5/27/06
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| C2 dermatome | a posterior 1/2 of skull cap
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| C3 dermatome | high turtleneck shirt
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| C4 dermatome | t-shirt collar
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| T4 dermatome | at the nipple
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| T7 dermatome | at the xiphoid process
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| T10 dermatome | at the umbilicus (important for early appendicitis referral); belly butTEN
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| L1 dermatome | at the inguinal ligament (IL)
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| L4 dermatome | includes the kneecaps
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| S2, 3, 4 dermatomes | erection and sensation of penis and anal zones; "...keeps the penis off the floor"
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| Gallbladder referred pain | goes to right shoulder via phrenic nerve
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| What do astrocytes do? | support, repair and metabolize K+
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| The function of microglia is: | phagocytosis
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| Oligodendrocytes differ from Schwann cells via: | they produce myelin in the CNS rather than the PNS
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| What kind of cells line the ventricles? | ependymal
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| The Blood Brain Barrier is fomed by 3 structures, what are they? | the CIA: Chorioid plexus epithelium, Intracerebral capillary endothelium, & Arachnoid
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| How do glucose and AAs cross BBB? | by carrier-mediated transporters
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| Functions of the hypothalamus: TAN HATS | thirst, adenohypophysis, neurohypophysis, hunger, autonomics, temperature, sexual urges
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| If you zap your ventromedial nucleus, you will | grow ventrally and medially d/t Hyperphagia and Obesity
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| If you zap your posterior hypothalamus, you become | a Poikilotherm (cold-blooded snake)
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| Supraoptic nucleus | thirst/water balance part of the hypothalmus
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| Lateral hypothalamic nucleus | hunger part
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| Ventromedial nucleus of hypothalamus | satiety part
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| anterior hypothalamus regulates what kind of autonomic activity? | parashympathetic
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| Circadian rhythms are controlled by the | suprachiasmatic nucleus
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| the posterior hypothalamus regulates | heat production/conservation when body is cold
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| the anterior hypothalamus regulates | cooling of the body when it is hot; the A/C is anterior/cooling unit
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| sexual urges and emotions come from what part of the hypothalamus? | septate nucleus
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| Lateral Geniculate Nucleus (LGN) of Thalamus is: | visual; (lateral is to look)
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| Medial Genigulate Nucleus (MGN) of thalamus is: | auditory; (medial is for music)
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| Ventral posterior nucleus, lateral part (VPL) is for | body senses (proprioception, pressure, pain, touch, vibration)
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| Ventral posterior nucleus, medial part (VPM) of thalamus is for: | facial sensation, including pain
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| Ventral anterior/lateral (VA/VL) nuclei of thalamus is for: | motor control
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| the 5 famous Fs of the limbic system's function: | feeding, fighting, flight, feeling, fornication
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| Choreaform movements are characteristic of: | basal ganglia lesions; ex: Huntington's disease; sudden jerky purposeless movements
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| Athetosis movements are characteristic of: | basal ganglia lesions; these are slow writing motions, esp fingers, that are snake-like
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| Hemiballismus is a sign of the loss of inhibition of the thalamus through the: | globus pallidus d/t contralateral subthalamic nucleus lesion; causes a sudden flailing of one arm
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| Lesions of Broca's area (44, 45) occur in what lobe and cause what problem? | frontal; motor (expressive) aphasia with good comprehension; BROken speech
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| Damage to Wernicke's area (22) occurs in what lobe and causes what problem? | temporal; sensory (fluent/receptive aphasia) with poor comprehension; Wordy but makes no sense
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| The role of the Arcuate fasciculus is to _; damage cause _: | connect Wernicke's and Broca's area; conduction aphasia; poor repetition with good comprehension and fluent speech
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| Damage to the Amygdala (bilateral) causes Kluver-Bucy syndrome which is characterized by: | hyperorality, hypersexuality, disinhibited behavior
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| Damage to the frontal lobe causes "frontal release signs" such as: | personality changes, deficits in concentration, orientation and judgement
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| When the right parietal lobe is damaged, the pt will have: | spatial neglect syndrome (agnosia of contralateral side of the world)
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| Coma is induced by damage to the: | reticular activating system (because this is the center of arousal)
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| Bilateral damage to the mammilary bodies occurs in alcoholics, producing: | Wernike-Korsakoff's encephalopathy of confabulations and anterograde amnesia)
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| Tremors at rest are indicative of | Parkinson's disease; basal ganglia damage
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| Intention tremors and limb ataxia arise from lesions of the | cerebellar hemisphere
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| Truncal ataxia and dysarthria correlate with lesions to the: | cerebellar Vermis
