___ (**So it has the least side effects)

** Also all of these receptors inhibit adenylyl cyclase

Metabotropic, Mu, kappa, delta

Analgesia, respiratory, euphoria, constipation

Analgesia, dysphoria



So just a quick recap, name which NT is found in the location

1) Pons/midbrain
2) Higher CNS
3) Spinal cord
4) Hypothalamus/medulla

2) Gaba
3) glycine
4) Opioids


There are two types of Endocannabinoids,

1) ___ which is made from arachidonic acid and ethanolamine

2) ____ which is arachidonic acid esterfied into the middle number 2 position of glycerol

*** So realize both of these are derived from arachidonic acid***

1) Anadamide

2) 2-Arachidonylglycerol (2-AG)


The location and functions of endocannabinoids vary greatly, however in the spinal cord their main action is to modulate ___, and in the ___ they have an affect/motor function

Nociception, Basal ganglia


There are two types of endocannabinoid receptors

CB-1 is a Gi protein coupled receptor found on axons and presynaptic terminals of EAA and GABA synapses and ____ NT release when activated

^**AKA it is most involved in Neural processes

CB-2 is a receptor found in the brain (microglia, not neurons) and is a strong mediated in the immune system and gut (has anti-inflammatory actions)

^** AKA most involved in the immune system

Also the ___ drug activates in part the endocannabinoid system




The excitatory amino acids include

1) Glutamate, which comes from ____

2) Aspartate, which comes from ____ and documented as the NT in visual cortex and pyramidal cells




EAAs can act on ionotropic and metabotropic receptors

The NMDA is an ___tropic receptor and when activated, it allows a __ influx (which produces a depolarization)

The EPSP is ___ than you would expect and the duration is prolonged because the receptor has multiple modulatory sites and ____ is a required co-agonist (which is inhibitory), along with ___, which is another molecule that binds inside the channel to block it and only depolarization can cause the magnesium to leave (since the cell becomes more positive and like charges repel each other)

^** Note glycine on its own cannot open the channel

There is also another modulator site even deeper inside the channel than than for Mg2+ and this is the ___ binding site that also blocks the channel

^** PCP acts as an irreversible blockade of the receptor when bound

So the longer latency (aka slower EPSP) is due to the time spent removing the ____, and the prolonged duration is due to the ____ influx

Ionotropic, Ca2+

Slower, glycine, Mg2+


Mg2+, Ca2+


Non-NMDA receptors, which are also activated via EAAs, are ___tropic and like the NMDA receptors, they are almost exclusively post-synaptic

When activated, they allow ____ influx and a small amount of ___ influx as well (but mainly Na+)

There are two types of these...
1) The AMPA receptor, which when AMPA and the EAA bind the receptor becomes activated and allows ___ to enter the cell and depolarize it

^** There is also a ____ site on the AMPA receptor that inhibits a response to the NT (less excitation)... ****** So realize you can get sedation via making lots of inhibition aka through GABA, or make less excitation aka through the AMPA Non-NMDA****

2) THe Kainate receptor, which when Kainate and the EAA bind to the receptor becomes activated and allows ____ and a little bit of ____ to flow into the cell

**Activation leads to the typical EPSP


Na+, Ca2+



Na+, Ca2+


It is important to note that both NMDA and Non-NMDA co-localize at the same synapse. **You can NOT have only NMDA receptors (must have both, but you could have a synapse with only Non-NMDAs)**

This is because when the NT is released from the presynaptic terminal, it wants to depolarize the cell and send on the next signal. Since you would have both NMDA and Non-NMDAs, both bind the NT but the NMDA can't allow any ions to pass through yet because it is blocked by ___.... However, the Non-NMDA will bind the EAA and allow mainly Na+ to flow in, which allows the cell to depolarize, and therefore nock of the Mg2+ from the NMDA receptor and now the NMDA receptor can allow Ca2+ to flow in, further depolarizing the cell



EAAs also have metabotropic receptors both pre and post synaptically

The ____-synaptic ones normally control NT relsease



Functional wise, the EAAs are the major ___ system in the CNS

Non-NMDA receptors are primary afferents and premotor (upper motor neruons) and the NMDAs have roles in long-term changes in synaptic strength, learning, and memory



To get rid of the EAAs, the NTs in the synaptic cleft are taken up by both the ___ and ___ cells and is secondary active transport, which is dependent on ___

If the EAA is taken up into the glia cell, it is converted to ___ and released into the ECF

^** Whereas if it is taken up into a neuron the EAA basically gets repackaged into a vesicle or it will take up the glutamine from the glial cells and convert it back into glutamate

Neurons and glia, Na+



Creating of NO is linked to the ___ receptors via the influx of Ca2+ into some of the neurons, which binds to ____ that activates a ____ and NOS catalyzes the reaction with arginine to create NO

