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73 Cards in this Set

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Chap 12

What do the three semicircular ducts in the ear do?
They respond to angular acceleration and deceleration of head.
Chap 12

What do the hair cells of the kinetic labryinth respond to?
Hair cells respond to endolymph flow.
Chap 12

What direction flow of endolymph across the hair cells is a stronger stimulus?
Flow towards the ampulla is stronger than flow away from the ampulla.
Chap 12

What is vestibular (horizontal) nystagmus?
As with all nystagmus it is mediated by the vestibular nuclei, MLF, ocular motor nuclei, and CN III, IV, and VI.

Horizontal nystagmus:
fast phase: in direction of rotation
slow phase: opposite direction
Chap 12

What is horizontal (postrotatory) nystagmus?
As with all nystagmus it is mediated by the vestibular nuclei, MLF, ocular motor nuclei, and CN III, IV, and VI.

Fast phase: opposite direction of rotation
Slow phase: direction of rotation
Chap 12

What happens in caloric nystagmus?
Stimulation of external auditory meatus with cold water causes nystagmus to the opposite side.

Mneumonic: COWS (cold opposite, warm the same)

Stimulation with warm water causes same side nystagmus.
Chap 12

With nystagmus what will happen in a patient with a brain stem infarct compared to someone with a bilateral MLF lesion and a low brain stem lesion:
Brain stem: nystagmus with both eyes toward the irrigated side.

MLF (bilateral): eye closest to the irrigation abducts towards the irrigation.

Low brain stem lesion: no nystagmus occurs (vestibular nuclei, MLF, ocular motor nuclei, and CN III, IV, and VI are all dysfunctional-MOW)
FA, p.343

What does perilymph consist of?
Perilymph: Na rich (similar to ECF)
FA, p.343

What is the temporal bone's bont labyrinth filled with?

What is the membraneous labyrinth (which is inside the bony labyrinth) filled with?
Bony labyrinth: perilymph (Na rich)

Membranous labyrinth: endolymph (K rich)
FA, p.343

What does the membranous labyrinth consist of (tubes)?
Membranous labyrinth:
1. endolymph
2. cochlear duct (within cochlea)
3. Utricle (within vestibule)
4. saccule (within vestibule)
5. semicircular canals
FA, p.343

What does the bony labyrinth consist of?
Bony labyrinth:
1. cochlea
2. vestibule
3. semicircular canals
4. membranous labyrinth
FA, p.343

What important area is in the semicircular canal?
Semicircular canals: contain the Ampulla (detect Angular acceleration)
FA, p.343

What is the main sensory element of the vestibular apparatus and the cochlea? What information does it transmit?
Both: Hair cells

Vestibular apparatus: spatial orientation

Cochlea: hearing
FA, p.343

Describe the base and apex of the cochlea:
What type of sound is picked up in the base of the cochlea?
Apex of the cochlea?
Base of cochlea (narrow and stiff): High frequency sound

Apex of cochlea (wide and flexable): low-frequency sound
FA, p.343

What detects linear acceleration?
Utricle and saccule
FA, p.343

In hearing loss of the elderly, what frequency do they lose first?
Lose high frequency first
FA, p.343

Describe the three structures that form the blood brain barrier:
BBB:
1. tight junctions between nonfesetrated capillary endothelial cells
2. basement membrane
3. astrocyte processes
FA, p.343

What two things can cross the BBB using carrier-mediated transport?
glucose and AA's
FA, p.343

Both nonpolar and polar substances can cross the BBB - which crosses more readily?
Nonpolar substances cross more readily
FA, p.343

There are a few specialized brain regions with fenestrated capillaries and no BBB allowing blood to affect brain function, what are these two areas?
1. area postrema: vomiting after chemo
2. neurohypophysis: ex. ADH release (other neurosecretory products can enter circulation)
FA, p.343

Other than the BBB, what are two other barriers in the body?
Other barriers:
1. blood-testis barrier
2. maternal-fetal blood barrier of placenta
FA, p.343

What can an infarction do to the BBB?
It can damage the BBB by destroying endothelial cells tight junctions resulting in vasogenic edema.
Cranial Nerves

What is the only sensory nerve that has no precortical relay in the thalamus?
Olfactory nerve
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN I:
Nerve: Olfactory

Function: smell

Type: Sensory

Mneumonic: Some
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN II
Nerve: Optic, II

