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Neurology

FA complete review part 2 Anatomy and Physiology

QuestionAnswer
Which medulla nucleus coordinates the vomiting center? Nucleus tractus solitarius (NTS) in the medulla
Which areas or zones send to NTS in medulla? 1. Chemoreceptor trigger zone (CTZ) 2. GI tract via vagus nerve 3. Vestibular system 4. CNS
Where is the CTZ located? Within area postrema in 4th ventricle
CTZ and adjacent vomiting center nuclei receive input form 5 major receptos: 1. Muscarinic (M1), 2. Dopamine (D2), 3. Histamine (H3), 4. Serotonin (5-HT), 5. Neurokinin (NK-1)
What muscarinic receptor is associated with the CTZ and vomiting centers nuclei? M1
Which receptor antagonists are used to treat chemotherapy-induced vomit? 5-HT3, D2, and NK-1 receptors
Which two of the five antagonists are sued to motion sickness and hyperemesis gravidarum? M1 and H1 receptors
M1 and H1 antagonists are used to treat? Motion sickness and hyperemesis gravidarum
Serotonin, D2, and NK-1 antagonists are used to treat: Chemotherapy-induced vomiting
What important physiologic center is located in the NTS in the medulla? Vomiting center
The sleep cycle is regulated by the _______________ rhythm. Circadian rhythm
The Suprachiasmatic nucleus of hypothalamus ---> Drives the sleep cycle with regulates the circadian rhythm.
What is controlled by the Circadian rhythm? Nocturnal release of ACTH, prolactin, melatonin, norepinephrine
What regulates Suprachiasmatic nucleus (SCN)? Environment (light)
Which gland releases melatonin? Pineal gland
SCN --(+)---> NE release ==> Pineal gland which releases melatonin
What are the two stages of Sleep physiology? Rapid-eye movement (REM) and non-REM
What substances and drug types are associated with a decrease in REM sleep and delta wave sleep? Alcohol, benzodiazepines, and barbiturates
What happens to REM sleep with increase norepinephrine? Decrease REM sleep
A patient with decreased REM sleep and a decreased delta wave is often associated to consumption of : Alcohol, benzodiazepines, and barbiturates
Which type of medications are proven to help for night terrors? Benzodiazepines
Which sleep disorder conditions are treated with Benzodiazepines? Night terrors and sleepwalking
What is the MOA of benzodiazepines ahta aid in treating Night terrors and sleepwalking? Decreased N3 and REM sleep
What are the main sleep stages? 1. Awake (eyes open/closed) 2. Non-REM sleep (N1, N2, and N3) 3. REM sleep
Which is the description for the awake with eyes open sleep stage? Aleer, active mental concentrations
What is the associated EEG waveform of the Awake with eyes open of the sleep stages? Beta waves
Which sleep stages have Beta waves in the EEG? 1. Awake (eyes open) 2. REM sleep
Alpha waves of EEG are associated with which sleep stage? Awake (eyes closed)
What are the subdivisions of Non-REM sleep? Stage N1, Stage N2, and Stage N3
Which non-REM sleep is the largest or with the largest percentage? Stage N2
What is the description of Stage N1 of sleep? Light sleep
Which stage of sleep is described as "light sleep"? Stage N1
What are the associated EEG waveforms of Non-REM Stage N1? Theta waves
(+) Theta waves on EEG. Stage N1
Which sleep stage accounts for approximately 75% of all sleep cycle? Non-REM sleep
Description of N2 stage of Non-REM sleep Deeper sleep that Stage N1; bruxism occurs
Which sleep stage is associated with Bruxism? Stage N2
What is Bruxism? Teeth grinding
EEG waveform of Non-REM stage N2 sleep Sleep spindles and K complexes
(+) Sleep spindles and K complexes on EEG Non-REM sleep stage N2
Which stage has the deepest non-REM sleep? Stage N3
Which EEG waveform has the lowest frequency and highest amplitude? Delta wave
Associated waveform of Stage N3 of sleep? Delta wave
Slow-wave sleep? Stage N3
What is the description of non-REM sleep Stage N3? Deepest non-REM sleep; associated with sleepwalking, night terrors, and bedwetting
Which conditions are associated with non-REM Stage N3 sleep? 1. Sleepwalking 2. Night terrors 3. Bedwetting
Loss of motor tone, increased brain oxygen use, and increase variable pulse and BP, and elevated ACh Description of REM sleep
What physiological conditions are associated REM sleep? - Dreaming - Nightmares - Penile/clitoral tumensce
Which sleep stage may present with penile erection? REM sleep
Which mood disorder is associated with increased REM sleep but decreased REM latency? Depression
What accounts for the extraocular movements in REM sleep? Activity of PPRF
What is the PPRF? Paramedian Pontine Reticular formation/ conjugate gaze center.