The NO can dissolve through the lipid membrane and go wherever it wants

The functions of NO play in role in ___ creation, and cardiovascular and respiratory control

**NO can be toxic in high concentrations because it produces a lot of free radicals**

NMDA, Calcineurin, NOS (nitric oxide synthase)



Excitotoxicity can be involved in cerebral ischemia/strokes, hypoxia or anoxia (no oxygen), mechanical trauma to the CNS, or hypoglycemia (like that found in Type 1 diabetics), along with epilepsy

When an ischemic event occurs (anoxic core), the area directly effected will lose oxygen and the cells will be unable to meet metabolic needs and depolarize because ___ levels drops to 0 and therefore the Na/K ATPase activity also stops (the pump was pumping out 3 Na for every 2 K, so now that it stops there is an increased + charge inside the cell and depolarization occurs)

Now the cells that are hypoxic and depolarized fire constant APs (since depolarization takes no energy) and as it does so, it releases NTs from its presynaptic terminal that can be some distance away from the damaged part of the brain



The EAA levels during excitotoxicity in the synaptic cleft are increased due to increased release of them (via constant APs being fired) and the fact that EAA re-uptake is ___ dependent but since the Na/K ATPase pump isn't working, re-uptake is also defective

The end result is extensive activation of the ___ receptor which allows for a huge amount of Ca2+ influx


NMDA (some Nono-NMDA, but NMDA is most important)



In excitotoxicity, the end result is increased Ca2+ influx into the cells

This is problematic because various increases in activation occur, including

1) Increased activation of _____, which is an enzyme that cleaves lipids out of the membrane (damage to the membrane), specifically ____ from the membrane and cleaves

^** Along with membrane damage, the arachodonic acid that gets cleaved can act on the ryanodine receptors of the ER to increase FURTHER release of ___ from intracellular stores (including the ER and mitochondria)

The release of Ca2+ from the ER triggers the unfolded protein response, which stops the production of ___

Phospholipase A2, arachidonate (aka arachodonic acid)




In excitotoxicity, the end result is increased Ca2+ influx into the cells

This is problematic because various increases in activation occur, including

2) Activation of the protease ___ that chews on proteins aka proteolysis, which can destroy various proteins like spectrin (needed for structural support of the cell) or elF4G (needed for protein synthesis)

**So in relation to #1 and #2, you can't make new proteins due to the unfolded protein response, and on top of that you are destroying existing proteins... So this is damaging those neurons that may not have been hypoxic enough to die**



In excitotoxicity, the end result is increased Ca2+ influx into the cells

This is problematic because various increases in activation occur, including

3) Activation of a phosphatase called ___, which increases ___ and this causes toxicity

Calcineurin, NOS


In excitotoxicity, the end result is increased Ca2+ influx into the cells

This is problematic because various increases in activation occur, including

4) #1, #2, and #3 come together to cause ____ of the cells via the release of ____ and ___ from the mitochondria, which activates ___ and these act as proteolytic enzymes and apoptosis


Cytochrome C and Caspase 9, Caspase 3


A reperfusion injury occurs when you provide oxygen to cells that had been hypoxic and these cells dont use the O2 as well as they should and this casues much of the O2 to end up as ___ somewhere else

This is problematic as well because even though there is now an adequate supply of O2, most of the mitochondria can't make ATP anymore since they dumped all of their contents needed for the process, and the neurons that CAN make ATP will make it, but the ATP won't necessarily be used the way you would want it to be since the enzymes active in the cell aren't the normal set (they are the apopotic set)

Therefore when ATP is released, a lot of ___ phosphorylate things that are not suppose to be phosphorylated (since these kinases use ATP and turn it into ADP and PO4)

Free radicals (peroxides)



One protein that becomes phosphorylated via the kinases during a reperfusion injury is the ___ kinase, which leads to a decreased in protein synthesis and activation of ____, which increases apoptosis signaling

NO can also lead to edema by damaging capillary endothelial cells

ElF2-alpha, Caspase 3


Preganglionic sympathetic neurons are located in the intermediolateral cell column of the ____ segments of the spinal cord (T1-L2)

For the head and neck region, the postganglionic sympathetic neurons are located in the ____ ganglion

****The ___ cervical sympathetic ganglion is the major outflow to the head******

The _____ has descending fibers that eventually terminates on preganglionic sympathetic neurons in the intermediolateral cell column of the spinal cord (T1-T2 mainly)


Cervical sympathetic ganglion




The preganglionic sympathetic fibers that go specifically to the head and neck originate in preganglionic sympathetic cell bodies located in the intermediolateral cell column of T__-T__ via info from the hypothalamus



The ___ ganglion sends psotganglionic fibers to the sixth cervical nerve AND perivascular plexus to the anterior surface of the vertebral artery

