Question | Answer |
Arachanoid granulation | aka Arachanoid villi.
reabsorb CSF back into the blood at a rate equal to formation. |
CSF | -CSF filled cavities are known as Ventricles
-Most CSF forms in the lateral ventricles
-Formed by blood filtration. |
Choroid plexus | name of the network of capillaries that line the walls of ventricles.
-Produce the CSF by flitrating/pushing blood plasma |
3 ways CSF maintains homeostasis | Mechanical protection-shock absorber
Chemical protection-maintains an ionic env for(AP)
Circulation-a medium exchange of nutrients and waste products btw blood and nervous tissue. |
Hydocephalus | blood blocked interfering w drainage of CSF from ventricles.
AKA-enlargement of the ventricles
kids-bulging of the head. |
Blood supply of the brain | 20% oxygen
4 mins or more of interruption of blood flow=permanent damage to the brain.
-Supply by the Circle of willis
-Lysosomes if lack of O2 release enzymes and they destroy neurons. |
Can the blood brain barrier store glucose? | NO, so blood supply is important!! |
What are of the Brain stores more O2? | Cerebrum |
BBB | Blood brain barrier
crosses over and interacts with neurons
Capillaries of the brain r less permeable bc of their endothelial cells.
Astrocytes- stars cells! press against capills and allow specif substances. |
Circle of Willis | main trunk that supplies brain. if blood is blocked, can still get to brain.
-is a point where the blood carried by th 2 internal carotids and basilar systems come 2gether and then redistributed by the ant, mid, and pos cerebral arteries. |
Falx cerebrix | from the dura mater-separater the hemispheres of the cerebrum. |
What are the layers of the brain? | protection layers
Dura mate-outer
Arachanoid-middle
Pia mater-inner most |
What produces CSF and where? | secreted by-Choroid plexuses-located in the 4 ventricles
circulates through the brain and enters the superior sagittal sinus.
Arachnoid layer-middle |
What is Sensation? | State of awareness pf external or internal conditions of the body.
Info travels via
Conscious relay path
divergent path
and unconscious relay paths. |
What 3 ways does sensation get to the brain? | Conscious relay path-discriminative touch
divergent path-aching pain
unconscious relay paths-how I move(cerebellum) |
Sensation receptor classifications | Exteroceptors-external/superficial env(nose,eyes,touch,sound)
Visceroceptors or interoceptors- internal.
Proprioceptors- movement-joints ligs,tendons. |
What is a mechanoreceptor? | sensory recepts, touch, pressure, stretch, |
Thermoreceptor? | temp warm and cold receptors
thermal sensation |
Nociceptors? | Pain sensation
sensitive to chemicals released. |
Photoreceptors? | eyes |
Chemoreceptors? | responds to chemical receptors>O2 levels
taste. |
Proprioceptive | aka kinesthetic sense.
info regarding movement and positions.
joint, hair cells, ms spindles, GTO-ms strength. |
Sensory intergration | ability of the brain to organize, interpret, and use sensory info. occurs automatically.
-ways to teach kids better. |
Sensory Arousal levels or SAL | Alert
Lethargic-drowsy w lessened focus
Obtunded-difficulty to arouse, confused when awake.
Stupor-responce to painful stimuli only. then back to unconscio.
Coma- no arousal by any stimuli |
Orientation- | pt's awareness of, TIME, PERSON, PLACE
pt orientate X3
pt orientate X1 (place)
Pt orientate X2 (time and person)
Soap note i.e=O+A X3 |
Labeled line principle | line going from tongue to brain. |
Receptive field | area of skin innervated by a single afferent neuron(sensory)
different types cutaneous, superficial, thermal, ect...
More sensory distally! |
Modality sensation | each sense is a modality sensation.
i.e hearing, vision, taste, touch. |
Superficial fine touch | smaller receptive fields |
Merkels discs | superficial fine touch receptive field.
free nerve endings wraps around base of hair follicle; TOUCH RECEPTOR
detects mechanical movement/touch.
feel me touch the hair |
Meissner's corpuscles | in superficial dermis, light pressure. rapidly adapt. RECOGNIZE OF TEXTURE. |
Pacinian corpuscles | deep dermis, deep pressure and vibration.
(circle) |
Subcutaneous fine touch | larger receptor fields |
Ruffinis corpuscles | deep dermis, sensitive to stretch of the skin.
Assist w joint position sense. |
Thermal receptors | free nerve endings in dermis, ms, liver.
rapidly adapt.
