Neuro.sleep&coma

Front 1

Maintenance of consciousness is dependent of the _ system.
Activation of this group is largely by ___.

Back 1

ARAS - ascending reticular arousal system

Sensory stimulation (although with continuous stimulation, you eventually get sensory resistance)

Front 2

There are 5 NTs associated with the ARAS, what are they?

Back 2

Norepinephrine (from locus coeruleus)

Serotonin (from rostrally projecting raphe nuclei)

ACh (most active during waking state and REM sleep)

Histamine (tuberomammilary nucleus)

Orexin (Hypothalamus, controls sleep cycles)

Front 3

The circadian variation in wakefulness is controlled through the ___

Back 3

ventrolateral preoptic nucleus.

Front 4

____ in the hypothalamus sends regulatory neurons containing ___ to the brainstem reticular formation. This neurotransmitter promotes wakefulness

Back 4

Tuberomammillary nucleus

Orexin

Front 5

Non REM sleep can be divided into _ stages on the basis of EEG. In general, this consists of a gradual change from a __ to __ state

Back 5

4

desynchronized to a synchronized

Front 6

Stage 1 of NREM sleep is dominated by _ waves.

Back 6

Theta

this lasts for 10 min or less, and the subject is easily awakened

Front 7

Stage 2 of NREM sleep contains ___, generated from the __

Back 7

sleep spindle complexes

thalamus

Front 8

Stages III and IV are _ wave

Back 8

Slow or delta wave

The patient is in deep sleep, and they are difficult to awaken

Front 9

During NREM, there is a decrease in _, _, _, and _.
Muscle tone is _, and spinal reflexes are _

Back 9

respiration, heart rate, blood pressure, and thermal regulation ability.

reduced (present in neck muscles),
active

Front 10

NREM is associated with _ functions

Back 10

restorative

Front 11

During REM sleep, what is muscle tone like? What about muscle reflexes?

Back 11

There is a profound inhibition of muscle tone, particularly in postural muscles

Muscle reflexes will be absent, except for ocular, respiratory, and middle ear muscles. However, phasic muscle twitches may also be present.

Front 12

REM sleep can be used to clinically distinguish physiological and psychological ____

Back 12

impotence

Penile and clitoral erection are REM features

Front 13

REM sleep is terminated by a gradual increase in the activity of __ and _ systems

Back 13

noradrenergic and serotinergic

Front 14

Falling asleep involves a general inactivation of ascending systems:
Pedunculopontine area, containing ___; Locus Coeruleus containing ___; Raphe Nuclei containing ____ ; and tuberomammillary nucleus (of the hypothalamus) containing ___.

Back 14

Acetylcholine
NE
Serotonin
Histamine

Front 15

REM sleep is induced by inhibiting ___ systems and activating _

Back 15

aminergic
acetylcholine

Front 16

The rapid eye movements in REM sleep are produced by activation of the ___ reticular formation

Back 16

paramedian pontine

Front 17

Muscle atonia is modulated through a __ mediated mechanism.

The decreased sensitivity is produced by directly inhibiting the _ nuclei and the _

Back 17

glycine

dorsal column nuclei and the periaqueductal grey

Front 18

The phasic muscle twitches are believed to be produced through activation of the ____

Back 18

pontine reticulospinal tracts

Front 19

_ is similar to the atonia of REM sleep or sleep paralysis, but consciousness is intact.

These attacks may by triggered by ___

Back 19

Cataplexy

strong emotional expression (particularly laughter)

Front 20

Narcolepsy and cataplexy are related to genetic causes that result in an alteration of __ containing neurons or their receptors,

Back 20

orexin

Front 21

Parasomnias (sleep talking or walking) typically occur during which phase of sleep?

Back 21

NREM...typically stage IV

Front 22

Lesions of the brainstem involving disturbances of consciousness must be __

Back 22

bilateral

Front 23

In upper brainstem lesions of the ARAS, there is continuous ___, they are in a vigilant coma - meaning __ but no __ movements.
These states include _, slow _, and an EEG with _ waves

Back 23

hypersomnia
eye movements, but no conscious movements
muscular relaxation, slow respiration, large amplitude, slow waves

Front 24

Lower brainstem (medulla) lesions involving the ARAS involve _ and _ responses and are therefore _.

Back 24

cardiac and respiratory responses

Fatal

Front 25

A drug induced coma, or anesthetic state means what? (4)

Back 25

1. loss of sensory perception
2. no motor activity
3. reduced muscle tone
4. loss of consciousness

Front 26

With the Glasgow Coma scale, coma is defined by a score of _ or below.

Back 26

8

Front 27

Lesions above the diencephalon may result in ____

Back 27

Cheyne-Stokes respiration

This is due to a decrease in sensitivity of the pCO2, breathing pattern consists of apnea gradually moving to hyperapnea, then back again.

Front 28

Lesions at the pons midbrain junction can produce central ___.

This is characterized by __

Back 28

neurogenic hyperventilation.

continuous and rapid respirations

Front 29

Lesions of the __ can cause apneuristic respirations.

Damage at slightly lower levels may result in ___ breathing

Back 29

Dorsal Pons (parabrachial)

cluster

Front 30

___ respiration signifies lower pontine or medullary respiratory center disruption

Back 30

Ataxic respiration (irregular breathing patterns)

This usually leads to respiratory arrest (death)

Front 31

In a persistent vegetative state, the patient has intermittent wakefulness manifested by the presence of __

Back 31

sleep wake cycles

Front 32

The principle causes of brain death in adults are _ and _.

Back 32

traumatic brain injury and subarachnoid hemorrhage.
In children, its abuse

Front 33

Spinal cord based reflex movements are absent in patients who are brain dead (T/F)

Back 33

False. These reflexes are still present, The body may flex at the waist, twitch, turn the head, persistent Babinski, tendon abdominal and cremasteric reflexes.

Front 34

For patients who are brain dead, an EEG shows electrical activity that is absent at levels higher that _ microvolts

Back 34

2