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| Which nerves pass through the cavernous sinus? | all nerves that control extraocular muscles (III, VI, VI) as well as V1 and V2
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| Which cranial nerves pass through the sphenoid bone (middle cranial fossa)? | CN II - VI
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| the 3 divisions of CN V passes through the following: | "Standing Room Only" = superior orbital fissure, foramen rotundum, foramen ovale
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| Name the foramina in the sphenoid bone: (5) | optic canal, superior orbital fissure, foramina rotundum, ovale, spinosum
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| Name the structures exiting the optic canal: (3) | CN II, ophthalmic artery and central retinal vein
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| Name the 5 structures exiting the superior orbital fissure: | CN III, IV, VI, V1, and ophthalmic vein
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| What exits the foramen spinosum? | middle meningeal artery
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| The posterior fossa has 4 foramina and is made up of 2 bones, what are they? | Internal auditory meatus, Jugular foramen, Hypoglossal canal, Foramen magnum; Temporal and Occipital bones
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| Which CNs travel through the internal auditory meatus? | VII, VIII
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| Which structures exit thru the jugular foramen? | CN IX, X, XI and jugular vein
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| Which 3 structures pass thru the foramen magnum? | spinal roots of CN XI, brainstem and vertebral arteries
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| How do we remember the control of extraocular muscles? | SO4, LR6, all the rest are 3
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| Which directions are controlled by the superior oblique? | abduction, introversion and depression of eye
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| What is the nucleus that receives light signals from either retina? Where is it? What does it activate bilaterally? | pretectal nuclei in the midbrain; Edinger-Westphal nucleus (CNIII) a consensual reflex to contract both pupils
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| Will illuminating one eye cause bilateral pupillary constriction? | yes
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| What happens when the medial longitudinal fasciculus (MLF) sustains a lesion? What disease is this common in? | Internuclear ophthalmoplegia with paralysis of the medial rectus on attempted lateral gaze, nystagmus in abduction w/normal convergence; Multiple sclerosis
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| When you look left, the nucleus of CN _ fires, which contracts the _ _ _ and stimulates the contralateral nucleus of CN _ via the MLF to contract the _ _ | VI; left lateral rectus; III; medial rectus
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| An injury to a single optic nerve causes | unilateral anopsia
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| Lesions at the optic chiasm cause | bilateral hemianopsia
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| lesions of one optic tract (fibers from both eyes) possibly d/t a posterior cerebral artery occlusion causes: | either R or L homonymous hemianopsia (in both eyes)
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| a right temporal lesion affects vision in this way: | left upper quadrantic anopsia
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| a right parietal lesion disrupts the visual field by causing: | left lower quadrantic anopsia
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| Pneumonic for remembering which cranial nerves have motor or sensory functions: | Some say marry money but my brother says big brains matter most
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| How does the lateral ventricle drain into the 3rd ventricle? | via the foramen of Monro
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| how does CSF get from the 3rd ventricle to the 4th? | via the aqueduct of Sylvius
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| The 4th ventricle dumps CSF into the: | subarachnoid space via foramina of Luschka (lateral) and Magendie (medial)
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| Anterior cerebral artery | supplies medial surface of brain; leg-foot area of motor and sensory cortices
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| Middle cerebral artery | supplies lateral aspect of brain; trunk-arm-face area of motor and sensory cortices of brain, Broca's and Wernike's speech areas
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| Anterior communicating artery | this is the most common circle of Willis aneurysm; it may cause visual field defects
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| Posterior communicating artery | this is a common site for aneurysms; it causes CN III palsy
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| Lateral striate (branches of internal carotid) | these are the "arteries of stroke" that supply the internal capsule, caudate, putamen, globus pallidus
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| Stroke of the anteior circle causes | general sensory and motor dysfunction and aphasia
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| Strokes of the posterior circle cause | cranial nerve deficits (vertigo, visual defects), coma and cerebellar deficits (ex: ataxia)
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| KLM (kuh, la, mi) sounds to test CN X, XII, VII | kuh-kuh-kuh (palate elevation; vagus), la-la-la (tongue; hypoglossal), mi-mi-mi (lips; facial)
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| What are the 3 vagal nuclei? | Nucleus solitarius, nucleus ambiguus and dorsal motor nucleus
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| What does the nucleus solitarius do? | senses visceral Sensory information (taste, gut distention, etc); VII, IX, X
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| What does the nucleus aMbiguus do? | sends Motor innervation to pharynx, laynx, and upper esophagus; IX, X, XI
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| What does the dorsal motor nucleus do? | sends autonomic (parasympathetic fibers) to the heart, lungs and upper GI
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| A lesion of CN XII (LMN) deviates the tongue... | towards the side of the lesion (lick your wounds)
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| A CN V motor lesion deviates the jaw | Towards the side of the lesion
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| a unilateral lesion to the cerebellum causes the patients head to fall | toward the side of the lesion