How often does REM sleep occur? Every 90 minutes, and duration increases through the night
REM sleep associated EEG waves Beta waves
Dreams happen during __________________ sleep. REM
Major relay for all ascending sensory information except olfaction Thalamus
Which are the nuclei of the Thalamus? 1. Ventral Postero-Lateral nucleus 2. Ventral Postero-Medial nucleus 3. Lateral geniculate nucleus 4. Medial geniculate nucleus 5. Ventral lateral nucleus
The VPL and VPM nucleus are part of the _________________. Thalamus
Which ascending sensory information does not relay in the Thalamus? Olfactory
What is the input of the Ventral Posterolateral nucleus of the Thalamus? Spinothalamic and dorsal columns/ medial lemniscus
The Spinothalamic and dorsal columns and medial lemniscus is the input of the: Ventral Posterolateral nucleus of the Thalamus
What is sensed by the VPL nucleus of the Thalamus? Vibration, Pain, Pressure, Proprioception, Light touch, and temperature.
What is the destination of of the sensory information coming from the VPL nucleus of thalamus? Primary somatosensory cortex
Which thalamic nucleus have as destination the Primary somatosensory cortex? VPL and VPM nuclei
What is the input of the Ventral posterolateral nucleus of the thalamus? Trigeminal and gustatory pathway
What are the sensation of the VPM nuclei of the thalamus? Face sensation and taste
Which hypothalamic nucleus is damaged if there is decreased sensation of the face and taste? Ventral Postero-Medial nucleus
Input Trigeminal and gustatory pathway. Thalamic nucleus? Ventral Postero-Medial nucleus
What is the input of the Thalamic lateral geniculate nucleus? CN II, Optic chiasm, and Optic tract
Associated thalamic nucleus of the CN II, optic chiasm, and optic tract? Lateral geniculate nucleus
What is sensed by LGN of the thalamus? Vision
Vision associated ________ _________ nucleus of the thalamus Lateral geniculate nucleus
What is the destination of the Lateral geniculate nucleus sensory input? Calcarine sulcus
The Calcarine sulcus receives sensory information of which Thalamic nucleus? Lateral geniculate nucleus
Medial geniculate nucleus receives input from the: Superior olive and inferior colliculus of tectum
What senses the Medial geniculate nucleus sensory fibers? Hearing
Hearing is sense by the ____________ nucleus of the thalamus Medial geniculate nucleus
What is the destination of the sensor pathways that relay by the Medial geniculate nucleus? Auditory cortex of temporal lobe
Associated destination of the MGN of the thalamus? Auditory cortex of temporal lobe
The ventral lateral nucleus has input of : Basal ganglia and cerebellum
The Ventral lateral nucleus senses ________________ functions. Motor
What is the final destination of the sensory information relayed in the thalamus ventral lateral nucleus? Motor cortex
What is the Limbic system? Collection of neural structures involved in emotion, long-term memory, olfaction, behavior modulation, and ANS function
What does the Limbic system consists of? Hippocampus, Amygdala, Mammillary bodes, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex.