Warm rec- respond to temps btw 77-113 degrees
Cold recep- respond to temps btw 50-68 degrees F |
Nociceptors | scatter about
free nerve endingd w LARGE receptive fields. found in superficial skin, joint caps, periosteum, around walls of b. vessles,
A-fibers-carry fast pain
C-fibers-carry slow burning aching pain |
Periosteum- | fiber connective tissue that wraps around ms spindles. |
Coarse touch | free nerve endings throughout skin,
detect crudely localized touch/pressure/tickle/itch. |
Deep sensory receptors | in ms, tendons, joints
GAMMA motor neurons fiber. |
Ms spindles | intrafusal fibers parallel to extrafusal fibers.
monitor changes in ms length n velocity.
motor learning! |
Golgi tendon organ | in tendons. monitor tension in a ms.
Golgi-protective, 2 relax ms w/in a tendon.
will inhibit contracting.
deep sensory receptors |
Free nerve endings | w/in fascia of a ms. respond to pain/pressure/vibration |
Pacinian corpuscles | in tendons/around joints. respond to deep pressure and vibration. circle! |
Golgi | type nerve ending- receptors in ligs. detect rate of joint movement. |
Ruffini endings | in joint caps and ligs.
joint receptor. respond to direction of joint movement. |
Dorsal column | sensory axon enter the SC via dorsal horn.
Fast conducting fibers.
two-point discrimination. Lager fibers.
Discriminative touch.
skin,joints, |
Sensory receptors- | are located at the distal end of an afferent nerve fiber. |
Anterolateral spinothlamic | Anterior-carry info regarding crude touch.
Lateral-pain and temp.
SMALL conducting fibers.
Mechanoreceptors, thermo, and nociceptors. Afferent fibers that slowly conduct. |
Dyscalculia-define- | difficulty calculating. |
Barognosis | regcognition of weight |
Graphethsia | traced figure ID.
like letters |
Stereognosis | id a common object w/out site.
key,pen, |
2 point discrimination | aesthesoimeter or circular disk measures distance on skin that 2 points are felt. |
Kinesthesia | PROM. where is joint moving? up or down? |
Proprioception | move joint then stop. eyes closed. |
Quantitative | sensory testing |
Varicella zoster | shingles.
infection of senory root cell body. |
Define Pain | pain is objective.
peripheral nociceptors r found through out skin and internal tissues, cept tissue of the brain. |
Ischemia | deficiency of blood. resulting in deficiency of )2 (hypoxa) |
Cramp pain | ms's tighten up and squeezing caps. which decrease blood. then pain-stimi chems accumulate. BUT if u apply heat=dialtes blood, increasing blood flow/O2=less pain. |
a-delta fibers | fast carrying pain info. myelinated axons. |
C-fibers | slow carrying dull aching pain. on unmyelinated axons. synapse on neurons in dorsal horn.
to the limbic system(emotional response) and reticular-wake up! turn towards pain. |
Somatosensory cortex | pain perception or localization. |
Gate theory | (non pain)if alpha-beta fibers are stimulated more then the alpha-delta fibers(pain fibers)then the pain is inhibited in the dorsal horn. 'closing the gate'
rubbing the pain inhibits the T-cells=stopped the pain! |
Alpha-beta fibers | non-nociceptors(non pain receptors)carry info from mechnoreceptors |
What does lower levels of serotonin mean? | increased pain!
so increased levels of serotonin and dopamine in brain means = inhibit pain!
Neurotransmitter |
Counterirritant theory | pressure stimulates mechanoreceptor afferent branches, which attivate interneurons that release Enkephalin, which decreases the release of Substance P(chronic pain nt) |
Antinociception | suppression of pain |
Neuromodulators | produced in brain. enkephalin, beta-endorphin
can inhibit pain |
Peripheral pain | aspirin can inhibit pain |
Brainstem descending tacts | become activated, and inhibit pain by increasing the release of serotonin in the dorsal horn, which increases enkephalins. |
Hormonal system | pituitary gland and adrenal medulla release enkephalin during acute stress.
thats y ppl walk away w a broken leg. |
Cortical | ihibits pain by distraction, placebo, excitement. |
Pronociception | edema- endogenous chems-sunburn
anxiety-can increase pain. increased levels of norepinphrine can increase pain. |
Multiple ways to shut down pain | Neurotransmitters-increased serotonin
Doral horn-TENS
Hormonal- stress |
Types of pain | Acute, referred, Chronic
Chronic pain-Nociceptive- continuing stimulation all the time
Chronic pain neuropathic- a disease. pain continues after stimi is gone. |
Chronic pain-Nociceptive | Chronic pain-Nociceptive- continuing stimulation all the time bc of cancer or tumor. takes less stimi to generation AP. |
Chronic pain neuropathic- | a disease. pain continues after stimi is gone. |
Symptoms of neuropathic pain | paresthesia-painless. abnorm sensation.
Dysethesia-unpleasant. abnorm sensation. burning, shooting pain.
Allodynia-norm non-painful touch produces pain.
