Neuro

Front 1

Functions of the frontal lobe:

Back 1

planning and excecution of motor tasks

personality (reasoning & planning)

Damage to the frontal lobe causes aphasia

Broca's lesions cause broken speech

contains broca's area - responsible for speech production

Front 2

Functions of the Parietal lobe:

Back 2

Sensory activity and recognition

A patient with a parietal lobe lesion would be able to tell you that a pen is used for writing, but would be unable to call the object a pen.

Front 3

Functions of the Temporal Lobe:

Back 3

Auditory stimuli, speech

Hippocampus: memory and spatial orientation

Wernicke's area - wordy speech - words due not make any sense.

Front 4

Function of the medulla:

Back 4

Controls autonaumic functions like heart rate, digestion, breathing.

UPPER MEDULLA: contains the PYRAMIDS and the MEDIAL LEMISCUS

the MEDIAL LEMISCUS is made up of the gracillus and cuneate fasciculi, which carry information about lower body of trunk respecitvely

The MLF (medial longitudianl fasiculus) relays vestibular information to EOMs and coordinates VOR.

LOWER MEDULLA: pyramids, olivary nuclei (learning and memory), vestibular nuclei

Front 5

Function of the pons:

Back 5

Pons coordinate movement related information and relay it to other areas of the brain.

It is the location of the PONTINE NUCLEI, which serve as relay stations for motor information transferred between the cortex and the cerebellum.

Location of cranial nerves V-VIII

Front 6

Function of the midbrain:

Back 6

Midbrain SIRE - superior & inferior colliculus, Red nucleus, & EWN

the midbrain controls an array of sensory and motor funtions, including the coordination of eye movement and visual reflexes.

The upper midbrain is the location of the superior colliculus, which controls eye and head movements.

Red nucleaus - which controls movement of the arms and the oculomotor nuclei

The edengerwestphal (III) nuclei contribute to the parasympathetic innervation of the iris.

The lower midbrain contains the inferior colliculus, which is responsible for reflex response head/neck to auditory stimuli, as well as teh cranial nerve IV nucleus which provides innervation to the contralateral eye.

Front 7

A lesion to the OCULOMOTOR NUCLEUS or the EWN would result in the loss of all EOMs except_____________

Back 7

superior oblique and lateral rectus

Front 8

Paton's Folds

Back 8

Circumferential retinal folds -Papilledema

Front 9

Pathogenesis of papilledema

Back 9

axoplasmic stasis as a result of elevated cerebrospinal fluid pressure in the SUBARACHNOID space of the INTRAORBITAL portion of the optic nerve.

PAPILLA - SUBA - INTRA

Front 10

Most common causes of papilledema

Back 10

Papilledema CHIPT:

Compromised venous flow
Hypertension (malignant)
Inflammatory
Pseudotumor
Tumor

Front 11

Define orthograde degeneration as it relates to an atrophic optic nerve.

Back 11

From eye to brain -

Sufficient damage to retinal ganglion cells causing nerve pallor to develop.

Examples are PRP & CRAO

Front 12

Define retrograde degeneration as it relates to an atrophic optic nerve.

Back 12

From brain to eye -

Damage to the retrobulbar optic nerve eventually causing pallor to the optic nerve. An example of this is pituitary tumor.

Front 13

What are the risk factors for NAION?

Back 13

HTN, DM, hypercholesteremia, disc at risk

Diabetic papillopathy is a form of NAION without the vision loss.

Front 14

Define Optic Neuritis

Back 14

Primary inflammation of the optic nerve.

Usually occurs between the ages of 20-45, female predilection

Sings: unilateral, rapid vision loss, PAIN on eye movement, +APD

Vision will likely return to normal, patient will have a pale optic nerve and decreased contrast sensitivity

Associated with MS

Front 15

Define Internuclear ophthalmoplegia

Back 15

Due to a lesion of the MLF resulting in no ABduction on the ipsilateral side and possible nystagmus on the contralateral side. Convergence may or may not be intact.