What neurological structure or system is made up of the hippocampus, amygdala, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, and entorhinal cortex? Limbic system
The limbic system is responsible for: 1. Feeding, 2. Fleeing, 3. Fighting, 4, Feeling, 5. Sex (fucking)
What are the famous 5 F's of the limbic system? Feeding, fleeing, fighting, feeling, and Fukcing (sex)
List of Dopaminergic pathways: 1. Mesocortical 2. Mesolimbic 3. Nigrostriatal 4. Tuberoinfundibular
What are the "negative"symptoms associated with Dopamine? Anergia, apathy, and lack of spontaneity
A decreased in which dopaminergic pathway lead to development of negative symptoms? Mesocortical
Decreased activity in the mesocortical dopaminergic pathway --> "negative" symptoms
Antipsychotic drugs have a limited effect on which dopaminergic pathway? Mesocortical
Increased activity in the Mesolimbic dopaminergic pathway lead to: Development of "positive" symptoms
What are the positive symptoms associated with Dopamine? Delusions and hallucinations
Which dopaminergic pathway represents the primary target of the antipsychotic drugs? Mesolimbic
Inhibition of the mesolimbic dopaminergic pathway lead to: Decrease positive symptoms in Schizophrenia
Dopaminergic pathways are altered by which drugs? Antipsychotics
Which two features alter the Dopaminergic pathways? Drugs (antipsychotics) and movement disorders (Parkinson disease).
What is the major dopaminergic pathway in the brain? Nigrostriatal
Decreased activity of this dopaminergic pathway leads to the development of Extrapyramidal symptoms? Nigrostriatal
What are the Extrapyramidal symptoms? Dystonia, Akathisia, parkinsonism, and tardive dyskinesia
Which Dopaminergic pathway is most affected by drugs and movement disorders? Nigrostriatal
Disorder that leads to an undeveloped or nonfunctional Nigrostriatal dopaminergic pathway will present clinically be the development of: Extrapyramidal symptoms
Which Dopaminergic pathway is associated with libido, sexual function, galactorrhea and gynecomastia in men? Tuberoinfundibular
A decrease activity in the Dopaminergic Tuberoinfundibular pathway leads to a ____________________ in prolactin. Increase
Hyperprolactinemia may be due to damage to which dopaminergic pathway? Tuberoinfundibular
What are the results of decrease activity in the Tuberoinfundibular pathway? Hyperprolactinemia which leads to decreased libido, sexual dysfunction, galactorrhea, and gynecomastia in men.
Functions of the Cerebellum: 1. Modulates movement 2. Aids in coordination and balance
What are the 2 inputs of the Cerebellum? 1. Contralateral cortex via middle cerebellar peduncle 2. Ipsilateral cerebellar peduncle from spinal cord
What i the contralateral input of the cerebellum? Cortix via middle cerebellar peduncle
What is the is ipsilateral input of the cerebellum? Proprioceptive information via inferior cerebellar peduncle form the spinal cord
Output of the Cerebellar cortex: Purkinje cells --> deep nuclei of cerebellum ----> contralateral cortex via superior cerebellar peduncle
Which cerebellar peduncle is used output information from the cerebellar cortex? Superior cerebellar peduncle
What cells are involved in the output of information form the cerebellar cortex? Purkinje cells
Cerebellar Purkinje cells are always _________________. Inhibitory
True or False. Cerebellar Purkinje fibres are stimulatory and inhibitory. False; Always and only inhibitory
What is the deep nuclei out of the cerebellum? Dentate, Embolofrm, Globose, and Fatigal
Direction of output for the cerebellum deep nuclei output? Lateral to medial
What is affected by LATERAL lesions to the cerebellum? Voluntary movement of the extremities
What is a common symptom of a cerebellum lateral injury? Propensity to fall toward ipsilateral side