Vertebral ganglion


The internal carotid nerve leaves the ___ cervical ganglion and forms the internal carotid plexus in the tunica adventitia of the artery

It follows the artery into the skull and branches at the level of the carotid siphion into 4 parts, name them

1) Postganglionic fibers that continue to course along the tunica adventitia of the cerebral blood vessels and are named according to their corresponding arteries

2) *****Postganglionic fibers that innervate the dilator pupillae and tarsal msucles******

3) Postganglionic fibers distribute to the palate, nasal cavity, pharynx, orbit and lacrimal gland

4) Postganglionic fibers to the parotid gland


1) Perivascular plexus
2) Sympathetic branch to the ciliary ganglion
3) Deep petrosal nerve
4) Carotico-tympanic nerve


The ____ ganglion is a large ganglion formed by a fusion of the inferior cervical and the first thoracic ganglia.

It sends fibers to the lower cervical and first thoracic nerves, heart, and vertebral and subclavian plexuses. It also receives a cord from the vertebral ganglion called the ____

Stellate, Ansa subclavia


*************Spinal cord damage above the level of T1 can disrupt the fibers from the hypothalamus descending inside the brainstem to the upper cervical/ upper thoracic cord (around T1) and this can result in ___ syndrome*********

^**This can also happen from a thyroidectomy where they go to deep and destroy the cervical sympathetic trunk

Characteristics include a dry flushed face (anhidrosis and blusing), pupillary constriction, and slight ___ (aka droopy eyelid)

Horner's, Ptosis


Preganglionic parasympathetic neurons are located in the ____ nuclei of the brainstem and spinal cord and in our case for head and neck, it's the brainstem

These fibers run with cranial nerves 3, 7, 9, or 10 and synapse on postganglionic neurons in the parasympathetic ganglion, which then distribute the postganglionic fibers to nearby glands or smooth muscle



The ____ nucleus sends preganglionic parasympathetic fibers to the ciliary ganglion via the ____ nerve. Then the postganglionic parasympathetic fibers go to the ___ muscle of the ____ and the ____ muscle of the ___

Edinger-Westphal nucleus, ciliary muscle of the lens, sphincter pupillae muscle of the iris


The ____ nucleus sends preganglionic parasympathetic fibers to the sphenopalatine and submandibular ganglion via the ____ nerve and then a branch called the ____ nerve which turns into the Vidian nerve once the deep petrosal n meets up with it

Then the postganglionic parasympathetic fibers from the sphenopalatine ganglion innervate the __ gland, nasal cavity, nasopharynx, palate, and orbit

The postganglionic parasympathetic fibers from the submandibular ganglion innervate the ___ and ____ salivary glands

Postganglionic sympathetic fibers coming from the SCG (superior cervical ganglion) through the internal carotid nerve and plexus, and then through the ____ nerve eventually joins with the greater petrosal nerve and then then vidian nerve to innervate the lacrimal gland

Superior Salivatory nucleus, Facial nerve (VII), greater petrosal nerve


Submandibular and sublingual

Deep petrosal nerve


The ____ nucleus sends preganglionic parasympathetic fibers to the Otic ganglion via the ____ nerve. The branch of the IX never that sends the preganglionic parasympathetic fibers to the otic ganglion is the ___ nerve

Then the postganglionic parasympathetic fibers go to the ___ gland

Postganglionic sympathetic neurons to the parotid gland are located in the ___ cervical ganglion and run as the caroticotympanic nerve and course through the lesser petrosal nerve to the partoid gland

Inferior salivatory nucleus, glossopharyngeal (IX), lesser petrosal nerve




**************The _____ nucleus of ___ sends long, pregaglionic parasympathetic fibers to the scattered ganglia in the pharynx, larynx, thorax, and abdomen via the ___ nerve, and the postabglionic parasynpathetic fibers are distributed to the adjacent glands of the pharynx, larynx, thorax and abdomen***************

Dorsal Motor nucleus of X, Vagus (X)


Superiorly in the infratemporal fossa, a branch of the facial nerve called the ____ merges with the lingual nerve and sends preganglionic parasympathetic fibers that terminate in the submandibular ganglion, which then send postganglionic parasympathetic fibers to the submandibular and sublingual salivary glands

** Note there are also postganglionic sympathetic fibers from the facial plexus on the facial artery at the intermediolateral cell column

Chorda Tympani


Swallowing involves 3 phases including the ___ phase which is synonymous with mastication, the ___ phase which involves the elevation of the floor of the mouth and tounge in order to push the bolus into the oropharynx, and the ___ phase which is when the oropharynx elevates and constricts around the bolus and propels it down the esophagus

