Pbl Test 4

Front 1

there are ___ bones in body, made of __% organic (mostly __) and __% inorganic compounds

Back 1

206...25%...collagen I....75%

Front 2

intestinal absorption of calcium is 2 types: ___, and ___ dependent

Back 2

facilitated....calcitrol

Front 3

Osteoclast formation needs 2 signalling proteins: ___ (can cause osteoclast ___ or can "decoyed" into binding with ___) and ___

Back 3

RANK ligand...maturation... osteoprotegerin....M-CSF

Front 4

25% of ___ bone is remodeled, but only 3% of ___ bone is remodeled.. so problems remodeling can effect bones like ___

Back 4

trabecular...cortical...vertebrae

Front 5

remodeling is carried out by ___ consisting of osteoblasts and osteoclasts

Back 5

BMU's (basic multicellular units)

Front 6

problems remodeling can be r/t a ___ deficiency. Also important is ___ consumption

Back 6

carbonic anhydrase....OH-

Front 7

___ are a good indicator of total body bone resorption

Back 7

collagen I metabolites

Front 8

absorption of bone releases ___ that activate osteoblasts, which secrete ___ to get rid of ___

Back 8

cytokines...alkaline phosphatase...pyrophosphate

Front 9

after becoming osteocytes, they release ___ to inhibit bone formation

Back 9

sclerostin

Front 10

when the __ of parathyroid glands sense low Ca, PTH is released. FASTEST effect is on the kidney to ___ and ___. Slower effects are for osteoblasts to make more ___ and less ___. Also it indirectly increases intestinal absorption of Ca/phosphate via ___.

Back 10

CaSR...increase Ca reabsorption....decrease phosphate reabsorption.... RANKL...OPG... Vitamin D

Front 11

PTH also has paradoxical effect of increasing ____ survival. Brief PTH elevation causes ___

Back 11

osteoblast... bone formation

Front 12

active Vitamin D is created in ___ and increases intestinal Ca absorption via ___, ___, and ___

Back 12

proximal tubule, luminal Ca pump, basal Ca pump, and Calbindin

Front 13

Calcitrol also inhibits ___

Back 13

PTH

Front 14

FGF23 increases ____ and suppresses ___. FGF23 is categorized as a ____

Back 14

renal clearance of phosphate...calcitrol...phosphatonin

Front 15

calcitonin from __ of ___ of ___ directly inhibits ___

Back 15

C cells...parafollicle space...thyroid...osteoclasts

Front 16

glucocorticoids decreases ___ activity and to a lesser extent also ___ activity

Back 16

osteoblast...osteoclast

Front 17

thryoid hormones in excess increases ____

Back 17

bone turnover

Front 18

estrogen inhibits ___ production. Also causes __ apoptosis and inhibits ___ apoptosis

Back 18

RANKL...osteoclast...osteoblast

Front 19

areal bone mineral density scan (aBMD) can be measured against your demographic (__ score) or a healthy young person (__ score). Compared to T score, 1-2.5 SD below is ___, greater than 2.5 SD below is ___

Back 19

Z score.... T score... osteopenia...osteoporosis

Front 20

since trabecular bone is more affected, which bone is more affected: appendicular or axial?

Back 20

axial

Front 21

paget's disease is ____... test with ___

Back 21

too much local bone turnover....ALP

Front 22

chronic renal disease can cause secondary ___, because of inadequate ___, and too much ___ that can cause more secreted ___

Back 22

hyperparathyroidism....vitamin D.... phosphate... FGF23

Front 23

antiresorptive agents don't really cause an increase in ___ except ___ inhibitors

Back 23

bone tissue....cathepsin K inhibitors

Front 24

HRT is ___ , but can cause ___ tenderness, ___ bleeding, increased ___, and increased ___

Back 24

hormone replacement...breast...vaginal...clotting...CA risk

Front 25

selective estrogen receptor modulators have ____ on different tissues. An example is Raloxifine, which is an estrogen agonist for __, but antagonist for ___/___. Reduces risk for ___, but still has risk of ____. Also slightly lowers ___. Does NOT reduce risk of ___

Back 25

different effects....bone...breast/endometrium..... breast cancer.... thrombosis.... LDL...non-vertebral fractures

Front 26

the "-dronate" class of drugs are ___ that are analogues of ___.They block the ___ to impair osteoclast function... side effects include ___ for oral route, and ___ for IV route. Another possible effect could be lack of ___

Back 26

biphosphates....pyrophosphate.... mevalonate pathway... pill-induced esophagitis...renal failure.... bone healing/repair

Front 27

Denosumab is a ___ that reduces ___ numbers

Back 27

RANKL antagonist...osteoclast

Front 28

synthetic calcitonin is derived from ___ and has longer __ and higher ___ . Low efficacy

Back 28

salmon...half life...affinity for receptor

Front 29

Bone anabolic agents include fluroide (increases __ bone mass, converts hydroxyapatite to ___) and teriparatide (synthetic ___)

Back 29

trabecular...fluroapatite...PTH

Front 30

secondary hyperparathyroidism secondary to chronic kidney diesease is treated with 3 classes of drugs: ___ (aluminum hydroxide, calcium carbonate, calcium acetate, sevelamer), ___ , and ___ (cinacalcet) to ___

Back 30

oral phosphate binders....calcitrol.... calcimimetics.... binds to CaSR

Front 31

significant osteoporosis can cause thoracic ___ and cervical ___ (aka ___)

Back 31

kyphosis....lordosis....dowager's hump

Front 32

cheapest biphosphate:

Back 32

alendronate

Front 33

the developed kyphosis and vertebral compression can be treated with

Back 33

cement

Front 34

bone matrix is 90% ___, and also ground substance, containing 4 major groups of proteins: ____ (like ___), ____, ____(like ___ to capture calcium and ___ to remove apoptotic cells and ____ which helps in vascular calcification development), and ____

Back 34

collagen I...proteoglycan (GAG's).... multiadhesive glycoproteins, vitamin K dependent proteins... osteocalcin... protein S... MGP... cytokines

Front 35

bones can be ___ (femur), ___ (carpal), ____ (sternum), ____ (vertebrae)

Back 35

long...short...flat...irregular

Front 36

the shaft is ___, ends are ___, and between them is ___. Marrow is in ____ . ___ covers bone

Back 36

diaphysis, epiphysis, metaphysis, marrow cavity,periosteum

Front 37

collagen fibers of periosteum are parallel to bone, except where things attach (these are __)

Back 37

sharpey's fibers

Front 38

on inside, bone cavity is lined by ___, composed mostly of ___ cells

Back 38

endosteum....osteogenic

Front 39

Osteon (basic unit of bone) has central __, have concentric ___, through which ___ goes thru

Back 39

haversian canal...lamellae...volkmann's canal

Front 40

bones have openings for blood vessels called ___, mostly located on ___ and ___

Back 40

nutrient foramina....epiphysis and diaphysis

Front 41

immature bone is ____, has more ___

Back 41

not lamellar...ground substance

Front 42

osteoprogenitor cells are from ____ and differentiate due to the factor __. Found on _ and __

Back 42

mesenchymal stem cells...CBFA1...endosteum...periosteum

Front 43

calcification is initiated by osteoblast secretion of ___ that are rich in ____

Back 43

matrix vesicles....ALP

Front 44

osteoblasts communicate with ____

Back 44

gap junctions

Front 45

osteocytes have resorptive abilities in respond to ___, and does it by secreting ____

Back 45

mechanical stress....MMP

Front 46

osteoclasts make a shallow bay (___/___ bay) where they secrete ___ (can be a marker)

Back 46

resorption/howship....TRAP

Front 47

osteoclasts have 3 regions: ___, ___, ___ (where digested material is exocytosed)

Back 47

ruffled border....clear zone....basolateral region

Front 48

osteoclasts secrete __ to degrade collagen and __ (cysteine protease). Also for acid it has __

Back 48

MMP...cathepsin K...proton pump (and carbonic anhydrase)

Front 49

osteopetrosis is a disease with ___ and is caused by defective ___

Back 49

increased bone density....osteoclast

Front 50

type I primary osteoporosis occurs ____ and type II primary osteoporosis occurs ___

Back 50

after menopause... in 70's and 80's

Front 51

intramembranous ossification is when ___ differentiates into ___ by the factor ___

Back 51

mesenchymal....osteoprogenitor...Cbfa1

Front 52

appositional growth is part of ___ and is when ___

Back 52

intramembranous ossification...spicules enlarge

Front 53

endochondral ossification ___ turns into bone, starting first with the formation of a ___

Back 53

hyaline cartilage...bony collar

Front 54

hemopoietic stem cells differentiate from

Back 54

mesenchymal stem cells

Front 55

Primary site of ossification is ____, secondary site of ossification is ___

Back 55

diaphysis....proximal epiphysis

Front 56

during bone remodeling, there is the advancing ___ and the ___ behind it

Back 56

cutting cone...closing cone

Front 57

ALP causes

Back 57

increase in local concentration of PO4 ions

Front 58

When bone heals, there is first new loose CT, ___, and then a __ and then a ___. Takes ___

Back 58

granulation tissue...soft callus...bony callus...6-12 weeks

Front 59

appositional growth is growth by

Back 59

depositing new bone on preexisting surface

Front 60

Developmental anomalies of local problems of migration of mesenchymal cells

Back 60

dysostoses

Front 61

mutations of signalling molecules and matrix components that affect cartilage/bone globally

Back 61

dysplasias

Front 62

Achondroplasia and thanatophoric dwarfism are r/t ____ defect, which usually does what?

Back 62

FGFR3....suppresses cartilage proliferation

Front 63

type I collagen disease is ___ (brittle bone disease). Often these patients have __ sclera, hearing ___, dental ___, and in general ____ bone.

Back 63

osteogenesis imperfecta....blue....loss...problems... not enough

Front 64

marble bone disease (___) have bones that fracture too easy... often r/t not enough ___

Back 64

osteopetrosis.....carbonic anhydrase

Front 65

osteoporosis can't be detected in plain Xrays until ___ to __% of bone mass is lost

Back 65

30-40%

Front 66

Paget's disease has 3 phases: ___, ___, ___. Net effect is ___ bone mass, but it is ___

Back 66

osteolytic...mixed...osteosclerotic....more....unstable

Front 67

Histologic hallmark of Paget disease is ___ of lamellar bone

Back 67

mosaic pattern

Front 68

renal failure can cause too much ____, which causes more ___, which inhibits formation of ___ which causes low levels of ____

Back 68

phosphate...PTH....vitamin D...Ca

Front 69

comminuted fractures are those in which

Back 69

bone is splintered

Front 70

infarcation of bone/marrow can be ___ (generally stable) or ____ (often collapse

Back 70

medullary....subchondral

Front 71

a healing response to infarction involves new deposition of bone in a process called

Back 71

creeping substitution

Front 72

when newly deposited bone forms a sleeve around a segment of devitalized infected bone

Back 72

involucrum

Front 73

small intraosseous abscess invoving cortex, walled off by reactive bone

Back 73

brodie abscess

Front 74

extensive new bone in jaw that obscures underlying osseous structure

Back 74

sclerosing osteomyelitis of garre

Front 75

Pancreas has islets of Langerhans has alpha cells (makes ___), beta cells (makes __ and __), delta cells (makes ___ and __) and PP cells that make ___

Back 75

glucagon...insulin and amylin....somatostatin and gastrin.... pancreatic polypeptide

Front 76

insulin primarily targets ___, ___, and ___

Back 76

muscle, adipose, liver

Front 77

leptin secreted from adipocytes does what?

Back 77

signals that energy stores are filled

Front 78

PPAR gamma does what?

Back 78

causes adipocytes to store more fatty acids

Front 79

AMPK shifts from ___ activites to ____

Back 79

anabolic....catabolic

Front 80

Glucose enters beta-cells via ____ and increases the __:__ ratio, which ____ the K+/ATP channel and depolarizes the cell, allowing __ in and allows insulin to be released

Back 80

GLUT2.....ATP:ADP.....inactivates...Ca

Front 81

insulin binds to insulin receptors (2 __ and 2 __). Binding activates ____ that recruits second messengers that contain ___ domains

Back 81

alpha subunits...beta subunits...tyrosine kinase.. SH2

Front 82

glucagon binds to ___ receptor and works by ____. Insulin and glucagon BOTH have half life of

Back 82

G protein-coupled....cAMP....6 min

Front 83

amylin is released with ___, binds to receptors of ___ and does 3 things:

Back 83

insulin...CNS...inhibit glucagon, slow gastric motility, decreases food intake

Front 84

GLP-1 (___) is made by __ of ___. Causes __ secretion. Degraded by ___.