A person falls has a tendency to fall to the right side, and has difficulty moving arms on command. Dx? Right side cerebellum injury
What are the medial structures of the Cerebellum? Vermis, fastigial nuclei, and floculonodular lobe
What clinical features of a medial cerebellar lesion? 1. Truncal ataxia 2. Nystagmus 3. Head tilting
Lateral of Medial lesions to the cerebellum cause bilateral motor deficits affecting axial and proximal limb musculature? Medial
What structures, medial or lateral cerebellum, in order to show wide-based cerebellar gait? Medial
Modulates movement and aids in coordination and balance. Cerebellum
The contralateral cortex input of the cerebellum is via the: Middle cerebellar peduncle
Function of middle peduncle of cerebellum Provide input to the contralateral cortex of the cerebellum
Function of the Inferior cerebellar peduncle? Provide input concerning ipsilateral proprioception
Which structure is important in voluntary movements and making postural adjustments? Basal ganglia
What type of input is received by the Basal ganglia? Cortical input
Provides negative feedback to cortex to modulate movement. Basal ganglia
What type of feedback is provided by the Basal ganglia? Negative feedback to cortex to modulate movement
Putamen + Caudate = Striatum
What composes the Striatum? Putamen and Caudate
What provides the motor part of the Striatum? Putamen
Which component of the Striatum provides the cognitive features? Caudate
Lentiform = Putamen + globus pallidus
Putamen and the Globus pallidus, compose the ________________, of the basal ganglia. Lentiform
If the putamen is added to the caudate, it then makes up the _______________. Striatum
Lentiform = Putamen + _____________________. Globus pallidus
Which, D1 or D2, is the direct pathway in the basal ganglia? D1
Which is the inhibitory pathway of the basal ganglia, D1 or D2? D2
What is another way to refer to the Direct pathway of the Basal ganglia? Excitatory
What is another form to refer to the Indirect pathway of the Basal ganglia? Inhibitory
SNc input stimulate the striatum, stimulating the release of GABA, which inhibits GABA release from the GPi, disinhibiting the thalamus via the GPi. Direct (excitatory) pathway of the basal ganglia
The direct pathway of the Basal ganglia, stimulates the striatum which causes ---> Striatal release of GABA
What is the overall result of the direct pathway of the basal ganglia? Increase motion
Which pathway of the basal ganglia is designed to decrease motion? Indirect (inhibitory) pathway
Which structure stimulates the striatum in both, the indirect and direct pathways of the basal ganglia? SNc (Substantia nigra)
How does dopamine causes increased motion by acting on the Basal ganglia pathways? Binding to D1 to stimulate the excitatory pathway, and D2, by inhibiting the inhibitory pathway
Inhibition of the inhibitory pathway leads to increased movement Dopamine binding to D2 receptor in the Basal ganglia
Which areas of the brain are located in the Frontal lobe? - Primary motor - Premotor cortex - Frontal eye field - Prefrontal association area - Broca area
The Sylvian fissure borders with brain lobes? Frontal lobe and Temporal lobe
On which brain lobe is the Wernicke area located? Temporal lobe
Which important area or brain region is located at the Occipital lobe of the brain? Primary visual cortex
Which lobe would be affected if there is traumatic damage to the Primary visual cortex? Occipital lobe
On which brain lobe is the Primary auditory cortex located? Temporal lobe
Which are the gyri and areas associated with the Parietal lobe? - Primary somatosensory gyrus - Somatosensory association cortex
What association area is located in the anterior part of the Temporal lobe of the brain? Limbic association area
Which areas and cortex are located in the Temporal lobe of the brain? Limbic association area, Wernicke area, and Primary auditory cortex.