Function: Sight

Type: Sensory

Mneumonic: Say
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN III
Nerve: Oculomotor

Function: Eye movement, pupil constriction, accomodation, eyelid opening

Type: Motor

Mneumonic: Marry
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN IV
Nerve: Trochlear, CN IV

Function: Eye movement

Type: Motor

Mneumonic: Money
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN V
Nerve: Trigeminal

Function: Mastication, facial sensation

Type: Both

Mneumonic: But
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN VI
Nerve: Abducens

Function: Eye movement

Type: Motor

Mneumonic: My
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: VII
Nerve: Facial, CN IV

Function: Facial movement, taste from anterior 2/3 of tongue, lacrimation, salivation (submaxillary and sublingual glands), eyelid closing

Type: Both

Mneumonic: Brother
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: VIII
Nerve: Vestibulocochlear

Function: Hearing, balance

Type: Sensory

Mneumonic: Says
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: IX
Nerve: Glossopharyngeal, IX

Function: Taste from posterior 1/3 tongue, swallowing, salivation (parotid gland), monitoring carotid body, and sinus chemo- and baroreceptors

Type: Both

Mneumonic: Big
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: X
Nerve: Vagus, CN X

Function: Taste from epiglottic region, swallowing, palate elevation, talking, thoracoabdominal viscera

Type: Both

Mnemonic: Brains
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: XI
Nerve: Accessory, CN XI

Function: Head turning, shoulder shrugging

Type: Motor

Mneumonic: Matter
Cranial Nerves
FA, p.354
What is the function, type, and mneumonic for:

CN: XII
Nerve: Hypoglossal

Function: Tongue movement

Type: Motor

Mneumonic: Most
FA, p.354

What are the two cranial nerve nuclei in the midbrain?
Midbrain:
CN III
CN IV
FA, p.354

What are the five cranial nerve nuclei in the pons?
Pons:
CN 5, 6, 7, 8
FA, p.354

What are the four cranial nerve nuclei in the medulla?
Medulla:
CN 9, 10, 11, 12
FA, p.354

What is the function of the nucleus Solitarius?
visceral Sensory informatin (eg taste, baroreceptors, gut distentions):

CN 7, 9, 10
FA, p.354

What is the function of nucleus aMbiguous?
nucleus aMbiguus:
Motor innervation of pharynx, larynx, and upper esophagus (eg swallowing, palate elevation)

CN: 9, 10, 11
FA, p.354

What does a dorsal motor nucleus do?
Sends autonomic (parasympathic) fibers to heart, lungs, and upper GI
FA, p.355
Cranial pathways: CN?

Cribriform plate
CN I
FA, p.355

What five nerves run through the middle cranial fossa?

What bone do these nerves run through?
Middle cranial fossa: CN II-VI

Runs through the sphenoid bone
FA, p.355

Within the middle cranial fossa, what five holes/canals, have nerves/vessels running through them?
Middle cranial fossa:
1. optic canal: CN II, ophthalmic artery, central retinal artery
2. superior orbital fissure (CN 3, 4, V1, 6, opthalmic vein)
3. foramen rotundum (CN V2)
4. foramen ovale (CN V3)
5. foramen spinosum (middle meningeal artery)
FA, p.355

What is the mneumonic for the holes that CN V1, V2, and V3 runs through?
Standing Room Only

S: superior orbital fissure (V1, III, IV, VI, opthalmic vein)

R: foramen Rotundum (V2)

O: Ovale (V3)
FA, p.355

That six cranial nerves run through the posterior cranial fossa?
CN 7, 8, 9, 10, 11, 12 (runs through the temporal or occipital bone)
FA, p.355

Within the posterior cranial fossa, what six nerves runs through which openings?
Posterior cranial fossa (CN VII-XII)
1. internal auditory meatus (CN 7, 8)
2. jugular foramen (CN 9, 10, 11, jugular vein)
3. hypoglossal canal (CN 12)
4. foramen magnum (spinal roots of CN 11, brainstem, vertebral arteries)
Chap 13

Lesions of the olfactory pathway:
Cause ipsilateral anosmia
Chap 13

Lesions of the oculomotor nerve:
Causes:
1. ptosis (denervation of levator palpebrae
2. looks "down and out" (extraocular muscle damage) -- diplopia
3. pupil is fixed, dilated, and can't accomidate (interruption of parasympathetic innervation)
3.
Chap 13

Three most common causes of CN III impairment:
CN III:
1. uncal herniation
2. aneurysms - esp. of carotid and posterior communicating arteries.
3. diabetes mellitus: damages central fibers but spares the pupilloconstrictor fibers.
FA, p.356

What are the muscles of mastication?