Secondary hyperalgesia-fibromyalgia pain. normal touch feels painful! |
Secondary hyperalgesia | fibromyalgia pain. normal touch feels mildly painful! |
Allodynia- | norm non-painful touch produces pain. |
paresthesia | painless. abnorm sensation. (tickle)lesions |
Dysethesia- | unpleasant. abnorm sensation. burning, shooting pain. |
PNS neuropathic pain | injury or disease of peripheral nerve.
Ectopic foci- myelin damage make AP w/out stimi. Ectopic develop at nerve stump ends and tapping induces pain AKA Tinels sign! |
Tinels sign | Ectopic foci- myelin damage produces AP w/out stimi. this develops at stump nerve ends and when tapping=induces pain- TINELS sign. |
Mononeuropathy | PNS- one nerve
median or ulna nerve compression |
Polyneuropathies | PNS- more than one nerve. like diabetic neuropathy and guillain barre. |
CNS neuropathic pain | if peripheral sensory info in completely absent.(sensory info coming in) then CNS neurons in the pain pathway become abnormally active! |
Deafferentation | CNS neuropathic pain
avulsion of afferent roots (MVA)(cutting off dorsal roots)
causes burning pain in area of sensation loss |
Phantom limb pain | CNS neuropathic pain |
Pain matrix malfunction | Antinociception is decreased and pronociception is increasesd.
Fibromyalgia, Complex regional pain syndrome. |
Complex regional pain syndrome | abnormal response to trama leading to limb disuse. excessive sweating, edema, red/pink skin, |
Chronic pain syndromes | migraine, chronic low back pain-never stops. |
Simple descriptive pain scale | a line....no pain,mild, moderate, severe,-max pain tolerable |
VAS-visual analog scale | a line...no pain-max. |
Pain estimate (scale) | a line---0-100 or 0-10 |
Face pain scale | faces for kids |
Mcgill pain questionnaire | 20 categories of descriptive words.
pain clinics use this a lot.
1-10 sensory
11-15 affective
number 16 evaluative |
Caregiver checklist | list of demonstrated pain behaviors for pt's who cant communicate. |
Observe- | gait, posture, skin, ROM, ms strength, sensation. |
Disorders of Vascular supply | Anerism- dislocation of wall, abnormal widening.
TIA-stroke
Angedogphy -X-ray pictures of the inside of blood vessels.
Hemerage- thin wall vessles |
What makes up the CNS? | brain and sc |
PNS | 31 SP-pairs nerves
12 pairs-cranal.
Subdivision-ANS |
CNS-all nervous systems ARE encased in Vertebral column. (brainstem, SC, skull)
Neuroglia cell types-Astrocytes, Oligodendrocytes, microglia, ependyma.
No Neurolemma-> NO REGENERATE!
Oligodendrocytes-myelinate.
Mulitple Sclerosis)
Has nucleus and PNS | PNS-all nervous systems NOT encased in bone
Have ganglia,carry info to and from CNS.
Neurolemma AKA Schwann Cells->mylinate -regeneration
Guillian-barre
Divided into 2 systems- Somatic-voluntary-motor control ability.ANS-involuntary2 subdiv
sympath+ |
PNS-two systems | ANS-sympathic s-fight or flight. and Parasympathic s-restful.
Somatic-voluntary. contraction of ms. motor control. |
Afferent fibers | sensory. info to the CNS.
somatic afferent-to CNS-skin, skeleton, joints, |
Efferent fibers | Motor-leaves CNS
Somatic efferent-skeletal ms's.
Viseral efferent fibers- heart, smooth ms, glands, to autonomic sys. |
Neurons | Dendrites receive, Axons conduct. |
Node of Ranvier | space btw mylein
exposed 2 extracelluar fuild.
Where the gates open!! |
Spinal cord-how long and how many nerves? | 31 pairs of nerves
runs to medulla-L1/L2
18"
Gray matter inside-unmyleinated axon. cell bodies. |
Sensory coming in from where? | Dorsal roots gangila.
Motor coming out-Ventral. |
Reflex arch? | quick response. |
Lateral spinothalamic tract | pain/temp |
Lateral Corico tract* | BIG AIS motor-distal- |
UMN vs LMN | UMN-synapse w.inhibitory
hyper reflexia, hypertonia (babinski)
LMN-directly to Ms. Hypotonia. |
Flaccid- | no resistance, |
Cranial nerve VIII | Vestibulocochlear
balance, auditory sensations from inner ear. |
Cranial nerve XII | Hypoglossal
motor to tongue |
X cranial nerve | Vagus nerve-only cranial nerve to descend below neck. autonomic. throacic and abdom organs. |
Cranial nerve IV | Trochlear- motor for chewing |
area of brain which has cardiac, vasomotor, and respiratory centers. | Medulla |
Hypothalmus is which part of the brain? | Diencephalon |
Area of brain which can modify the respiratory phythmicity center and contains 4 nuclei? | PONS |
Cognitive, problem solving, are functions of what area of the brain? | Parietotemporal ass cortex |
Crutch palsy is from compression of which nerve? | radial |
Primary motor area is where? | frontal lobe and is the source of most of the corticospinal tract neurons. |
Brocas area is | area of the cerebral cortex which provides motor control of the mouth, tongue, and larynx for speech. |
Wrenicke's are is? | comprehension of spoken language |
The primary somatosensory area receives info regarding? | touch, pain, temp, proprioception |
Cerebellum | compares intended movement with actual movement.