Back 84

Glucagon-like peptide...L cells.. illeum... insulin... DPP4

Front 85

Type 1 diabetes (IDDM) is from ___ destruction of ___. Causes __ blood sugar, ___ protein breakdown, ___ fat breakdown (which causes ketone bodies to deplete __ causing ___). Also patients have ___ urination, ___ hunger, ___ weight. "Flu-like" symptoms trigger symptoms. Fast onset when ___% of __ are destroyed

Back 85

autoimmune....beta cells....high....more...more... bicarb... DKA.... more.... more.... less.... 85%... beta cells

Front 86

type II diabetes (NIDDM) is from ___. 2 possible mechanisms: ___ and ___. Compensation occurs by ___. Most important risk factor is ___

Back 86

insulin resistance...lipid buildup in liver and muscle... inflammation.... more insulin made... obesity

Front 87

alpha-glucosidase inhibitors work by inhibiting ___ and are effective ___. Contraindicated for:

Back 87

brush border enzymes....after meals...IBS patients

Front 88

Two types of insulin: prandial bolus insulins (___) and NPH insulin (___)... major danger is ___

Back 88

short acting...long acting.... hypoglycemia

Front 89

sulfonylureas and meglitinides are insulin secretagogues that bind to ___ to __ the K/ATP channel, thereby causing ___

Back 89

SUR1...inactivate...more insulin secretion

Front 90

Biguanides (like ___) work to activate ___ (inhibits ___ and ___-synthesis). Also it improves __in muscle. Common side effect is ___. More serious side effect is ___. __ hypoglycemia risk.

Back 90

metformin...AMPK....gluconeogenesis....fatty acid.... glucose uptake.... GI problems....lactic acidosis...no

Front 91

pramlintide is a ___ analogue. For type __ diabetics.. ___ risk of hypoglycemia. Can cause ___

Back 91

amylin...I and II....no....nausea

Front 92

Exenatide and liraglutide are ___ analogues... for type __ diabetics. Must be injected. Increases ___ and decreases both ___ and ___. Common side effect is __ but most serious is ___. Used in combination with sulfonylureas (in which case there is risk for ___)

Back 92

GLP-1....II...insulin secretion.... glucagon secretion... appetite.. nausea... acute pancreatitis.... hypoglycemia

Front 93

sitagliptin and saxagliptin are DPP4 inhibitors work to ____ by inactivating DPP4. ___ risk for hypoglycemia. Reduce HbA1C by 0.5%. Commonly used with TZD or metformin

Back 93

lengthen GLP1 half-life....no

Front 94

TZD's (rosiglitazone and pioglitazone) are ____ that work to enhance insulin at ____. They are synthetic ligands for ___, which once activated, makes fatty acids tend to accumulate in ___. This makes ___ and ___ more sensitive to insulin.

Back 94

insulin sensitizers....target tissues... PPARgamma... adipose.... liver and muscle

Front 95

diazoxide binds to ___ and ___ the K+/ATP channel. Octreotide is a __ analogue. Both treat __

Back 95

SUR1...activates....somatostatin...insulinomas

Front 96

60% of islet cells are ___, 25% are __, and 10% are ___

Back 96

Beta...Alpha....Delta

Front 97

insulin starts as ___ and is cleaved to ___ which has A, B, and C peptides. Which peptide has very few functions but can be measured in DM pt to see how much insulin they make?

Back 97

preproinsulin....proinsulin....C

Front 98

Without insulin, __ is only slightly permeable to glucose. 2 conditions where this is not true:

Back 98

muscle...heavy exercise...high glucose in blood

Front 99

Insulin inactivates liver ___ (usually breaks down glycogen) and enhances liver uptake by activating ____... and it promotes glycogen synthesis by activating ___

Back 99

phosphorylase....glucokinase....glycogen synthase

Front 100

As liver hits its limit of glycogen production, the glucose is then split into ___ by the ___ pathway and then converted into ___. Also ___ and ___ from citric acid cycle is activates acetyl-CoA carboxylase to form ____

Back 100

pyruvate...glycolytic pathway...acetyl-CoA... citrate... isocitrate... malonyl-CoA

Front 101

In adipose cells, insulin causes glucose to be made into ___ that is used to make triglycerides

Back 101

alpha-glycerol phosphate

Front 102

lack of insulin activates __ on fat cells, which causes ___ of stored fat, also releasing __ and __

Back 102

lipase...hydrolysis..phospholipids..cholesterol

Front 103

insulin (like GH) has what 4 effects on protein metabolism

Back 103

less usage, more intake, more translation and transcription

Front 104

growth hormone requires ___ for growth

Back 104

insulin

Front 105

amino acids (especially ___ and ___) make beta cells _____. GI hormones do the same

Back 105

arginine...lysine...more sensitive to blood sugar

Front 106

GH and cortisol are secreted in response to ___ and both inhibit ___ and promote ___

Back 106

hypoglycemia...glucose usage....fat usage

Front 107

epi increases plasma __ and __

Back 107

glucose...fatty acids

Front 108

insulin secretion: ___ transporters bring glucose into beta cell, which is phosphorylated to ___ by ___. This is rate limiting step

Back 108

GLUT2....glucose-6-phosphate....glucokinase

Front 109

Glucagon works by a ___ that activates ___. Each step in the process is important b/c ___

Back 109

cAMP second messenger...protein kinase A....amplifies

Front 110

only thing that stimulates BOTH glucagon and insulin

Back 110

high blood amino acids

Front 111

spaces in which osteocytes live are ___, and from this, small tunnels (_____) branch out

Back 111

lacunae....canaliculae

Front 112

Exercise ___ glucagon secretion. Beta-adrenergic stimulation ___ glucagon secretion

Back 112

increase...increase

Front 113

somatostatin basically does what?

Back 113

extend time in which food is absorbed into blood

Front 114

uncontrolled hyperglycemia can cause ___ and also damages ___

Back 114

dehydration .... blood vessel

Front 115

HbA1c is formed by ___ of HbA....this occurs in ___ states

Back 115

glycosylated.... hyperglycemic

Front 116

threshold for insulin release is

Back 116

80

Front 117

epi ___ release of insulin

Back 117

decrease

Front 118

blood flow in islets is from center _ cells to peripheral _ cells, so released __ can supress __

Back 118

beta...alpha....insulin...glucagon

Front 119

MODY is ____ which is type __ diabetes resulting from a ___ mutation

Back 119

maturity onset diabetes of young...II...glucokinase

Front 120

glucagon binds to receptor and raises ___ levels. ____ opposes this.

Back 120

cAMP....cAMP phosphodieterase

Front 121

glucagon mostly acts on ___ to do 2 things:__,__. Other effects are to activate ___ on fat cells

Back 121

liver...gluconeogenesis...glycogenolysis...lipase

Front 122

Dx for DM is when sugar is ever >__, fasting glucose is >___, oral glucose test >__ 2 hrs later

Back 122

200...126...200

Front 123

glucagon, epi, cortisol are all considered

Back 123

counter-regulatory hormones

Front 124

in insulin receptor, the alpha is for ___ and the beta is ___

Back 124

binding...tyrosine kinase

Front 125

Type II diabetes is mostly caused by loss of insulin sensitivity in ___.

Back 125

hepatocytes

Front 126

Obesity (especially __ obesity) can release ___ that overwhelm ____ pathways, causing toxic intermediates like DAG and ceramide that causes phosphorylation of serine residues that ____ insulin signalling, increasing ____

Back 126

central...NEFA's...fatty acid oxidation pathways... attenuates.. gluconeogenesis

Front 127

Obesity reduces adipokines like __ and ___, which usually enhance ___ (target of metformin)

Back 127

leptin....adiponectin....AMPK

Front 128

Adipose can release ___ that cause an inflammatory response that decreases insulin action

Back 128

cytokines

Front 129

primary defect in B-cell function (MODY) is autosomal-__, does not appear with __ or __

Back 129

dominant...obesity...autoantibodies

Front 130

maternally inherited diabetes and deafness comes from __ DNA mutations

Back 130

mitochondrial

Front 131

macrovascular complications include large/medium arteries causing ____ and microvascular complications cause ___ in retina, ___ kidneys and ___ in peripheral nerves. All r/t ___

Back 131

accelerated atherosclerosis....retinopathy...nephropathy... neuropathy... constant hyperglycemia

Front 132

1st way hyperglycemia causes problem is through AGEs (___) formed from reactions between __ derived products with ___. This causes release of ___/__ by macrophages, ___, and in general pro____ activity. Can also crosslink with collagen I (___) and IV (___). Causes __ of renal capillaries' ____. Ironically, renal capillaries become _____

Back 132

Advanced glycation end-products....glucose...amino acids.. cytokines/GF....ROS... coagulant..... vessels not as elastic... extravasation... thickening...basement membranes... more leaky to proteins

Front 133

2nd way is activating ___ and the second messenger __. These cause __ VEGF, __ endothelin, ___ NO, ___ TGF-beta, __ PAI, ___ cytokines

Back 133

protein kinase C... DAG... more... more....
less.... more.... more... more

Front 134

3rd way is that in tissues that don't need insulin, hyperglycemia causes high ___ glucose, which is metabolized to sorbitol (a polyol) and then to fructose. This needs __ which means less ___, which means more cellular susceptibility to ____. This is the cause of neuropathy

Back 134

intracellular....NADPH.....reduced glutathione.... oxidative injury

Front 135

the honeymoon period is when type __ diabetics are asymptomatic b/c of ___

Back 135

I...compensation

Front 136

type 2 diabetes is often milder because of higher ___ insulin levels that keeps ___ in check

Back 136

portal vein....ketone body formation

Front 137

insulin resistance causes higher LDL and lower HDL because it supresses ___ in tissues

Back 137

lipid uptake

Front 138

diabetes can cause retinopathy when hypoxia causes __ expression and causes ___

Back 138

VEGF....neovascularization

Front 139

Diabetics also have enhanced susceptibility to __, because of vascular/leukocyte compromise

Back 139

infections

Front 140

The pancreatic duct empties into duodenum at the ___ which is surrounded by ___

Back 140

ampulla of Vater...sphincter of Oddi

Front 141

The pancreas has a ____ (adds __ and __ and ___) that leads from within the acini (formed by ___ cells that are connected by ___)

Back 141

intercalated duct...Na..H2O...bicarb....centroacinar... junctional complexes

Front 142

trypsiongen is activated by ___ secreted by intestinal cells

Back 142

enterokinases

Front 143

the islets of Langerhans are most numerous in the __ of the pancreas. ___ may also be secreted here, so tumors can cause ____ syndrome (too much acid)

Back 143

tail....gastrin....zollinger-ellison

Front 144

increased fatty acid in blood, gastrin, CCK, secretin, and glucagon all ___ insulin release

Back 144

stimulate

Front 145

parasympathetics ___ insulin secretion and ___ glucagon secretion

Back 145

increases ... increases

Front 146

sympathetics ___ insulin secretion and ___ glucagon secretion

Back 146

decreases...increases

Front 147

insulin, VIP, and CCK ___ exocrine secretion

Back 147

increase

Front 148

glucagon, pancreatic polypeptide, and somatostatin ___ exocrine secretion

Back 148

decrease

Front 149

acetylcholinesterase (AChE) does what?