MS patients may suffer from INO

Front 16

Define Neuroretinitis

Back 16

anterior optic neuritis with a stellate macular star

infectious/immune mediated: CAT SCRATCH FEVER, histoplasmosis, toxoplasmosis

CAT SCRATCH FEVER - PARINAUD'S OCULOGLANDULAR SYNDROME (granulomatous palpebral conjunctivitis) & NEURORETINITS

Front 17

Name the two EOMs most often affected by Graves Disease.

Back 17

Inferior and Medial Recti

Front 18

NO SPECS grading system for Graves:

Back 18

N - no signs or symptoms
O - only signs such as upper lid retraction
S - soft tissue involvement, such as lid edema, lagophthalmos, conjunctival chemosis
P - Proptosis
E - EOM involvement
C - Corneal involvement
S - slight loss, likely due to optic nerve compression

Front 19

What is considered normal for exophthalmometry?

Back 19

whites 12-22, African Americans 12-24, Asians 12-18

also considered abnormal if the asymmetry is >3 mm

Front 20

Define malignant hypertension.

Back 20

Papilledema wtih dangerously high blood pressure - send to the ER

Always check blood pressure on papilledema patients.

Front 21

Foster - Kennedy syndrome

Back 21

Due to frontal lobe lesion

one eye has acuity loss while the other eye has disc edema

Front 22

Name the possible causes of pseudotumor

Back 22

CANT - as in I CANT find the cause of pseudotumor

Contraceptives
vitamin A
Naladixic acid
Tetracycline

Front 23

Define Optic Nerve Pit.

Back 23

depression of the disc, usually inferior/temporal; unilateral; can develop a serous detachment extending from the pit to the macula; asymptomatic unless macula is involved.

Front 24

Morning Glory Syndrome

Back 24

unilateral, enlarged, funnel-shaped, excavated disc; poor acuity

Front 25

Melanocytoma

Back 25

Optic Nerve Tumor - darkly pigmented tumor lying adjacent to or on top of the optic nerve

Front 26

Optic Nerve Sheath Meningioma

Back 26

Generally benign; young, middle-aged women; typically unilateral; first is SWOLLEN and then PALE; progressive visual loss

Meningioma - think middle aged women

Front 27

Optic Nerve Glioma

Back 27

If present in childhood, it is benign. If present in adulthood, it is malignant. Can be associated with neurofibromatosis.

Front 28

Which CN is responsible for efferent response of the pupil?

Back 28

CN III

Front 29

Which CN is responsible for afferent response of the pupil?

Back 29

CN II

Front 30

Differentials if pupil is mitotic in the dark:

Back 30

Horner's

Uveitis

Argyll Robertson Pupil - (accommodative response present)

Front 31

Differentials if the pupil is fixed and dilated - bigger in the light:

Back 31

Adie's Tonic Pupil

CN III (with ptosis & diplopia)

Trauma to sphincter after intraocular surgery

Front 32

If the pupil constricts with 0.125% pilocarpine

Back 32

Patient has Adie's Tonic Pupil

Front 33

Describe Adie's Tonic Pupil:

Back 33

Common in ages 20-40 years, more common in females.

Lesion is located in the ciliary ganglion or ciliary nerves

Front 34

Describe Argyll Robertson Pupil

Back 34

Associated with NEUROSYPHILIS, diabetes, alcoholism.

Lesion of the tectotegmental tract - carries information from pretectal nuclei to EWN

Begins unilateral and becomes bilateral with time

Light - near dissociation

Front 35

Describe Horner's Syndrome

Back 35

Mitotic pupil

Lesion of the sympathetic pathway - most notable in Pancoast's tumor at the apex of the lung

Cocaine does NOT cause dilation in a patient with Horner's syndrome.

If 1% Hydroxyamphetamine fails to dilate a Horner's pupil, then a postganglionic lesion is suspected.

Front 36

Hutchison's Pupil

Back 36

Unilateral, dilated pupil in a comatose patient.