Innervation?
Muscles of mastication:

The three muscles that close the jaw:
Masseter, teMporalis, Medial pterygoid.
+
One muscle that opens mouth: Lateral pterygoid

All are innervated by the trigeminal nerve (V2)

Mneumonic: M&M's munch and Lateral Lowers (when speaking of pterygoids with respect to jaw motion).
High Yield Vignettes:

Patient presents with decreased pain and temperature sensation over the lateral aspects of both arms.

What is the lesion?
Syringomyelia
High Yield Vignettes:

Penlight in patient's right eye produces bilateral pupillary constriction. When moved to the left eye, there is paradoxical dilation.

What is the defect?
Atrophy of the left optic nerve
High Yield Vignettes:

Patient describes a decreased prick sensation on the lateral aspect of her leg and foot.

A deficit in what muscular action can also be expected?
Dorsiflexion and eversion of foot (common peroneal nerve).
High Yield Vignettes:

Elderly women presents with arthritis and tingling over the lateral digits of her right hand.

What is the diagnosis?
Carpal tunnel syndrome, median nerve compression
High Yield Vignettes:

20 year old dancer reports a decreased plantar flexion and decreased sensation over the back of her thigh, calf, and lateral half of her foot.

What spinal nerve is involved?
Tibial (L4-S3)
High Yield Vignettes:

Women involved in a motor vehicle accident cannot turn her head to the left and has right shoulder droop.

What structure is damaged?
Right CN XI (runs through the jugular foramen with CN IX and X), innervating sternocleidomastoid and trapezius muscles.
High Yield Vignettes:

Man presents with one wild, flailing arm.

Where is the lesion?
Contralateral subthalamic nuclei (hemiballismus).
High Yield Vignettes:

Patient with coritical lesion does not know that he has a disease.

Where is the lesion?
Right parietal lobe
High Yield Vignettes:

Patient cannot protrude tongue toward left side and has a right-sided spastic paralysis.

Where is the lesion?
Left medulla, CN 12
High Yield Vignettes:

Teen falls while rollerblading and hurts his elbow. He can't feel the medial part of his palm.

Which nerve and what injury?
Ulnar nerve due to broken condyle.
High Yield Vignettes:

Field hockey player presents to the ER after falling on her arm during practice. X-ray shows midshaft break of the humerus.

Which nerve and which artery are most likely damaged?
Radial nerve and deep brachial artery, which run together.
High Yield Vignettes:

Patient cannot blink his right eye or seal his lips and has mild ptosis on the right side.

What is the diagnosis and which nerve is affected?
Bell's palsy, CN VII
High Yield Vignettes:

Patient complains of pain, numbness, and a tingling sensation. On exam, she has wasting of the thenar eminence.

What is the diagnosis, and what nerve is often affected?
Carpal tunnel syndrome; median nerve.
High Yield Vignettes:

Women presents with headache, visual disturbance, galactorrhea, and amenorrhea.

What is the diagnosis?
Prolactinoma
High Yield Vignettes:

43 yo man experiences dizziness and tinnitus. CT shows enlarged internal acoutic meatus.

What is the diagnosis?
Schwannoma
High Yield Vignettes:

25 yo female presents with sudden uniocular vision loss and slightly slurred speech. She has a history of weakness and paresthesias that have resolved.

What is the diagnosis?
Multiple sclerosis
High Yield Vignettes:

10yo child "spaces out" in class (eg stops talking midsentence and then continues as if nothing had happened). During spells, there is slight quivering of lips.

What is the diagnosis?
Absence seizures
FA, p.366

CN XI lesion?
Tongue deviates toward side of lesion (lick your wound)
FA, p.366

CN V motor lesion?
Jaw deviates toward the side of lesion
FA, p.366

Unilateral lesion of the cerebellum?
Patient tends to fall toward the side of the lesion
FA, p.366

CN X lesion?
Uvula deviates away from side of lesion
FA, p.366

CN XI lesion?
Weakness turning head to contralateral side of lesion.

Shoulder droop on side of lesion.