What is the "Homunculus"? Topographic representation of motor ans sensory areas in the cerebral cortex
Which is the Homunculus presented with a "distorted appearance"? Due to certain body regios being more richly innervated and thus having increased cortical representation
Brain perfusion relies strongly on ____________________. Autoregulation
Cerebral perfusion is primarily driven by: P CO2
At what point is PO2 also a modulator of cerebral perfusion? Severe hypoxia
What is the pressure gradient by which cerebral perfusion is based on? Between mean arterial pressure (MAP) and ICP
A decrease on BP has what effect on cerebral perfusion pressure? Decreased cerebral perfusion pressure
A decrease or increase on ICP will result in a decrease on CPP (cerebral perfusion pressure)? Increase in ICP
Therapeutic hyperventilation: 1. Decreases Partial CO2 (PCO2), which leads to ---> 2. Vasoconstriction, ---> 3. Decrease in cerebral blood flow which causes: 4. Decreased ICP
In order to achieve physiological decrease of ICP, the patient can be instructed to modified his/her breathing in what way? Hyperventilate
What does the hyperventilation causes to the levels of PCO2 in the brain vasculature? Decreases PCO2 with causes vasoconstriction
What is a possible reason to apply therapeutic hyperventilation? Treat acute cerebral edema unresponsive to other interventions
CPP = (mathematical equation) MAP - ICP
What is the difference of MAP -ICP? Cerebral perfusion pressure
What does a CPP = 0, indicate? No cerebral perfusion leading to brain death
When can hypoxemia cause an increase in CPP? Only if P O2 is < 50 mm Hg
CPP is directly proportional to PCO2 until? PCO2 is > 90 mm Hg.
Which cerebral artery supplies the anteromedial surface of the cortical brain? Anterior cerebral artery
What is irrigated by the Middle cerebral artery? Lateral surface of the cortical brain
Which cortical surfaces of the brain are supplied by the Posterior cerebral artery? Posterior and Inferior surfaces
Watershed areas of the brain: 1. Between the ACA and MCA 2. Between the PCA and MCA 3. Between the Superficial and deep vascular territories of the MCA
What condition affects the brain watershed areas? Severe hypotension
What are the symptoms of damage of watershed areas by severe hypotension? - Proximal upper and lower extremity weakness - Higher order visual dysfunction
What are the expected clinical signs of watershed zone damage if the internal border zone was damaged? Proximal upper and lower extremity weakness
What is clinically seen in damgate to the watershed area formed between the PCA and MCA border zone? Higher order visual dysfunction
What is the Circle of Willis? System of anastomoses between anterior and posterior blood supplies to brain.
Which arteries form the anterior circulation of the brain? ACA, ICA, and MCA
PCA, Basilar artery, and the Vertebral artery make up the _______________ circulation of the brain. Posterior
The Lenticulostriate arteries branch off the ___________. MCA
What are the Dural venous sinuses? Large venous channel that run through the periosteal and meningeal layer of the dura mater
What is the function of the dural venous sinuses? 1. Drain blood from cerebral veins and, 2. Receive CSF from arachnoid granulations
Into which important venous body do dural venous sinuses drain? Internal jugular vein
The internal jugular vein receives drainage from: The dural venous sinuses
What is the main clinical presentation of a patient with a Venous sinus thrombosis? Increased ICP
What are the common clinical signs of increased ICP? Headache, seizures, papilledema, and focal neurological defects
Serious complication of venous sinus thrombosis? Venous hemorrhage
What are the associated hypercoagulable states that increase risk for venous sinus thrombosis development? Pregnancy, OCP use, and factor V Leiden
Which is the main location of CSF return via the arachnoid granulations? Superior sagittal sinus
Anatomically, wheres is the Cavernous sinus located with respect to the Sphenoparietal sinus? Posteriorly
Which dural venous sinus is the the most superior? Superior sagittal sinus
On which lobe of the brain is the Confluence of the sinuses located? Occipital lobe
What are the ventricles that make up the CNS ventricular system? Lateral ventricles, Third ventricle, and the Fourth ventricle