Oral, Oropharyngeal, pharyngo-esophageal


The ___ is located posterior to the nasal cavity and communicates with the nasal cavity via the ___, middle ear cavity via the auditory tube, and the oropharynx via the ___

The ____ is located behind the oral cavity and communicates with the nasopharynx via the ___, the oral cavity via the ___ and the laryngopharynx at the level of the hyoid

The ___ is located posterior to the larynx and communicates with the oropharynx at the level of the ___, larynx via the laryngeal aditus, and esophagus at the level of ___

Nasopharynx, Choanae, Pharyngeal isthmus

Oropharynx, Pharyngeal isthmus, faucial isthmus

Laryngopharynx, Hyoid, CV6


When bolus comes into the mouth it splits around the epiglottis and goes down the gutters on the side (located posterior and lateral to the arytenoid cartilages in the laryngeopharynx) and this is called the ___

The tongue is also very closely related to the ____ and is important because when the tongue comes back it closes the epiglottis over the opening of the larynx
^^ This is important because when people reflux, the epiglottis is not closed over (like is esophageal acid reflux)

^** In other words, the epiglottis is the structural component for airway protection

If food does get into the airways, the protective ___ reflex occurs, however sometimes patients with problems in their external abdominal obliques can compromise this system

Piriform recess




**************For The neurological protection of the airway, the nerve the supplies the superior portion of the larynx (above the vocal cord) is the ___ nerve*********** and it is involved in the ___ reflex so if it is damaged, you GET NO COUGH REFLEX********

Will be a test question

These are ___ fibers (because remember, they are mucosa)

**So if this nerve is damaged, like we already said you lose airway protection (aka no LCR) and food will get into the airways (aka increased risk for aspiration pneumonia)*****

Internal branch of the superior laryngeal nerve (ibSLN), cough (called the LCR aka the laryngeal cough reflex)



During the first year of life, the larynx displaces to a position lower in the neck and if it doesn't get displaced then you will have ___ speech

This is why children before the age of 1 are normally nasilized breathers



There are various layers of the pharyngeal wall (which remember, the pharynx has 3 components to it) starting from the inner most layer is the mucosa, the epithelium, then a submucosa of lose connective tissue, the inner layer of fascia called the ___ fascia, and next are the inner elevators of the pharynx

***************************The important inner elevator of the pharynx is the ___ muscle, which is innervated by SVE fibers of the ___ nerve AND THIS IS THE ONLY MUSCLE INNERVATED BY THE GLOSSOPHARYNGEAL NERVE*****************************

^**The final layer of the pharyngeal wall (the most outer layer) is discussed in the following notecard


Stylopharyngeus muscle, IX (glossopharyngeal)


********************** The final layer of the pharyngeal wall (the most outer layer) is the ___ fascia and it is here that the pharyngeal plexus is embedded

The ___ space is between this fascia and the pre vertebral fascia and this is where ***infections can spread*** along with this space being a point where surgeons can approach the ___ bodies of the cervical vertebra for ***anterior vertebral surgical fusions*********************


Retropharyngeal space, anterior


___ is an out pocketing of the mucosa of the pharynx, just above the cricopharyngeal muscle

Zenker's diverticulum


As we already mentioned, innervation of the pharynx occurs via the pharyngeal plexus, which is embedded in the buccopharyngeal fascia and receives sensory info (GVA) from the ___ nerve and motor (SVE) fibers from the ___ nerve

***********Also, the GVA fibers in this plexus convey afferent info for the __ reflex, so in other words, pharyngeal branches of the glossopharyngeal nerve convey the sensory component of the gag reflex and then the pharyngeal branches of the vagus nerve mediate the motor response (efferent component)***********

^****** In by 9 out by 10***********

Glossopharyngeal, Vagus



The cricoid arch (which is the main supporting element of the laryngeal airway is at the level of ___

During intubation the blade is placed in the ____, which are cup-shaped recesses between the tounge and epiglottis and as the blade moves forward (along with tongue and epiglottis) the laryngeal aditus opens

^** Large veins are also often seen in the valleculae


Valleculae Epiglottica


Cricothyrotomies aka emergency airway punctures occur through the ___

This membrane, along with the cricothyroid joint, is important for making ___ pitched sounds like "eeeeeeeeeeeee"

Cricothryoid membrane



The only abductor of the vocal cord is the ___

The adductor of the vocal cord is the ___

Posterior cricoarytenoid

Lateral cricoarytenoid (and arytenoideus)


The ___ muscle increases vocal cord tension and the ___ muscle decreases it

Cricothyroid, Vocalis


The ____ crosses the cricothryoid joint and enters the larynx and is now called the ____ nerve, which conveys SVE fibers to the laryngeal muscles, except the cricothryoid muscle which is innervated by the ___

RLN (recurrent laryngeal nerve), inferior laryngeal

External branch of the superior laryngeal nerve