Back 149

degrades acetylcholine

Front 150

Acetyl CoA + Choline ----(via enzyme ___)---> ___ + ___ + ___

Back 150

ChAT (choline acetyltransferase)...Acetylcholine...CoA..H2O

Front 151

rate limiting step for ACh is ____, which is available by two processes: slow ___ and fast ___

Back 151

choline substrate....facilitated....Na-dependent

Front 152

ACh is moved to vesicles by ___-___ antiport channel. Release is by intracellular ___

Back 152

ACh-H+.....Ca

Front 153

Two stores are ___ and ___ (required for sustained ACh release)

Back 153

depot...reserve

Front 154

Muscarinic receptors are __ transmembrane domain ___ receptors. Mostly in parasympathetic ___ fibers, a few sympathetic ___ fibers, autonomic ganglia, and CNS

Back 154

7....G-coupled protein.... postganglionic.... postganglionic

Front 155

Muscarinic receptors have alpha subunit that can activate ____ (M_, M_, M_)

Back 155

phospholipase C (M1, M3, M5)

Front 156

Other receptors (M_ and M_) can activate Gi to inhibit ___, or can open ion channels to _____ (beta-gamma subunit)

Back 156

(M2, M4)....adenyl cyclase.....hyperpolarize

Front 157

Nicotinic receptors are known as ___ ion channels that, when __ acetocholines bind to it, work to allow __ (and also __) into the cell, causing __ depolarization. Has 5 subunits.

Back 157

ligand-gated....2....Na...Ca....brief

Front 158

Skeletal muscle NMJ has what format of nicotinic receptor?

Back 158

alpha2-beta-epsilon-delta (A2BED)

Front 159

CNS nictonic receptors are N_ or N_.....NMJ are N_ or N_

Back 159

N2 or NN.....N1 or NM

Front 160

at NMJ, __ motor neurons release ACh vesicles. Each vesical causes a small __, but many together causes a ___ which causes a twitch. The ACh also binds to presynaptic receptors in a ___ feedback. After __ of these receptors are desensitized, there is a decline known as ___

Back 160

alpha...MEPP....EPPP....positive...half...tetanic fade

Front 161

4 autonomic post synaptic responses: mostly ___ by __ receptors, __ by __ receptors, ____ by catecholamines, and __ (might play role in regulation of sensitivity to constant depolarization)

Back 161

fast EPSP by nicotinic...slow EPSP by M1.... IPSP....
late slow EPSP

Front 162

__ ACh is good during awake states, but __ ACh is good for SWS (__) for memory formation

Back 162

high...low...slow-wave sleep

Front 163

AChE inhibitors belong to 3 classes: ___ (like edrophonium) are __ acting, ___ (like neostigimine and physostigimine) makes __ bonds and are __ acting, and ___ (like diisopropyl flurophosphate) are extremely ___. Good for treating NMJ diseases like myasthenis gravis (____ attack ___ receptors). Does not treat succs, because succs causes ___

Back 163

simple alcohols....short.... carbamic acid....
covalent... long... organophosphates....
long acting......
autoantibodies....NM...... sustained depolarization

Front 164

Muscarinic receptor agonists can be ____ like methacholine (for dx __), carbachol (miotic agent for __) or bethanechol (for promoting __ and __ motility). Or they can be ____ like muscarine, pilocarpine, and cevimeline. Pilocarpine and cevimeline are rx for __ (AKA __)

Back 164

choline esters.....asthma
glaucoma.....GI and urinary tract......alkaloids
xerostomia....dry mouth

Front 165

nicotinic receptor agonists include ___ which can paralyze b/c of 2 reasons: ___ and ___

Back 165

succinylcholine....constant depolarizing....desensitize

Front 166

muscarinic receptor antagonists include ___ to induce pupil dilation, or reverse bradycardia. Not much effects at ___.

Back 166

atropine....NMJ

Front 167

nicotinic receptor antagonists are used for ____, which can be reversed by giving ____. Intermediate duration versions of this include __ and __

Back 167

neuromuscular paralysis....AChE inhibitors... vecuronium and rocuronium

Front 168

tyrosine can be oxidated to ___ by the rate limiting enzyme ____. Then, it is converted into dopamine, which can be ___ by dopamine-beta-hydroxylase to make ___, which is then methylated by ___ into epi

Back 168

DOPA....tyrosine hydroxylase....hydroxylated.... norepi....PNMT

Front 169

Domapine is transported into synaptic vesicles by __ membrane spanning antiporter called __

Back 169

12....VMAT

Front 170

VMAT1 is expressed ___ but VMAT2 is expressed mainly in ___

Back 170

peripherally....CNS

Front 171

After its action, catecholamines are recycled by NET (aka ___) which is a __ or is broken down by MAO-A (for __, __, ___) or MAO-B (for __) or COMT (mainly in ___)

Back 171

Uptake 1....Na symporter... serotonin, norepi, dopamine... dopamine.... liver

Front 172

All catecholamines are ___ receptors that are __, __, or __

Back 172

G protein-coupled receptor ... alpha1, alpha2, beta

Front 173

alpha1 receptors activate ___ that makes IP3 (mobilizes __) and DAG (activates __). Mostly in ___, but also GI, urinary, heart, liver. Important to increase __

Back 173

phospholipase C....Ca....protein kinase C.... vascular smooth muscle...blood pressure

Front 174

alpha 2 activates __ thus inhibiting ___ and causing ___ and inhibiting neuronal ___. Also causes __ insulin release

Back 174

Gi...cAMP....hyperpolarization....Ca.....more

Front 175

Beta1 affects ___ of kidney to release ___ and also increases __ and __ of heart

Back 175

JG....renin.....force...HR

Front 176

Beta2 relaxes ___ and causes ___ in liver....Beta3 causes ___

Back 176

bronchial smooth muscle...glycogen release....lipolysis

Front 177

too much G protein receptor activity causes accumulation of __ subunits that recruits a ____ to phosphorylate a G protein to bind to a ___ to silence the signalling

Back 177

beta-gamma....G protein receptor kinase.... beta-arrestin

Front 178

epi works on __ and __ mainly, but can work on __ in high concentrations. Also prolongs ___

Back 178

beta1...beta2....alpha1.....local anesthetics

Front 179

norepi works on __ and __ mainly, good in treating __

Back 179

alpha1 .. beta1... shock

Front 180

dopamine does not cross ___, and causes __ and increased ___. At high rates, it activates ___ and increases ___ of heart, and at even higher rates, it acts on ___ to cause ____

Back 180

BBB....vasodilation...cAMP levels....beta1... force of contraction.....alpha1....vasoconstriction

Front 181

reserpine irreversibly binds to ___, thereby making vesicles unable to __ and __ norepi

Back 181

VMAT....concentrate...store

Front 182

tyramine (and its metabolite octopamine), guanethidine, and guanadrel are all "false neurotransmitters" that prevent ____ of ____.These treat ___

Back 182

storage....catecholamines....HTN

Front 183

Amphetamine ____ from vesicles and is a weak inhibitor of ___ and also blocks ___. Causes alertness, but can cause fatigue/depression after it wears off

Back 183

displaces catecholamines....MAO....catecholamine reuptake

Front 184

ephedrine, pseudoephedrine, and phenylpropanolamine work to

Back 184

activate adrenergic responses

Front 185

___ is a potent inhibitor of NET, thereby inhibiting catecholamine ___

Back 185

cocaine...reuptake

Front 186

phenelzine, iproniazid, and tranylcypromine are ____. clorgyline, brofaromine, befloxatone, and moclobemide are _____. Selegiline is a ___. These all are used to treat __

Back 186

nonselective MAO-inhibitors.....MAO-A inhibitors.... MAO-B inhinibtors...depression

Front 187

methoxamine, phenylephrine, oxymetazoline, and tetrahydrozoline are all ___ that treat ___ or opthalmic hyperemia and nasal congestion

Back 187

alpha1 agonists...shock

Front 188

clonidine is a ___ that treats ___.

Back 188

alpha2 agonist...HTN

Front 189

dobutamine is a selective ___ if given in a ___ mixture

Back 189

beta1 agonist...racemic

Front 190

beta2 agonists like ___ can treat ___

Back 190

albuterol...obstructive airway disease

Front 191

phenoxybenzamine, phentolamine, prazosin, terazosin, doxazosin, and tamsulosin are ___ that can treat ___. Prazosin has greater affinity for __

Back 191

alpha antagonists...HTN...alpha1

Front 192

propanolol, nadolol, and timolol are ___. Good rx for __ and __

Back 192

nonselective beta blockers...HTN and angina

Front 193

Labetolol and carvedilol block __, __, and __. Rx for ___. Labetalol is also partial agonist of __

Back 193

alpha1, beta1, beta2....hypertensive emergencies...beta2

Front 194

esmolol, metoprolol, atenolol, and betaxolol are ___. Shortest half life is ___. ___ and __ have intermediate half lives.

Back 194

beta1 selective blockers....esmolol....metoprolol...atenolol

Front 195

Anterior pituitary has what 5 cell types and what do they secrete?

Back 195

somatotropes- hGH, corticotropes - ACTH, thyrotropes - TSH, Gonadotropes - LH/FSH, lactotropes - prolactin

Front 196

Posterior pituitary secretes what hormones? these are actually made by ___ in the ___

Back 196

ADH and oxytocin...magnocellular neurons...hypothalamus

Front 197

anterior pituitary is stimulated by ___ or ___ through the ___ that goes through ___

Back 197

hypothalamic releasing or hypothalamic inhibitory ... hypothalamic-hypophysial portal vessel...median eminence

Front 198

the posterior pituitary is stimulated by ____ from ___ directly

Back 198

nervous signals...hypothalamus

Front 199

For most anterior pituitary hormones,__ is most important but for ___, ___ is more important

Back 199

hypothalamic releasing...prolactin...hypothalamic inhibitory

Front 200

other than growing, what 3 effects does growth hormone have on metabolism?

Back 200

more protein synthesis, conservation of carbs, uses fats

Front 201

GH increase protein synthesis by what 4 methods?

Back 201

more amino acid influx, more RNA tranlation, more DNA transcription, less breakdown of proteins

Front 202

3 effects of GH on bone:

Back 202

more protein deposition, more reproduction of chondrocyte and osteogenic cells, convert chondrocytes into osteogenic cells

Front 203

GH causes liver to make ___ that behave like ___. Most impt one is ___, has a long ____

Back 203

somatomedins...insulin...somatomedin C (IGF-I)...lifetime

Front 204

part of hypothalamus controlling GH is ___, which secretes ___ that acts via ___ (short term effect: ___, long term effect: ___)

Back 204

ventromedial nucleus...GHRH...adenylyl cyclase-cAMP system... more calcium... more transcription

Front 205

posterior pituitary gland (AKA ____) is composed of ___-like cells called ____

Back 205

neurohypophysis...glial.....pituicytes

Front 206

hormones in posterior pituitary are actually made in __(__) and __(__) nuclei and are transported by ___

Back 206

supraoptic nuclei (ADH)...paraventricular(oxytocin).... neruophysins

Front 207

all hypothalamic releasing factors are ___ except ___

Back 207

peptides...dopamine

Front 208

what 3 anterior pituitary hormones are glycoproteins?

Back 208

LH, FSH, TSH

Front 209

GHRH causes more __ and __ in somatotrophs, while somatostatin decreases them

Back 209

cAMP...Ca

Front 210

secondary endocrine disorder means ___ disease. Tertiary endocrine disorder means ___

Back 210

pituitary...hypothalamus

Front 211

Ghrelin, secreted by ___ during ___ state, works synergistically with ___

Back 211

gastric fundal cells....fasting....GHRH

Front 212

Somatropin is ____, and mecasermin is ___

Back 212

synthetic GH....synthetic IGF-1

Front 213

octreotide and lanreotide are SRL's (___). Pegvisomant prevents ____

Back 213

somatostatin receptor ligands.....GH receptor dimerization

Front 214

prolactin (inhibited by ___) can suppress hypothalamic release of __, causing less __ and __

Back 214

dopamine...GnRH...LH...FSH

Front 215

Bromocriptine, Cabergoline, and quinagolide are all ____

Back 215

dopamine receptor agonists

Front 216

thyrotropin is

Back 216

recombinant TSH

Front 217

hypothalamus secretes ___ to cause secretion of ___ to cause secretion of glucocorticoids

Back 217

CRH...ACTH

Front 218

Cushing's disease is ___ from an adenoma located in ___

Back 218

too much cortisol....pituitary

Front 219

cosyntropin is synthetic ____

Back 219

ACTH

Front 220

Inhibin inhibits ___ but has no effect on ___. Activin activates ___

Back 220

FSH...LH...FSH

Front 221

Leuprolide is a

Back 221

GnRH agonist

Front 222

cetrorelix and ganirelix are ____ that prevent __ surges, and help increase ___

Back 222

GnRH antagonists....LH...fertility

Front 223

ADH can bind to V1 (for ___) or V2 (____)

Back 223

vasoconstriction....water retention

Front 224

conivaptan and tolvaptan are ___ to treat ____ induced ____

Back 224

vasopressin receptor antagonists....SIADH...hyponatremia

Front 225

diabetes insipidus can be neurogenic (____ and treated with ___) or nephrogenic (___ and is treated ironically with __ like amiloride or HCTZ)

Back 225

hypothalamus doesn't make enough ADH....desmopressin... collecting ducts don't respond to ADH.....diuretics

Front 226

corticospinal tract has one ___ and one ___. Crossover occurs in which one and where?