In the ventricular system, arrange from the most superior to the inferior the ventricles involved: Lateral ventricles, Third Ventricle Fourth Ventricle
What structure is between the 3rd and 4th Ventricles? Cerebral aqueduct of Sylvius
Which structure connects the 3rd ventricle with the Lateral ventricle? Interventricular foramina of Monro
Which foramina connect or serve as conducts between the 4th Ventricle and the Subarachnoid space? 1. Foramina of Luschka 2. Foramen of Magendie
Which is the medial foramina that allows 4th ventricle CSF to reach the subarachnoid space? Foramen of Magendie
Foramina of Luschka, is it Lateral or Medial? Lateral
What makes the CSF? Choroid plexuses located in the lateral and fourth ventricles
Where are the choroid plexuses located? Lateral and Fourth ventricles
What structures reabsorb the CSF from the Foramina of Luschka and Magendie? Arachnoid granulations, which then drain into the dural venous sinuses
CSF in the arachnoid granulations is drain into the: Dural venous sinuses
Which are the 4 Cranial nerves above the Pons? I, II, III, and IV
Which 4 CNs exit the pons? V, VI, VII, and VIII
Which 4 cranial nerves are in the medulla? IX, X, XI, and XII
Which cranial nerve nuclei are MEDIAL ? III, IV, VI, and XII
What is common in CNs 3, 4, 6, and 12? Nuclei are medial
Actions or roles of the Pineal gland: 1. Melatonin secretion 2. Circadian rhythms
The circadian rhythm and melatonin secretion are actions performed by the __________ ___________. Pineal gland
What is the function of the Superior colliculi? Direct eye movements to stimuli or objects of interests
The inferior colliculi is involved in __________________. Auditatory
Where are the nuclei of the cranial nerves? In tegmentum portion of brain stem
Which CN nuclei are located in the midbrain? III and IV
Which cranial nerve nuclei are located in the Pons? CN V, VI, VII, and VIII
What structure is known to divide the lateral nuclei from the medial nuclei of the cranial nerves? Sulcus limitans
Cranial nerve LATERAL nuclei = Sensory (alar plate)
Cranial nerve MEDIAL nuclei = Motor (basal plate)
CN nerves in the medulla: CN IX, X, XII
Which cranial nerve's nucleus in in the Spinal cord? CN XI
Associated foramina of the Anterior cranial fossa? Cribriform plate
Which cranial nerve goes through the Cribriform plate? CN I
What structures (nerve/artery) pass through the Optic canal? CN II and Ophthalmic artery
Which foramen is used by the CN II? Optic canal
Which canal is used by the Ophthalmic artery? Optic canal
What are the associated foramina of the Middle Cranial fossa? 1. Optic canal 2. Superior orbital fissure 3. Foramen Rotundum 4. Foramen Ovale 5. Foramen Spinosum
What cranial nerves are known to pass through the Superior orbital fissure? CN II, IV, VI, and V1.
Which foramen is used by CN V2? Foramen Rotundum
Which foramen is used by CN V3? Foramen Ovale
Foramen Rotundum provides passage to which cranial nerve? CN V2
Foramen Ovale is used by which cranial nerve? CN V3
What structure goes through the Foramen Spinosum? Middle meningeal artery
The MMA uses which middle cranial fossa foramen? Foramen spinosum
Anterior cranial fossa is through the Ethmoid bone
Which cranial fossa is associated with "through sphenoid bone"? Middle cranial fossa
Through temporal or occipital bone. Cranial fossa? Posterior cranial fossa
What are the foramina associated with the Posterior cranial fossa? - Internal auditory meatus - Jugular foramen - Hypoglossal canal - Foramen magnum
What cranial nerves go through the Internal auditory meatus? CN VII and CN VIII
Which foramen is used by cranial nerves VII and VIII in the Posteror cranial fossa? Internal auditory meatus
Damage to the Jugular foramen will probably damage which cranial nerves and vein? CN 9, 10, 11, and Jugular vein
What foramen is used by Cranial nerve XII? Hypoglossal canal
What structures traverse by the Foramen magnum? 1. Brain stem 2. Spinal root of CN XI 3. Vertebral arteries
Which foramen is used in the Posterior cranial fossa by the Brain stem and Vertebral arteries? Foramen magnum
What is the associated cranial nerve that goes through the Foramen Magnum? Spinal root of CN XI
Created by: rakomi
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