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| a lesion of CN X deviates the uvula | away from the lesion
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| a lesion to CN XI causes weakness when turning head... and causing a shoulder droop... | away from the lesion; on the side of the lesion
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| A cingulate herniation occurs | under the falx cerebri and can compress the anterior artery
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| What kind of herniations in brain can cause coma and death d/t compression on brainstem? (3) | Transtentorial (central/downward); uncal; cerebellar tonsillar (into foramen magnum)
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| What are the clinical signs of an Uncal Herniation (4) | ipsilateral mydriasis/ptosis (d/t CN III stretch); Contralateral homonymou hemianopsia (ipsilat post cerebral a); Ipsilateral paresis (contra crus cerebri/Kernohan's notch); Duret hemorrhage (paramedian artery rupture)
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| Lumbar punctures obtains | CSF from subarachnoid space btw L4/L5 at level of iliac crests
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| What structures are pierced in a lumbar puncture? | skin, fascia, supraspinous/interspinous/ligamentum flavum, epidural space, dura mater, subdural space, arachnoid mater, subarachnoid space; NOT PIA
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| To keep the spinal cord alive, keep the needle between | L3 and L5; at level of cauda equina
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| Where does the spinal cord end in adults? subarachnoid space? | L1-L2; lower border of S2
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| How many spinal nerves are there?? | 31, like 31 flavors!; 8, 12, 5, 5, 1
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| The lateral corticospinal tract originates in the _ _ _, has the following function, and decussates at the _ | primary motor cortex; movement of contralateral limb; medulla (pyramidal)
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| The Dorsal column medial lemniscus originates at the following...., function to..., and decussates at the .... | Pacini's, Meissner's, muscle spindles, golgi tendon organs; Tactile and vibration sense; Arcuate fibers at medulla
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| The Spinothalmic tract originates in..., functions to...., and decussates at the... | free nerve endings & pain fibers; Pain and temperature sense; Ventral white commissure at spinal cord level
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| How is the dorsal column organized? | like you are; arms (fasciculus cuneatus) outside and legs (fasciculus gracilis) inside
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| Describe the lesion in Poliomyelitis/Werdnig-Hoffman disease | flaccid paralysis of lower motor neurons only
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| Describe the spinal cord lesion in Multiple Sclerosis | mostly white matter of cervical region and other random assymetric lesions
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| What does ALS look like at the spinal cord level? | combined upper and lower motor neuron deficits; no sensory loss
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| A complete occlusion of the ventral spinal artery spares what? | dorsal columns; so sensation (pressure, vibration, touch, proprioception) is still functioning; no motor, pain or temp
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| Tabes dorsalis is caused by tertiary syphilis leading to the following: | impaired proprioception and locomotor ataxia
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| Syringomyelia is a fluid filled cavity in the center of teh cord that damages the: | white commissure and ventral horns; may cause pain, loss of sensation and weakness in limbs
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| Vitamin B12 neuropathy/Friedrich's ataxia involves the: | dorsal columns, lateral corticospinal tracts and spinocerebellar tracts
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| Brown-Sequard Syndrome is a hemisection of the spinal cord with the following 4 findings: | Ipsilateral motor paralysis/spasticity (pyramidal tract), Ipsilateral loss of tactile, vibration, proprioception (dorsal column), Contralateral pain/temp loss (spinothalamic), Ipsilateral loss of sensation at level of lesion; Horner's if above T1
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| Lower motor neuron lesions have everything lowered: | less muscle mass, dec tone, dec reflexes, downgoing toes; fasciculations & weakness
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| Upper motor neuron lesion have everything going upward: | inc tone, DTRs, toes w/weakness
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| Central facial lesions cause paralysis to the | contralateral lower quadrant
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| Bell's palsy (ALexander Bell with an STD) | peripheral ipsilateral facial paralysis w/inability to close eye on involved side d/t destruction of facial nucleus its branchial fibers (CN VII); a/w AIDS, Lyme dz, Sarcoidosis, Tumors, Diabetes
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| UMN lesion and the face | lesion to internal capsule causes contralateral weakness of lower face only
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| LMN lesion and the face | causes upper and lower motor neuron lesion paralysis with weakness of upper and lower face
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| What is a spindle muscle reflex arc? | muscle stretch = intrafusal stretch = stimulation of Ia afferents = stimulation of alfa-motor neuron = reflex extrafusal contraction
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| Spindle muscle gamma loops involve: | CNS stimulation of gamma motor neuron = contracion of intrafusal fiber = increased sensitivity of reflex arc
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| what do the Ib fibers do in the golgi tendon organ? | they sense tension and provide inhibitory feedback to alfa motor neurons
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| Clinical reflexes "count up in order" | S1, 2, L3, 4, C5, 6, C7, 8
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| Biceps reflex | C5
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| Triceps reflex | C7
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| Patella reflex | L4
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| Achilles reflex | S1
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| Babinski reflex | dorsiflexion of big toe and fanning of over toes; normal in 1st yr of life; sign of UMN lesion
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bscaryp