Back 226

UMN..LMN..UMN.. junction of medulla and spinal cord

Front 227

posterior column pathway: enter spinal cord, ascend, synapse in ___, decussates in ____, proceeds to and synapses in ___, then proceeds to ____. How many neurons?

Back 227

medulla...medulla...thalamus... postcentral gyrus...3

Front 228

anterolateral pathway: enters spinal cord, synapses in ___, decussates in ___, synapses in ____ and then continues to ____. How many neurons?

Back 228

spinal cord...spinal cord....thalamus...postcentral gyrus...3

Front 229

sympathetics arise from

Back 229

T1-L2

Front 230

adrenal medulla, unlike most sympathetic postganglionic cells, secrete _ and release it into __

Back 230

epi....bloodstream

Front 231

CN III arises from ___ nucleus. CN VII stimulates __ and __ glands. CN IX stimulates __ gland

Back 231

edinger-westphal...submaxillary and sublingual...parotid

Front 232

sensory neurons have cell bodies in

Back 232

DRG

Front 233

brainstem is __, __, and __

Back 233

midbrain, pons, medulla

Front 234

cerebrum has ___ on top, __ below it, and ___ below it. The 2 halves are connected by ___

Back 234

cortex...white matter...basal ganglia....corpus callosum

Front 235

MS is r/t inflammatory cell collection in small vessels of ____

Back 235

cerebral white matter

Front 236

parkinson's disease affects the ____ tract

Back 236

nigrostriatal

Front 237

diencephalon is divided into ___ and ___. Clonidine works on ___

Back 237

thalamus....hypothalamus....hypothalamus

Front 238

long tract neuronal systems connect ___ areas. A preganglionic neuron can connect to many different postganglionic neurons (___) or many preganglionics can connect to one postganglionic (___). Also excitatory/inhibitory neurotransmitters can localize a signal (___)

Back 238

distant.....divergent signalling...convergent signalling... center-surround signalling

Front 239

local circuit neurons are responsible for ___ signal transmission

Back 239

modulating

Front 240

single-source divergent organization act via ___ receptors that alter membrane potentials

Back 240

G protein coupled receptors

Front 241

neurons from raphe nuclei of __ brainstem use the neurotransmitter ___ for pain

Back 241

caudal....serotonin

Front 242

histamine H1 receptor antagonists are for ___, H2 receptor antagonists are for ___

Back 242

allergies...GERD

Front 243

glutamate and aspartate are __, while GABA and glycine are __. They are all __

Back 243

excitatory...inhibitory....peptide

Front 244

barbituates and benzodiazepines bind to ___ receptors

Back 244

GABA

Front 245

SSRI's treat

Back 245

depression

Front 246

dopamine, norepi, epi, serotonin, and histamine are all ___ neurotransmitters

Back 246

biogenic amine

Front 247

adenosine is a ___ neurotransmitter

Back 247

purinergic

Front 248

opioids, tachykinins, secretins, insulins, and gastrins are all

Back 248

neuropeptides

Front 249

dopamine cannot cross BBB, but ___ can. Water and small molecules can pass through ___.

Back 249

L-DOPA....fenestrae

Front 250

BBB is covered by ____. ____ substances can go through easily (but toxic versions of these are blocked by ___). Glucose can pass via facilitated diffusion through a ____.

Back 250

astroglia....lipophilic...MDR...hexose transporters

Front 251

metabolic BBB is made up of enzymes that ____ stuff that shouldn't be there

Back 251

metabolize

Front 252

glucagon works by ____. Glucagon also stimulates ___

Back 252

cAMP...insulin

Front 253

SS-14 is the somatostatin found in ___, SS-28 is the one found in ____. ___ is more potent

Back 253

CNS....gut....SS-28

Front 254

somatostatin works by activating __ proteins to reduce ___

Back 254

Gi...cAMP

Front 255

in adipose, GH causes __ lipolysis, ___ LPL, ___ lipase, ___ glucose transport, ___ lipogenesis

Back 255

increased, decreased, increased, decreased, decreased

Front 256

in muscle, GH causes __ amino acid transport, __ N retention, __ lean tissue, __ energy usage

Back 256

increase, increase, increase, increase

Front 257

rising levels of fatty acid in blood ___ GH release, but in prolonged fasting state, it __ GH

Back 257

decrease....increase (to preserve protein)

Front 258

GH makes adipocytes ____ sensitive to catcholamines, and ___ sensitive to insulin

Back 258

more...less

Front 259

IGF-I receptors work by ____.

Back 259

tyrosine kinase

Front 260

neurotransmitters that cause secretion of CRH are ___ and ___. Negative feedback is by ___

Back 260

acetylcholine....serotonin...unbound cortisol

Front 261

Cortisol __ DNA/RNA/protein synthesis, __ glucose uptake, ___ lipolysis

Back 261

decrease...decrease...increase

Front 262

Iodide is pumped into thyroid acinar cell by ___ and is then pushed out of cell into ___ then oxidized by__and combined with__where it is made into T4. Released when __ causes more _

Back 262

Na symporter....colloid...thyroid peroxidase... thyroglobulin......TSH...Ca

Front 263

T4 __ glycolysis, __ cholesterol synthesis, ___ conversion of cholesterol to bile salts, ___ sensitivity of liver, fat, muscle to epi, __ lipolysis, ___ glucose uptake, __ protein synthesis, ___ sensitivity of beta cells and therefore __ insulin release. Also makes heat by making cell membrane ____ and thereby activating ___

Back 263

increase...increase...increase...increase...
increase... increase...increase...
increase...
more permeable to Na....Na-K-ATPase

Front 264

pancreatic polypeptide slows __ and __ motility. Peptide YY from ___ cells of islets inhibits __

Back 264

gastric....intestinal....alpha...gastric acid secretion

Front 265

__ and __ act as insulin secretagogues ONLY after a large meal. Which one inhibits glucagon?

Back 265

GLP-1 and GIP....GLP-1

Front 266

the cannabinoid ___ receptor has 2 major mechanisms on metabolism: ___ and ___

Back 266

CB1....more anterior pituitary secretions...the munchies

Front 267

CBI receptor antagonists increase the expression of

Back 267

GLUT4

Front 268

posterior pituitary gland is composed of ___ cells called ___

Back 268

glial..pituicytes

Front 269

a mass in the sella turcica will have what affect on vision?

Back 269

loss of lateral fields

Front 270

acute hemorrhage into an adenoma is

Back 270

apoplexy

Front 271

hyperpituitarism is most commonly r/t __,can be functional (occurs with __) or nonfunctional. G-protein mutations are a common cause, especially mutation of __ unit

Back 271

adenoma....hormone excess...alpha

Front 272

most common hyperfunctioning pituitary tumors is ___

Back 272

prolactinomas

Front 273

GH secreting tumors are densely granulated (__ and __) or sparsely granulated (__ staining)

Back 273

monomorphic....acidophilic....weak

Front 274

mammosomatotroph adenomas express both __ and ___

Back 274

GH and prolactin

Front 275

Dx by seeing if GH is suppressed by ___

Back 275

glucose load

Front 276

Cushing disease is when too much __ is made b/c of too much ___.

Back 276

cortisol....ACTH

Front 277

hypopituitarism is when __ of parenchyma is lost. If it appears with DI, it is r/t ___ problems

Back 277

75%...hypothalamic

Front 278

Sheehan syndrome is ___ of anterior pituitary

Back 278

postpartum necrosis

Front 279

Diabetes Insipidus is central if it is r/t ___, and nephrogenic if it is r/t ___

Back 279

not enough ADH.....decreased renal response

Front 280

Syndrome of inappropriate ADH is too much __

Back 280

ADH

Front 281

___ connects pituitary gland to hypothalamus

Back 281

infundibulum

Front 282

anterior pituitary gland is derived from ___, posterior pituitary is from ___ of ___

Back 282

rathke's pouch...neuroectoderm...third ventricle

Front 283

anterior lobe has 3 parts:

Back 283

pars distalis, pars intermedia, pars tuberalis

Front 284

posterior lobe has 2 parts:

Back 284

pars nervosa, infundibulum

Front 285

superior hypophyseal arteries supply ___, ___, and ___. Inferior hypophyseal arteries supply ____. Most of anterior lobe has ____. Blood drains mostly into ___

Back 285

pars tuberalis, median eminence, infundibulum.... pars nervosa...... no blood supply....cavernous sinus

Front 286

tropic hormones are those that effect ___. __ and ___ are not considered tropic

Back 286

other endocrine glands....GH...prolactin

Front 287

folliculo-stellate cells are in the ____ pituitary and are __-like and may regulate hormone

Back 287

anterior....star

Front 288

Herring bodies are ___ in the ___ caused by ___

Back 288

dilations...axon....vesicles

Front 289

Neurons receive signals through ___ and signals leave through ___.. signals always ___

Back 289

dendrites...axons...travel in one direction

Front 290

Sensory pathway: spinal cord and then ____ and then ___ and then___ and then ___

Back 290

reticular substance of medulla/pons/mesencephalon... cerebellum... thalamus... cortex

Front 291

Integrative function is how the brain _____. Ease of signal transmission is by ___/____ signals that can be selective or amplify signals

Back 291

channel and process info....facilitatory/inhibitory

Front 292

facilitation is how

Back 292

each time sensory signal passes through sequence of synapses, the easier it will be the next time

Front 293

higher brain/cortical level is impt, because without it, ____

Back 293

functions of lower brain is imprecise

Front 294

___ channels are excitatory, ___ channels are inhibitory

Back 294

cation...anion

Front 295

in 2nd messengers, the alpha component can do what 4 things?

Back 295

open ion channels, activate cAMP/cGMP, activate intracellular enzymes, activate gene transcription

Front 296

what 3 ions can do what things to make membrane potential higher and more excitable?

Back 296

Na coming in, less Cl going in, less K going out

Front 297

What are 3 characteristics of neuropeptides?

Back 297

potent, used in small quantities, prolonged actions

Front 298

Normally what are ion concentrations in/outside of cells? How much do you need for EPSP? Where does action potential start?

Back 298

Na, Cl high outside of cell...... K high inside cell........ 20mV. Initial part of axon

Front 299

Spatial summation is ____. Temporal summation is ____

Back 299

you add all presynaptic terminals being stimulated..... constant discharge of terminal can add together

Front 300

if resting potential is raised but not high enough for action potential, it is called

Back 300

facilitation

Front 301

Decremental conduction is ____. If excitatory state is above threshold, what does neuron do and what stops it?

Back 301

the further away it is from soma, the more loss of potential ... fires continually....fatigue

Front 302

Alkalosis ___ excitability. Hypoxia ____ excitability. Caffeine, theophylline, theobromine ____ excitability. Strychnine does what?