adjusts UMN activity.
helps w balance and coordination |
Gyri are | Convolutions |
Sulci are | shallow grooves |
The longitudinsal fissures separates | the cerebral hemspheres; the transverse. |
Taste is interpreted in what lobe? | parietal lobe |
Cerebral cortex | outer 2-5mm of the cerebrum. contains 75% of all neuron cell bodies. |
Prefrontal association area deals with | executive function and goal oriented behavior |
Thoracic plexus | is not considered a nerve plexus |
Commissural (cerebral white fiber) | cross to the opposite cerebral hemisp |
Association fiber | Stay w in same hemisphere |
Projection fiber | leave the cerebrum and descend towards spinal cord. |
LMN | cell bodies in SC or brainstem
communicate directly w skeletal ms.
Loss of reflexes-LMN
Hyperreflexia-LMN
Hypertonia-LMN |
UMN | Cell bodies in the cerebral cortex or brainstem. (rubrospinal tract)
UMN can inhibit LMN or modify them. |
Fasiculation | quick twitches of ms fibers visible under skin. |
Rigidity | type of hypertonia..
amt of resistance to passive stretch dont matter of velocity |
Hyperreflexia | ms spindle stretch leads to overactivity of lmn's |
Clasp-knife | strong resistance to stretch and then sudden give. |
Basal gangial masses of what kind of matter? | Gray matter
can adjust descending tracts activity
can provide subconscious control of ms tone and coordination. |
What neurotransmitter is lacking in Parkinsons? | Domonphine |
Auto immune disease that kills basal ganglia cells, leading to hyperkinesia? | Huntington's |
What gland scretes melatonin? | pineal gland |
Large tract of commissural fibers in brain? | Corpus collum |
Afferent | toward CNS |
Efferent | away CNS |
AP- | refers to a wave of charge that propagates alone axon of neuron til its reaches axon terminal. |
Microglia cell | a neuroglia cell of the CNS that breaksdown pathogens. |
Absolute refractory period | the cell cant respond to other stimi at this time.
it coincides w the ap and lasts for 1 millisecond. |
the parasympathic system is responsible for energy conservation | the sympathic sys is responsible for expenditure of energy. |
how long does the relative refractory period last? | 10-15 millisecs after an AP |
-90mV | hyperpolarization |
Acetycholine | is a neurontransmitter is the PNS that is a big conveyor of info and is always excitstory at th neuormuscular juction. |
Divergence | 1 pre-synptic neuron synapsing w MANY post syn. |
Sodium potassium pump, pumps sodium | out and potassium into the cell |
Neuroblastoma is | cancer of neurons |
Where are the abundant voltage gated Na+ and K+ channels? | at the axon and node of ranvier. |
Filum terminale | is ct from the end of the sc to the S2 level |
Which horn houses sensory endings and cell bodies of 2nd order sensory neurons? | dorsal horn
dorsal root consists of afferent fibers |
anterior/ventral roots consists of what fibers? | efferent |
Decussation pyramids | many sensory or motor tracts cross over here |
Perineurium | is a ct that wraps around a fascicle of nerve fibers (axons) |
Tectospinal | controls movements of the head in response to visual/auditory stimi. |
Spinocerebellar | unconscious proprioception |
upper truck, neck, vibration, kinesthesia, | Fasiculus cuneatue |
lateral spinothalamic | pain/temp |
lateral corticospinal | precise contraction of distasl extremities |
Rubrospinal | contralateral UE flexors and gross postural tone |
Vestibulospinal | regulates ms tone in response to head movement, balance. |
Anterior spinothalamic | crude touch and pressure |
Circle of willis info | There are some watershed areas in the brain located at the ends of the vascular sys. Problems with blood supply r here,
Blockages in the water shed areas can cause transcortical aphasia |
transcortical aphasia | from lesions outside of Broca's area or Wernicke's area of the cerebral cortex. |
aphasia | Loss of ability to understand or express speech, caused by brain damage |
Resting membrane potential? | -70mV |
Hyperpolerization threshold? | -90mV |