Commonly a result of an ipsilateral tumor or subdural hematoma that is compressing on the outside of the CN III (location of pupillary fibers)

Front 37

Superior Division of CN III

Back 37

innervates the levator and the superior rectus

SUPERIOR division innervates the SUPERIOR rectus and the levator which elevates the lid SUPERIORLY

Front 38

Inferior Division of CN III

Back 38

innervates the inferior rectus, medial rectus, inferior oblique and the parasympathetic pupil fibers run with this division, as well

INFERIORS AND MEDIALS

Front 39

Complete lesion to CN III

Back 39

Down and out with ptosis

Front 40

Lesion to CN III involving the pupil

Back 40

most often a compressive lesion

Front 41

MOA Alpha 1:

Back 41

increases IP3, which increases intracellular ca2+

Found in radial muscle of iris, vascular smooth muscle, & GI tract

Front 42

MOA Alpha 2:

Back 42

Inhibits Adenyl cyclase, decreases cAMP

Presynaptic adrenergic neurons, GI tract wall

Front 43

Beta 1 MOA:

Back 43

Stimulates adenyl cyclase, increases cAMP

Located Heart, Sallivary Glands, Adipose tissue, Kidneys

Front 44

Beta 2 MOA:

Back 44

Stimulates adenyl cyclase, increases cAMP

Located Bronchioles, GI tract, Bladder wall, Vascular SM

Front 45

Nicotinic Cholinoreceptors

Back 45

Nicotinic Receoptors have a NAK for being unique

Opens Na and K channels - causes depolarization

Nicotinic Receptors are UNIQUE - they are the only receptors that open Na and K channels. The other receptors either increase calcium or adenyl cyclase.

Located: skeletal muscle, motor end plate, postganglionic neurons, SNS and PNS, Adrenal Medulla

Front 46

Muscarinic MOA:

Back 46

Increases IP3, increasing intracellular calcium

Located: Vascular SM, sweat glands, PNS effector organs

Front 47

What are the ocular structures supplied by the sympathetic system?

Back 47

IRIS DILATOR,
ciliary muscle,
SMOOTH MUSCLE OF LIDS,
lacrimal gland,
and choroidal and conjunctival blood vessels.

Front 48

What are the ocular structures supplied by the parasympathetic system?

Back 48

sphincter,
ciliary muscle,
lacrimal gland,
blood vessels

Parasympathetic and sympathetic innervation to ciliary muscle, lacrimal gland, & blood vessels.

Front 49

Sympathetic pathway to ocular structures:

Back 49

T1-T3 - ventral root - superior cervical ganglion - internal carotid plexus - enters skull through carotid canal

Internal Carotid Plexus - 3 Divisions:
1. Ophthalmic division - Nasociliary nerve - long ciliary nerve to iris dilator & sympathetic root to ciliary ganglion to short ciliary nerves to choroidal blood vessels
2. Oculomotor nerve - Superior tarsal muscle (widening of palpebral fissure)
3. Deep Petrosal nerve - pterygopalatine ganglion - maxillary nerve - zygomatic nerve - lacrimal nerve - lacrimal gland blood vessels

Front 50

Parasympathetic pathway to ocular structures:

Back 50

EWN in midbrain - hitch ride with oculomotor fibers following the inferior division of the nerve into the orbit - leave the inferior division and enter the ciliary ganglion as the parasympatheic root.

Front 51

Describe the visual pathway.

Back 51

axons of gangion cells leave the retina via the optic nerve - the nasal fibers cross in the optic chiasm and terminate in the opposite side of the brain. The optic tract carries these fivers from teh chiasm to the LGN, where the next synapse occurs. The fibers leave the LGN as the optic radiations that terminate in the visual cortex of the occipital lobe.

Front 52

Define homonymous.

Back 52

A defect that affects the nasal field of one eye and the temporal field of the other eye is described as homonymous.

Front 53

The defects in a homonymous field are ___________ if the defects are similarly shaped and __________ if the defect shapes are disimilar.

Back 53

congruent, incongruent