Back 302

increases...decreases...increases...inhibits inhibitors

Front 303

each sensory receptor is sensitive to ____ and nonresponsive to ___

Back 303

one type of stimulus....other types

Front 304

the sensation felt when a nerve fiber is stimulated depends on ____. This is called ___

Back 304

where the fiber leads to....labeled line principle

Front 305

Max amplitude is about ____. After that to give stronger signal, ___ increases

Back 305

100 mV....frequency (of discharge)

Front 306

Almost all ____ adapt, but chemorecptors and pain receptors don't (they are called ___)

Back 306

mechanoreceptors....tonic

Front 307

pacinian corpsule adapts by 2 means: ___ and ___ (accomodation)

Back 307

fluid in corpuscle redistributes...nerve fiber inactivates Na channels

Front 308

Rapidly adapting (___) receptors react strongly to ____.... important for ___

Back 308

phasic...change...prediction

Front 309

Type A fibers are ___ ____ fibers and type C fibers are ___ ___

Back 309

large myelinated....small unmyelinated

Front 310

In the stimulatory field, there is the ___ zone and the ___ zone. Inhibitory zone is all the same

Back 310

discharge...facilitated

Front 311

Motor neurons can use a ____, where one fiber excites a nerve and another inhibits it

Back 311

recipricol inhibition circuit

Front 312

prolonged output discharge is called

Back 312

afterdiscarge

Front 313

reverberatory/oscillary circuits work by ___

Back 313

positive feedback

Front 314

constant cycle of re-excitation causes ___. Normally prevented by ___ and ___ (which works short term by _____ changes and long term by changing the ____)

Back 314

seizures....inhibitory circuits....fatigue.....sensitivity...... number of receptors

Front 315

exteroreceptive sensations are those from

Back 315

surface of body

Front 316

free nerve endings detect

Back 316

touch and presure

Front 317

Meissner's corpuscle is type __ that adapt ___

Back 317

A-beta....quicklly

Front 318

Expanded tip tactile receptors like ___ that determine ___. Often grouped into receptor organ called __ dome receptors. These are all type __

Back 318

Merkel's discs....constant touch.....Iggo... A-beta

Front 319

Ruffini's endings adapt ___ and are important for signalling about ____

Back 319

slowly....deformation

Front 320

pacinian corpuscles adapt __ and are good for detecting ___ or ___

Back 320

fast....vibration....other rapid changes

Front 321

Almost all tactile receptors transmit via ___ except for ____

Back 321

A-beta....free nerve endings

Front 322

which of the 2 sensory pathways is faster and has better spatial/temporal fidelity?

Back 322

dorsal

Front 323

somatosensory area I (as opposed to II) can ___ more. Here, the head is represented ___ and the lower body is ____.

Back 323

localized....laterally....medially

Front 324

Brodmann's areas __ and __ are "somatosensory association areas"

Back 324

5 and 7

Front 325

ammorphosynthesis is when you

Back 325

forget the other side even exists

Front 326

to help with two-point discrimination, the body uses

Back 326

lateral inhibition

Front 327

____ signals help control sensitivity of sensory imput. They are almost entirely ___

Back 327

corticofugal...inhibitory

Front 328

diabetic sores are r/t lack of ___ so your body doesn't know when something becomes ___

Back 328

pain.....ischemic

Front 329

fast pain is ___ localized and is not felt in ___. Slow pain is ___ localized and is r/t ___

Back 329

well...deep tissue...poorly.....tissue distruction

Front 330

pain receptors are ___. Three types of pain receptors are __, __, __. Pain receptors do not __, instead they ___ (called ___)

Back 330

free nerve endings....mechanical, thermal, chemical... adapt.... become more sensitive.... hyperalgesia

Front 331

pain from heat is closely related to ___ and not __

Back 331

rate tissues are being damaged.....total damage

Front 332

one chemical that is particularly painful is ____. Ischemia causes pain via ___

Back 332

bradykinin...lactic acid

Front 333

muscle spasms cause pain from __ and __

Back 333

mechanosensitive pain receptors....ischemia

Front 334

fast pain goes by __ fibers (uses the neruotransmitter __), slow pain goes by __ fibers (uses _)

Back 334

A-delta....glutamate....C...substance P

Front 335

fast pain's purpose is to ___ and slow pain's purpose is to __

Back 335

cause immediate response.....cause person to keep trying

Front 336

fast pain uses ___ tract, slow pain uses ___ tract

Back 336

neospinothalamic...paleospinothalamic

Front 337

2 major substances that are a part of analgesia system

Back 337

enkephalin and serotonin

Front 338

acupuncture works by ___

Back 338

lateral inhibition

Front 339

primary hyperalgesia is ___...secondary hyperalgesia is ____

Back 339

receptors more sensitive.....facilitation of transmission

Front 340

tic douloureux is extreme pain of dermatome of __ or ___

Back 340

CN V or CN IX

Front 341

brain can't feel pain but __ and __ can (especially __)

Back 341

dura...vessels....middle meningeal artery

Front 342

3 types of thermal receptors: ___, ___, ___.

Back 342

cold, warmth, pain

Front 343

warmth goes by ___ fibers, cold goes by ___ fibers

Back 343

type C....A-delta

Front 344

Thermal receptors __, so people are more sensitive to __

Back 344

adapt...change in temp

Front 345

thermal receptors don't directly sense temp, they are stimulated by ___

Back 345

changes in metabolic rates

Front 346

alpha motor neurons + muscle fibers are called

Back 346

motor unit

Front 347

Renshaw cells help in

Back 347

lateral inhibition

Front 348

muscle spindles have ___ at the end to help it contract. Inside, it has nuclear bag fibers and nuclear chain fibers. It has 2 sensory fibers: primary ending (Type __ and excited by ___ fibers) and secondary ending (Type _ and excited by ___ fibers).

Back 348

gamma motor neuron....Ia....nuclear bag and chain..... II... nuclear chain

Front 349

Slow stretch of muscle spindle excites ___. Dynamic stretch excites ___

Back 349

Ia and II.....Ia

Front 350

The muscle stretch reflex is a ___ pathway that helps prevent ___

Back 350

monosynaptic...sudden changes in muscle length

Front 351

Muscle spindle will contract for 2 reasons:

Back 351

prevent it from opposing muscle contraction, damping

Front 352

Muscle spindle system is important for ___ (thus useful for precise tasks)

Back 352

stabilizing

Front 353

clonus is oscillating __

Back 353

muscle jerks

Front 354

GTO detects ___ and have type __ fibers that activates ___ interneurons. Also helps ____

Back 354

muscle tension....Ib.....inhibitory...spreads muscle load

Front 355

Flexor reflex will begin to __ over a few seconds, and then takes a while to return to baseline because of ___. The crossed extensor reflex has longer ___ because of ___

Back 355

fatigue....afterdischarge....afterdischarge...reverberating circuits

Front 356

positive supportive reaction is when

Back 356

pressure on footpad causes limb to extend

Front 357

muscle cramps are due to

Back 357

positive feedback

Front 358

mass reflex is when

Back 358

spinal cord becomes too active

Front 359

Guillain-Barre is a ___ disease that causes ___. Often preceded by __. Starts __ and moves __

Back 359

autoimmune....demyelination....flu...low...up

Front 360

Inflammatory demyelinating polyradiculoneuropathy is like Guillain-Barre but __

Back 360

much slower

Front 361

Leprosy is ___ polyneuropathy affecting ___ extremities

Back 361

symmetric....cool

Front 362

Diptheria __ can cause damage to ___ ganglia

Back 362

endotoxin...sensory

Front 363

HMSN I is r/t ___ mutation and commonly causes muscular atrophy below ___. Nerves are__

Back 363

PMP22...knee...palpable

Front 364

HMSN II is different from HMSN I because nerves are __ and disease presents ___

Back 364

not palpable...later in life

Front 365

HMSN III is different in that atrophy affects

Back 365

limbs and trunk

Front 366

Peripheral neuropathy r/t DM is ____ ____ ____. It is caused by either __ pathyway or __. Can cause __. In elderly it can present different and can be r/t __

Back 366

symmetric axonal neuropathy....polyol...glycation of proteins...ulcers.....ischemia

Front 367

Neuropathy can also be caused by ___, ___ deficiency, and other factors

Back 367

renal failure....vitamin

Front 368

Neuropathy can be due to cancer via ____ means. Proof is from ___ and ___ infiltrates

Back 368

autoimmune...IgG....inflammatory

Front 369

Trauma can sever nerves. Regrowth may be __ and can be tangled (_____).

Back 369

slow...traumatic neuroma

Front 370

Saturday night palsy is

Back 370

radial nerve compression from sleeping weird

Front 371

corticospinal tract (___) decussates at ___. Posterior column-medial lemniscal pathway (___) decussates at ___. Anterolateral pathway (___) decussates at ___

Back 371

motor...cervico-medullary jxn....fine touch...medulla... crude touch... spinal cord

Front 372

in spinal cord, the medial gracile fasciculus is from ___, lateral cuneate fasciculus is from ____

Back 372

lower body....upper body

Front 373

posterior column fibers decussate as ___ and form ___ on other side of ___

Back 373

internal arcuate fibers...medial lemniscus...medulla

Front 374

spinothalamic tract synapse first in lamina __ and __, then decussates (takes __ or __ spinal segments to finish).

Back 374

I....V...2 or 3

Front 375

Anterolateral pathway consists of 3 tracts:

Back 375

spinalthalamic, spinoreticular, spinomesencephalic

Front 376

spinomesencephalic tract projects onto ____ and helps with __

Back 376

periaqueductal gray....modulation of pain

Front 377

part of thalamus that both sensory pathways synapse in

Back 377

ventral posterior lateral nucleus (VPL)

Front 378

Primary motor cortex is area __, primary sensory cortex is area __, premotor cortex is area __, and sensory association is areas ___

Back 378

4.....1,2,3......6.....5,7

Front 379

Lesions to sensory assoc. cortex causes ___ and lesions to motor assoc. cortex causes __

Back 379

problems analyzing sensory.....problems w/ motor planning

Front 380

arms are medial to legs with 2 exceptions:

Back 380

primary sensorimotor cortices and posterior columns

Front 381

there is more white matter at ___ levels. The cervical/lumbrosacral enlargements have more __ matter

Back 381

cervical....gray

Front 382

blood supply of spinal cord: one ___ artery and two ___ arteries, and 31 segmental arteries (out of which only 6-10 reach spinal cord as ___ arteries... a particularly big one is ___.

Back 382

anterior spinal....posterior spinal...radicular...great radicular artery of adamkiewicz

Front 383

T4-T8 is called the ___ zone because it is most susceptible to ___

Back 383

vulnerable...infarction

Front 384

spinal cord drains via ___ veins called ___ plexus which have no __

Back 384

epidural....bastson's....valves

Front 385

apraxia is

Back 385

no motor planning

Front 386

The 2 lateral motor systems are ____ (decussates at ___) and ___ (decussates at ___)

Back 386

lateral corticospinal....cervicomedullary junction.... rubrospinal tract....midbrain

Front 387

the 4 medial motor systems are more for ___ and tend to terminate on ___

Back 387

posture...interneurons

Front 388

unilateral lesions will cause dramatic deficits on ___ motor pathways (lateral vs medial)

Back 388

lateral

Front 389

3% of corticospinal neurons are giant pyramidal cells called ___ (largest neurons in humans)

Back 389

Betz cells

Front 390

Three parts of internal capsule are ___, ___, and __. Corticospinal tract lies in ___

Back 390

anterior, genu, posterior.....posterior

Front 391

The internal capsule continues into the midbrain ___ (feet of brain), the ventral part of which is called ____ (the middle third of which contains corticobulbar and cortical spinal fibers)

Back 391

cerebral peduncles....basis pedunculi

Front 392

parasympathetic postganglionic neurons release ___ to activate ____ receptors. Preganglionic neurons of BOTH sympathetics and parasympathetics release ___ to activate ___ receptors

Back 392

acetylcholine..muscarinic......acetylcholine...nicotinic

Front 393

sweat glands are innervated by ___ that release ___

Back 393

sympathetic postganglionics.....acetylcholine

Front 394

speech is controlled by

Back 394

Broca's area

Front 395

corticospinal tract: leaves cortex, goes through ___ of internal capsule, forms pyramids in ___, decussates, and then forms lateral corticospinal tract

Back 395

posterior limb.....medulla

Front 396

corticorubral tract neurons are located in the

Back 396

red nucleus

Front 397

muscles are put into motion by ___ neurons (more in __) and stay in motion by ___ neurons (more in ___)

Back 397

dynamic...red nucleus...static....primary motor cortex

Front 398

pontine reticular nuclei work to ___ postural muscles. Medullary reticular nuclei ___ postural muscles. Vestibular nuclei works to ___ postural muscles.

Back 398

excite...inhibit...selectively excite

Front 399

utricle and saccules both have a ___ for sensing.. which is covered by a gelatin layer that has crystals (___) embedded in it. Also there are many hair cells (___) with one large one (___).

Back 399

macula....statoconia....stereocilia...kinocilium

Front 400

If the hairs bend towards the kinocilium, you will have ___. If you bend away, you will have __

Back 400

depolarization...hyperpolarization

Front 401

utricle is oriented ___ and the saccule is oriented ___

Back 401

horizontal...vertical

Front 402

The 3 semicircular ducts are called ___, __, and ___. Each is filled with ___ has an enlargement called ___ which has a small crest (____), on top of which is a loose gelatin, ___

Back 402

anterior, posterior, lateral.....endolymph....ampula... crista ampullaris....cupula

Front 403

The semicircular ducts sense ___ and is important for ___

Back 403

change in rotation...prediction

Front 404

neurons that help you copy a motion you see

Back 404

mirror neuron

Front 405

Cerebellum has center __, and ___ next to it and ___ next to it, and __ lobe in the posterior

Back 405

vermis...intermediate zone...lateral zone... flocculonodular

Front 406

Cerebellum receives input from brain from _____ pathway, and receives input from body from ___ and ___ tracts. Each input divides and one goes to cerebellar ___ and one goes to ____. A fraction of a second later, the ___ sends an ___ signal to the ___

Back 406

corticopontocerebellar pathway..... dorsal spinocerebellar... ventral spinocerebelllar.... deep nucleus.... cerebellar cortex... cortex....inhibitory....deep nucleus

Front 407

Two types of afferent input: ___ fiber makes a ___ spike, and __ fiber makes a ___ spike. Both of these spikes are ___, but the Purkinje cells are ___

Back 407

climbing...complex....mossy...simple...excitatory.... inhibitory

Front 408

Climbing fibers is for

Back 408

learning

Front 409

Cerebellum has 3 ways of motor control. First is vestibulocerebellum for

Back 409

equilibrium during rapid motions

Front 410

second is spinocerebellum for ___ and also to prevent ___ (which would be a ___ tremor). It also helps in ballistic movements (____)

Back 410

correction...overshooting...intention....entire movement is preplanned

Front 411

3 effects of loss of spinocerebellum control:

Back 411

movements slow, weak, and slow to turn off

Front 412

Third is cerebrocerebellum, which uses ___ part of cerebellum to ___

Back 412

lateral zone....plan

Front 413

If you overshoot your movement, it is called

Back 413

dysmetria

Front 414

uncoordinated movements are called

Back 414

ataxia

Front 415

dysdiadochokinesia is when you can't perform ___

Back 415

rapid alternating movements

Front 416

dysarthria is when you have problems

Back 416

talking

Front 417

cerebellar nystagmus is

Back 417

tremor of eyeball

Front 418

the basal ganglia receives mostly from __ and outputs to ___

Back 418

cerebral cortex....cerebral cortex

Front 419

Two main circuits of basal ganglia:

Back 419

putamen and caudate

Front 420

The putamen circuit is to control ____ (like ___). Lesions can cause athetosis (___), hemiballismus (___), or chorea (___).

Back 420

complex patterns of motor activity...writing...writhing hand.... flailing limb..... flicking

Front 421

Caudate circuit is needed for ___ of sequences of motor patterns.

Back 421

cognitive control

Front 422

Basal ganglia is also important for ___ of movements

Back 422

scaling

Front 423

Parkinson’s is destruction of ___, treat with ___

Back 423

substantia nigra....L-DOPA

Front 424

Huntington's causes ____ movements + dementia. It is r/t loss of __-secreting neurons and loss of ___-secreting neurons

Back 424

distortional....GABA...acetylcholine

Front 425

hindbrain is programmed to do what for body?

Back 425

maintain posture

Front 426

basal ganglia is impt to help cortex execute subconscious but ___ patterns of movement

Back 426

learned

Front 427

astrocytes __ debris, provide __ as carbon source for neurons, and controls extracellular __

Back 427

eat...lactate....ion

Front 428

CSF does 2 functions:

Back 428

shock absorber....remove waste

Front 429

___ ___ amino acids are strongly restricted from entering BBB

Back 429

small neutral

Front 430

dopamine, norepi, epi all are made from

Back 430

L-tyrosine

Front 431

epi synthesis is dependent on __ and __

Back 431

B12 and folate

Front 432

dopa is ___ into dopamine

Back 432

decarboxylated

Front 433

___ of nerve activates tyrosine hydroxylase in short term by ___ and long term by ___

Back 433

depolarization....protein kinases....more mRNA

Front 434

serotonin is synthesized by ___ (___ is also synthesized from this)

Back 434

tryptophan....melatonin

Front 435

histamine is synthesized from ___ by ____. It is taken up by ___ and inactivated by ___

Back 435

histidine.....histidine decarboxylase...astrocytes...histamine methyltransferase

Front 436

Choline synthesis requires

Back 436

folate and B12

Front 437

glutamate is an ___ neurotransmitter, synthesized de novo from ___. Glutamate can be made into ___ by a ___ reaction. Glutamate is transported as___

Back 437

excitatory...glucose...GABA...decarboxylation...glutamine

Front 438

aspartate is made from the TCA cycle intermediate ___

Back 438

oxaloacetate

Front 439

glycine is the major ___ neurotransmittter of ___. It is made de novo from ___

Back 439

inhibitory...spinal cord.... serine

Front 440

NO is made from

Back 440

arginine

Front 441

as blood sugar falls, the brain starts using ___ and ___ as fuels. ___ and ___ are especially vulnerable parts of brain. Also when energy is gone, you can't reuptake ___ which causes ___

Back 441

glutamate....TCA cycle intermediates..hippocampus... cortex....glutamate....Ca influx

Front 442

hypoxia is bad for brain because of ___, and you stop making neurotransmitters, esp ___

Back 442

acidosis....acetylcholine

Front 443

which cell can myelinate multiple axons? which cell myelinates in PNS?

Back 443

oligodendrocytes.....schwann

Front 444

CNS myelination, ___ and ___ are important proteins. PNS myelination, ___ is important

Back 444

PLP...MBP...P0

Front 445

cerebral blood flow is by ___ and __ which form ___. Arteries from this give rise to ___ which branch out into ___ arteries/arterioles (slightly separated from brain by extension of ___ space called ____ space).

Back 445

2 cartoid...2 vertebral...circle of willis....pial arteris... penetrating... subarachnoid.....virchow-robin

Front 446

In cerebral arteries, a drop in O2 or CO2 causes ___. Also ___ work to do this

Back 446

vasodilation...astrocytes

Front 447

Cerebral flow can be maintained by sympathetics to prevent ___ in brain vessels even when ____. ___ can override it

Back 447

hypertension....body is hypertensive....autoregulation

Front 448

___ matter has 4x the metabolic needs of ___ matter

Back 448

gray.....white

Front 449

brain capillaries (vs normal) are less ___ and have astroglial cells to prevent ___ (prevents __)

Back 449

leaky....overstreach....edema

Front 450

1/4 of people who have strokes have ___ strokes. Most common stroke is blockage of ___ that causes dysfunction of __ and __. Another common stroke is blockage of __, causing ____

Back 450

hemorrhagic...middle cerebral a... wernicke...broca.... posterior cerebral a...loss of ipsilateral vision in both eyes

Front 451

strokes that involve blood supply to midbrain causes __ and ___ loss

Back 451

sensory and motor

Front 452

Damage to brain opposite to side it was impacted is a ____ injury. Same side is ___

Back 452

contrecoup....coup

Front 453

CSF made in ___ (blood vessels covered by ___) of ___, passes to ___ and then flows along the ___ into the ___. Then it leaves by 2 lateral foramina of __ and midline foramen of ___, draining into ___ which is continuous with the ___ of spinal cord and drains by ____

Back 453

choroid plexus..epithelium..lateral ventricles..3rd ventricles
aqueduct of Sylvius...4th ventricle...luschka...magendie... cisterna magna....subarachnoid space... arachnoidal villi

Front 454

secretion of CSF is by active transport of ___ and passive transport of __, __, __, __

Back 454

Na...water..K...bicarb...glucose

Front 455

__ is only loosely adherent to vessels of brain, so there is a ___ between them, acts like ___

Back 455

pia mater....perivascular space....lymph

Front 456

regulation of CSF pressure is by ___ which function like valves

Back 456

arachnoid villi

Front 457

high CSF pressure can cause ___, which is edema of ___

Back 457

papilledema....optic disk

Front 458

noncommunicating hydrocephalus is caused by block of ___. Communicating type is when fluid collects on ____ due to a block of ___

Back 458

aqueduct of sylvius....outside of brain...subarachnoid spaces

Front 459

BBB doesn't exist in ___, __, or ___ because they need to sense

Back 459

hypothalamus..pineal gland...area postrema

Front 460

brain edema can be r/t ___ (capillaries traumatized) and has 2 vicious cycle: ____ and ____

Back 460

concussion...edema compresses vasculature and less O2

Front 461

Rx brain edema with ___ solution (works by ___) or ventricular needle puncture to ___

Back 461

mannitol...osmosis...drain

Front 462

Most of brain metabolism is for ___. Brain can't use anaerobic b/c of ___. About __-minute supply of glucose is stored in neurons as ___. Glucose delivery is not ____

Back 462

ion transport....high energy demand....2....glycogen... insulin dependent

Front 463

cervicomedullary junction occurs at

Back 463

foramen magnum

Front 464

Anterior fossa contains __ lobe, middle fossa contains ___, and posterior fossa contains __ and __. Anterior fossa is divided from middle fossa by ____. Middle fossa divided from posterior fossa by ___ of ___.

Back 464

frontal...temporal...cerebellum and brainstem.... lesser wing of sphenoid...petrous ridge of temporal bone

Front 465

SCALP is

Back 465

skin, CT, aponeurosis, loose areolar CT, periosteum

Front 466

dura has two layers: __ and __. These are fused except at __ and ___

Back 466

periosteal layer...meningeal layer...falx cerebri..tentorium cerebelli

Front 467

___ and part of ___ rest on upper surface of tentorium cerebelli

Back 467

occipital lobes...part of temporal lobes

Front 468

midbrain goes through hole of tentorium cerebelli called ___

Back 468

tentorial incisura

Front 469

___ artery arises from __ and goes through ___can cause extradural bleed

Back 469

middle minengeal ...external carotid... foramen spinsoum

Front 470

subdural bleed is caused by ___. Dural sinuses drain mostly by ___ to reach __

Back 470

bridging veins....sigmoid sinuses....IJ

Front 471

spinal cord meninges differ from cranial in that there is a layer of __ (not in head)

Back 471

epidural fat

Front 472

3rd ventricle is located in ___, 4th ventricle is surrounded by __, __, __

Back 472

diencephalon.....pons, medulla, cerebellum

Front 473

Lateral ventricles (1st and 2nd) have frontal/anterial horn that begins anterior to ____. The body of lateral ventricle merges posteriorly with the __/___, which connects the 3 parts of the lateral ventricle: body, ___/___ horn, and the __/__ horn

Back 473

foramen of monro.....atrium/trigone....occipital/posterior... temporal/inferior

Front 474

Lateral ventricles communicate with 3rd ventricle via ___. Walls of 3rd ventricle are formed by ___ and ___. 3rd ventricle communicates with 4th ventricle by ____. Roof of 4th ventricle is ___ and floor of 4th ventricle is ___ and ___

Back 474

foramen of Monro....thalamus and hypothalamus....... aqueduct of sylvius..... cerebllum... pons and medulla

Front 475

Cisterns are collections of ___. Ambient cistern is located ___ to midbrain. Quadrigeminal cistern is ___ to midbrain. The interpeduncular cistern is on ___ surface of midbrain. Prepontine cistern is located ventral to the ___. Cisterna magna is __ the foramen magnum. Lumbar cistern is where ___ is and where a ___ is performed

Back 475

CSF...lateral...posterior....ventral....pons...under.... cauda equina.... LP

Front 476

area postrema is the only ___ (no BBB) organ and is for ___.

Back 476

circumventricular....vomiting

Front 477

cerebellum is separated into anterior and posterior lobes by

Back 477

primary fissure

Front 478

ataxia is __ to side of cerebllar lesion. Vermis/flocculonodular lobes cause ___ ataxia and ___while lesions in intermediate part cause ___ ataxia

Back 478

ipsilateral....truncal...eye movement problems... appendicular

Front 479

inferior surface of cerebellum has ___ that can herniate with edema and ____

Back 479

cerebellar tonsils...compress the medulla and cause death

Front 480

___ separates posterior lobe from flocculonodular lobe (the 2 floculi are connected by ___)

Back 480

posterolateral fissure...nodulus

Front 481

instead of gyri, the ridges in cerebellum are ___.

Back 481

folium

Front 482

Superior penduncle carries __ from __ (decussates in ___). Middle/inferior peduncles carry __

Back 482

outputs...cerebellum...midbrain...input

Front 483

All outputs from cerebellum are relayed by ___ and ___ nuclei

Back 483

deep cerebellar....vestibular

Front 484

deep cerebellar nuclei are from ___ to ___, "don't eat greasy foods", or __, __, __, __

Back 484

lateral to medial.....dentate...emboliform.. glubose.. fastigial

Front 485

Most fibers leaving inferior vermis and flocculi project to ____

Back 485

vestibular nuclei

Front 486

cerebellar cortex has 3 layers: __, __, __

Back 486

granule...purkinje...molecular

Front 487

2 types of synaptic inputs to cerebellum:

Back 487

mossy and climbing fibers

Front 488

mossy fibers have ___ function on ___cells, which in turn send out an axon to the ___ layer. During the course, it also excites ____ cells (which then inhibit __ and ___ nuclei, so that they can output to other regions through ___ synapses)

Back 488

excitatory....granule.....molecular layer... purkinje cells... deep cerebllar and vestibular..... excitatory

Front 489

climbing fibers arise from contralateral ___ nucleus and excite ___ cells

Back 489

inferior olivary nucleus..purkinje

Front 490

___ and ___ are inhibitory interneurons from ___ layer. They are excited by ___ cell fibers

Back 490

basket cells and stellate cells...molecular...granule

Front 491

Golgi cells are in ___ layer and receive excitatory input from ___ cell and provide feedback inhibition onto ___ cells in order to ____ of excitatory inputs

Back 491

granule cell...granule...granule...shorten duration

Front 492

complex synaptic interactions occur in the granular cell layer in a special region called ____

Back 492

cerebellar glomerulus

Front 493

all axons in cerebellum projecting upwards are ___. All axons projecting downwards are ___. Deep cerebellar nuclei are ___

Back 493

excitatory...inhibitory...excitatory

Front 494

lateral motor systems are "double crossed". 1st decussation is in __. 2nd is ___

Back 494

superior cerebellar peduncle....pyramidal

Front 495

medial motor system lesions are not

Back 495

unilateral

Front 496

lateral cerebellar hemisphere projects to the ___ nucleus, which projects via superior cerebellar peduncle which decussates in ____ and then reaches contralateral ____ nucleus (at this point they are AKA the ___)

Back 496

dentate...midbrain....ventral lateral nucleus.... thalamic fasciculus

Front 497

the intermediate hemisphere projects to the ___ and __ nuclei and project via ___ to the ___ where it influences the ____ and to the __ where it influences the ___

Back 497

emboliform...glubose...superior cerebellar peduncle... contralateral thalamic VL...lateral corticospinal tract.. red nucleus...rubrospinal tract

Front 498

cerebellar vermis and flucculonodular lobes projects through the __ nucleus. Outputs from this are carried by uncinate fasciculus and juxtarestiform body through the __ to affect the __

Back 498

fastigial....superior cerebellar peduncle....medial corticospinal tracts

Front 499

cerebellar inputs are carried by mossy fibers (except those from __ are by climbing fibers)

Back 499

inferior olivary nucleus

Front 500

major input source is ___ from frontal/temporal/parietal/occipital lobes that travel in ___ and ___ to the ___ pons and synapse in pontine nuclei. Then ___ fibers enter ___ cerebellar ___ peduncle and give rise to __ fibers

Back 500

corticopontine...internal capsule and cerebral peduncles.... ipsilateral....pontocerebellar...contralateral...middle.... mossy

Front 501

Spinocerebellar fibers also give input. Includes dorsal spinocerebellar (info about ___ ), cuneocerebellar tract (info about __), ventral spinocerebellar tract (info about ___), and rostral spinocerebellar tract (info about )

Back 501

LE limb movements....UE limb movements....LE interneuron activity....UE interneuron activity

Front 502

3 arteries that supply cerebellum: ___ artery from ___artery, __ artery from ___artery, ___ artery from __ artery

Back 502

posterior inferior cerebellar...vertebral...anterior inferior cerebellar artery...basilar...superior cerebellar... basilar

Front 503

Infarcts of cerebellum usually r/t _ and _ arteries. Infarcts that ONLY affect cerebellum is r/t _

Back 503

PICA...SCA....SCA

Front 504

truncal ataxia is r/t ___ involvement. Appendicular ataxia is r/t __/__ parts of cerebellum

Back 504

vermis...intermediate/lateral

Front 505

ataxia-hemparesis (___) is caused by ___ infarcts and presents on ___ side

Back 505

weakness on one side...lacunar...contralateral

Front 506

sensory ataxia occurs when ___ is disrupted

Back 506

posterior column-medial lemniscal pathway

Front 507

titubation is

Back 507

tremor of trunk or head

Front 508

truncal ataxia pt walk like

Back 508

drunk or toddler

Front 509

network of axonal, dendritic, and glial processes associated with gray matter is called

Back 509

neuropil

Front 510

spinal cord has __ cervical, __ thoracic, __ lumbar, __ sacral, __ coccygeal

Back 510

8...12...5...5...1

Front 511

subarachnoid space is maintained by

Back 511

arachnoid trabeculae

Front 512

substances greater than ___ cannot cross BBB. Astrocytes buffer __ concentration

Back 512

500 daltons........K

Front 513

__ axons are harder to regenerate, because of the lack of __

Back 513

CNS...phagocytosis

Front 514

degeneration of axon distal to injury site is ___. Axonal cytoskeleton ___, Schwann cells produce ___. In CNS, oligodendrocytes ___, and astrocytes ___.

Back 514

anterograde degeneration...disintegrates...glial growth factor... die by apoptosis... scars

Front 515

axonal injury makes the nerve upregulate the gene ___. Nucleus and Nissl bodies move to ___ in a process called ___.

Back 515

c-jun...periphery....chromatolysis

Front 516

In PNS the empty myelin tubes form ___ tubes. New proliferating Schwann cells organize themselves into ___ and guide new nerve processes (___)

Back 516

endoneural...bands of Bungner...neurites

Front 517

which is stronger, tumor immunity or antimicrobial immunity?

Back 517

antimicrobial

Front 518

main tumor-killing cell

Back 518

CTL

Front 519

Antibodies specific for ___ are used to treat B cell tumors

Back 519

CD20

Front 520

what are 2 reasons why T cells react so strongly to allogenic MHC molecules?

Back 520

no selection...single allogenic cell expresses 1000's of MHC

Front 521

2 clinical situations where minor antigens are important

Back 521

bone marrow transplant, and blood transfusion

Front 522

T cell seeing MHC displayed by GRAFT dendritic cell is ___ recognition and causes __ rejection

Back 522

direct....acute

Front 523

T cell seeing MHC on body's own dendritic cell is ___ recognition and causes __ rejection

Back 523

indirect....chronic

Front 524

hyperacute rejection occurs within ___ and is caused by ____. Acute rejection occurs within __ or ___ and is caused by ___. Chronic rejection occurs over __ or __ and is caused by __

Back 524

minutes...antibodies...days or weeks...T cells.... months or years... T cells and cytokines

Front 525

Good drug for immunosuppression is ___ which blocks the T cell ___ that is needed to activate transcription factor ___ which usually helps transcribe ___ genes

Back 525

cyclosporine...phosphatase...NFAT...cytokines

Front 526

hematopoietic stem cell transplant causes immunosuppression by ___

Back 526

clearing out marrow

Front 527

In liver, ALP is in ___ cells. Increased ALP is associated with ___. Which ALP is heat-stable and from the liver? ALPS that has 5'-nucleotidase is from ___

Back 527

Kupffer....bone growth.....ALP1...liver

Front 528

nonparathyroid ectopic PGH-producing tumors are

Back 528

pseudohyperparathyroidism

Front 529

primary hyperparathyroidism is caused by ____ and pt presents with __ PTH and __ Ca

Back 529

adenoma....high...high

Front 530

secondary hyperparathyroidism is caused by ___ and pt presents with __ PTH and __ Ca

Back 530

compensating for CRF....high...low

Front 531

tertiary hyperparathyroidism is caused by ___ and pt presents with __ PTH and __ Ca

Back 531

overshooting compensation for CRF....high...high

Front 532

alendronate is classified as a ___ that works to decrease ____

Back 532

biphosphaate...osteoclast activity

Front 533

___ is an estrogen agonist in bone and estrogen antagonist in breasts/endometrium

Back 533

raloxifene

Front 534

calcitonin is given to

Back 534

decrease osteoclast activity

Front 535

simvastatin works as a

Back 535

HMG-CoA reductase inhibitor

Front 536

HCTZ and triamterene are both diuretics, often used together. HCTZ prevents sodium reabsorption in ___, and triamterene prevents sodium reabsorption in __. HCTZ is __ sparing

Back 536

distal convoluted tubule...collecting tubule...Ca

Front 537

amlodipine is a ___ blocker to help treat ___, preferentially dilates ___

Back 537

Ca channel...angina...arteries

Front 538

ecchymoses is bigger than ___....petechiae is about __

Back 538

1 cm... 1 mm

Front 539

blood CO2 is an indirect measurement of ___ actually

Back 539

bicarb

Front 540

transport maximum for glucose in kidney

Back 540

180

Front 541

ketonuria can also occur in ___ children/infants

Back 541

febrile

Front 542

kussmaul breathing is __ breathing due to ____

Back 542

deep...metabolic acidosis

Front 543

normal conduction velocity is about ____, distal latency is time between ____

Back 543

50-60 m/s....end of nerve to muscle contraction

Front 544

glucose tolerance test: give ___ of glucose and check ___, ___, ___, ____ later. For pregnant women, give ___ and test ___ later (___ test)

Back 544

75g...30 min... 1hr...2hr...3hr...50 g...2hr...O'sullivan

Front 545

Enalapril is

Back 545

ace inhibitor

Front 546

verapramil is a ____ like ___

Back 546

Ca channel blocker.....dilt

Front 547

hydrocortisone is a

Back 547

glucocorticoid agonist

Front 548

octreotide is synthetic ___ that prevents ___ release

Back 548

somatostatin...GH

Front 549

post-prandial glucose is tested ___ after meal, and a level > ___ means you can dx, level between ___ and ___ means you have to do glucose tolerance test of HbA1C

Back 549

2 hr....200....140...200

Front 550

HbA1C gives info for about __ to __ days. 1% change in HbA1C is a change of __ of bood sugar

Back 550

100-120....35

Front 551

prolonged B12 deficiency can be measured by ___ levels

Back 551

MMA

Front 552

ezetimibe inhibits ___ and works by inhibiting ___

Back 552

coholesterol absorption....NPC1L1

Front 553

lisinopril is

Back 553

ACE inhibitor

Front 554

glyburide is a

Back 554

second generation sulfonylurea

Front 555

an aneurysm is an ___ of a blood vessel or the heart. It is a true aneurysm if the wall is ___. It is a false when the wall ___. Dissection is when blood ____

Back 555

abnormal dilation....intact.....has a defect..... enters the wall itself

Front 556

saccular is when there is _____... fusiform is ____

Back 556

only a part of the wall involved....involved circumfrentially

Front 557

Some etiologies of aneurysms include ____ causes, inflammation causes too much ___, and vascular wall weakening due to ___

Back 557

genetic...MMP...ischemia

Front 558

2 most important disorders that can cause aneurysms, and what kind of aneurysm they cause

Back 558

atherosclerosis (AAA) and HTN (ascending aortic aneurysm)

Front 559

mycotic aneurysms are due to

Back 559

septic embolus

Front 560

AAA usually arises between ___ and ___. Managed aggressively if it is less than ___

Back 560

bifurcation...renal arteries...5cm

Front 561

thoracic aortic aneurysms can causes issues in the ___, particularly: respiratory structure ___, difficulty ___, persistent __, and most patients die of ___

Back 561

mediastinum....compression...swallowing...cough.... aortic valve incompetence

Front 562

Dissection almost always occurs in presence of ____. Most frequent lesion is ___

Back 562

atherosclerosis....cystic medial degneration

Front 563

double-barreled aorta is when there is:

Back 563

a second intimal tear

Front 564

Type A dissections involve ___ or ___. Type B dissections are usually located ___. Which is more dangerous?

Back 564

ascending or both ascending and descending.....distal to subclavian artery......type A

Front 565

acute neuronal injury causes ___ (cells shrink and die)

Back 565

red neurons

Front 566

subacute/chronic neuronal injury is identified by ___. Trans-synaptic degeneration is when the majority of ___ to a group of neurons is interrupted. Axonal reaction is attempted ___

Back 566

cell loss....afferent input....regeneration

Front 567

___ is an important indicator of CNS injury and is characterized by __ and __

Back 567

gliosis....hypertrophy...hyperplasia

Front 568

Thick elongated astrocytic processes

Back 568

rosenthal fibers

Front 569

myoclonic epilepsy can cause ___ in cytoplasm of neurons

Back 569

lafora bodies

Front 570

cerebral edema can be vasogenic (___) or cytotoxic (___)

Back 570

primary....secondary

Front 571

noncommunicating hydrocephalus shows up as ___. Communicating ones shows up as ____

Back 571

only a part is enlarged.....all enlarged

Front 572

subfalcine herniation is when ___ herniates under ___

Back 572

cingulate gyrus....falx cerebri

Front 573

transtentorial herniation is when __ ___ lobe goes under ____. ___ may be compromised

Back 573

medial temporal lobe....tentorium cerebelli...CN III

Front 574

tonsillar herniation is when cerebellar tonsils herniate through ___

Back 574

foramen magnum

Front 575

spina bifida can be r/t ___ deficiency

Back 575

folate

Front 576

microencephaly is often r/t __ or __

Back 576

HIV....alcholism

Front 577

polymicrogyria is ___ but ___ cerebral convulutions

Back 577

small...many

Front 578

neuronal heterotopias is when there are ___

Back 578

collections of neurons in inappropriate locations

Front 579

holoprosencephaly is lack of ___ , what gene is involved?

Back 579

midline structures...sonic hedgehog

Front 580

dandy-walker malformation is characterized by an enlarged

Back 580

posterior fossa

Front 581

arnold-chiari is when ___ goes through ___

Back 581

vermis...foramen magnum

Front 582

discontinuous multisegmental or confluent expansion of ependymal-lined central canal

Back 582

hydromyelia

Front 583

fluid-filled cleftlike cavity in inner portion of cord

Back 583

syringomyelia

Front 584

displaced skull fracture: fracture when bone is diplaced into head at a distance greater than

Back 584

thickness of bone

Front 585

with contusions/lacerations what part of brain is most susceptible?

Back 585

crests of gyri

Front 586

when trauma affects deep structures

Back 586

diffuse axonal injury

Front 587

why are the elderly more susceptible to subdural hematomas?

Back 587

brain atrophy (more space)

Front 588

in CVA's the "at-risk" but not yet infracted region is the

Back 588

penumbra

Front 589

border zone infarcts occur at the areas of the brain that are located

Back 589

most distal to blood supply

Front 590

in global ischemia, brain is __, gyri are ___, sulci are ___, gray/white matter border is ___

Back 590

swollen...widened...narrowed...poorly defined

Front 591

inflammatory process that involves blood vessels that can cause luminal narrowing

Back 591

infectious vasculitis

Front 592

hemorrhages after infarcts is r/t

Back 592

reperfusion of damaged vessels

Front 593

lacunar infarcts are when you have __, and is r/t __

Back 593

multiple small infarcts....HTN

Front 594

HTN caused rupture of small vessels causes bleeding that gets reabsorbed, leaving cavity

Back 594

slit hemorrhage

Front 595

when HTN encephalopathy preferentially involves large areas of subcortical white matter

Back 595

Binswanger disease

Front 596

hemorrhages in basal ganglia or thalamus are called

Back 596

ganglionic hemorrhages

Front 597

cerebral autosomal dominant arteriopathy w/subcortical infarcts + leukoencephalopathy is r/t

Back 597

Notch3

Front 598

after any subarachnoid hemorrhage, you have risk of ___ r/t __

Back 598

ischemia...vasospasm

Front 599

most common vascular malformation of brain is ___ (most common site is ___). That one and ___ are associated with risk of hemorrhage

Back 599

AV malformation....middle cerebral artery.... cavernous malformation

Front 600

the two vertebral arteries come from the ___ part of the subclavian, enter the cranial cavity through the __ and then gives off a __ branch. They combine to form the __, forming the 2 __

Back 600

first part....foramen magnum...meningeal....basilar artery.... posterior cerebral

Front 601

circle of willis has

Back 601

2 posterior communicating, 1 anterior communicating, 2 anterior cerebral, 2 posterior cerebral

Front 602

in many pt, an atherosclerotic plaque can occur at or near ____

Back 602

splitting of the common carotid

Front 603

infections can enter cranial cavity through ___ because they have no ___

Back 603

emissary veins....valves

Front 604

3 sinuses that drain into the confluence of sinuses

Back 604

superior sagittal, straight, occipital

Front 605

the 2 cavernous sinuses are against the lateral sides of ___ bone on either side of the ___. ____ and ___ pass through it, and CN __, __, __, __ pass along the lateral wall

Back 605

sphenoid...sella turcica....ICA...CN VI......III, IV, V1, V2

Front 606

squeezing the brain and brainstem through foramen magnum is called ___

Back 606

coning

Front 607

you can prevent swelling of brain by ___ or ___

Back 607

corticosteroids...hyperventilation

Front 608

terminal branches of ICA

Back 608

ACA....MCA

Front 609

the name of the S shaped turn the ICA makes in the cavernous sinus

Back 609

carotid siphon

Front 610

ICA branches are OPAAM (______________________)

Back 610

opthalmic, posterior communicating, anterior choroidal, ACA, MCA

Front 611

ACA is AKA ___, and the branch would be called __

Back 611

A1, A2

Front 612

ACA splits into the ___ (anterior) and ___ (posterior)

Back 612

callosomarginal artery....pericallosal artery

Front 613

the MCA bifurcates into superior and inferior divisions while inside the ____. Before this happens, the ___ come off of it, which is important because it can stenose and cause ___ (can also be caused by the ___ of the ICA...both of these can cause ___ ____)

Back 613

sylvian fissure.....lenticulostriate arteries....lacunar infarction....anterior choroidal....contralateral hemiparesis

Front 614

ACA also gives ___ to supply caudate, anterior putamen, globus pallidus, and internal capsule

Back 614

recurrent artery of Heubner

Front 615

Small penetrating arteries from proximal posterior cerebral arteries that supplies thalamus

Back 615

thalamoperforator arteries

Front 616

HTN related changes in a blood vessel are

Back 616

lipohyalinosis

Front 617

tPA is good if given within first __ hrs, and possibly within __ hrs

Back 617

3....4.5

Front 618

carotid stenosis is associated with ___ territory symptoms, and possibly opthalmic artery symptoms (ipsilateral monocular vision loss, AKA ___)

Back 618

MCA.....amaurosis fugax

Front 619

carotid dissection can present with ipsilateral ___

Back 619

horner's syndrome

Front 620

superficial veins drain mainly into ___ and ___. Deep veins drain to ___

Back 620

superior sagittal sinus..cavernous sinus...great vein of Galen

Front 621

sagittal sinus thrombosis is frequent in ___, do a contrast CT, positive if you see ____

Back 621

pregnant women...empty delta sign

Front 622

endothelial cells use ___ to make NO. NO works by activating __ dependent __ channels, and it does this via ____. Opposite of NO is ___, particularly the ___ isoform for the heart

Back 622

eNOS....Ca..K...guanylyl cyclase....endothelin....ET1

Front 623

NO preferentially dilates ___, decreasing ___, thereby decreasing ___. Coronary artery-wise, NO dilates ____ preferentially, preventing ___. Unfortunately hypotension can cause ___

Back 623

veins...preload...heart O2 demand...large epicardial arteries.. coronary steal....reflex tachycardia

Front 624

Sodium nitroprusside is different from nitrates in that it

Back 624

dilates both arteries and veins

Front 625

IV NTG is a good route when __ is necessary, like for ___

Back 625

titration...unstable angina

Front 626

Isosorbide 5-mononitrate is good because oral bioavailability is

Back 626

almost 100%

Front 627

NTG is contraindicated in patients with ___ or ___

Back 627

hypotension....elevated intracranial pressure

Front 628

sildenafil, fardenafil, and tadalfil are _____ that are selective for ___ (which usually works to ____). First developed to rx ___, contraindicated for ____

Back 628

phosphodieterase inhibitors....PDE5....prevents cGMP hydrolysis..... ED.....pt who are also taking NTG

Front 629

of the Ca channels, __ is important for vascular tone. Ca channel blockers preferentially dilate ___. The 3 types are ___ (nifedipine, amlodipine, felodipine), ___ (diltazem), and ___ (verapamil). Don't take these with ___

Back 629

L ....arteries...dihydropyridines...benzothiazepines... phenylalkylamines...beta blockers

Front 630

____ like minoxidil, cromakalim, pinacidil, and nicorandil work to ___. Danger is ___

Back 630

K channel openers...hyperpolarize...reflex sympathetics

Front 631

Bosentan is a __/___ antagonist. Ambrisentan is a ___ antagnoist

Back 631

ETa/ETb....ETa

Front 632

___ is taken with isosorbide dinitrate sometimes, in order to prevent ___

Back 632

hydralazine....nitrate tolerance

Front 633

to visualize tympanic membrane pull ear __, __, __. Use pneumatic otoscope to assess ___ (if it doesn't, then pt may have ___)

Back 633

up, back, out........tympanic membrane mobility..... middle ear effusion

Front 634

O'sullivan test tests for ___ which is the most common complication of pregnancy (3-8%)

Back 634

gestational diabetes

Front 635

normal HbA1C is

Back 635

7%

Front 636

In MRI, blood appears ___. Also you can use phase contrast where you visualize based on ___

Back 636

dark...movement

Front 637

arteriography is done by taking __ with dye (can use __ ). Digital subtraction angiography is where you ___

Back 637

X ray....CO2...remove bone

Front 638

in X ray, air is __, fat is __, water is __, metal/bone is __. The shades of gray are known as ___

Back 638

black...black...gray...white...water density

Front 639

myelography is when you put contrast in ___

Back 639

subarachnoid space

Front 640

MRI is good for __ and __ imaging, whereas CT is good for __ imaging

Back 640

coronal...sagittal...axial

Front 641

In T1, water is __ and fat is __

Back 641

darker...brighter

Front 642

fMRI is when you see change in ___ in response to the ____

Back 642

oxygenated blood flow....cognitive test

Front 643

DWIMR is good to check for

Back 643

ischemic stroke

Front 644

MRS shows stroke by showing increase in

Back 644

lactate

Front 645

Brudzinski's sign is when if you flex the neck, ____. It indicates ___

Back 645

hips and knees flex....meningitis

Front 646

Babinski sign is if you stroke foot __ across the ball. Positive is ___ of big toe, indicates _____

Back 646

medially....dorsiflexion....CNS lesion

Front 647

in CT's, scout images help determine what __ the cross section is taken at

Back 647

angle

Front 648

in CT, CSF is __, __ matter is darker than __ matter

Back 648

dark gray.....white....gray

Front 649

3 properties of tissues that determine MRI intesity

Back 649

proton density, proton relaxation times T1 and T2

Front 650

in T1, gray matter is __, and white matter is __

Back 650

gray...white

Front 651

FLAIR helps remove __ from T_ images

Back 651

CSF...T2

Front 652

cisplatin is rx for __ and works by ___. Vincristine is for ___ and works by inhibiting ___. Dexamethasone is a ___ agonist. Lomustine is AKA ___ and can cross ___ and is a form of __

Back 652

CA...modifying DNA structure...leukemia...microtubule polymerization...glucorticoid...CCNU...BBB...chemotherapy

Front 653

pupils are normally __ to __ mm. Miosis is ___, Mydriasis is ___. Anisocoria is ___. Light reflections should be slightly __. Lid lag occurs in ___

Back 653

3-5....constriction...dilation...unequal pupil size... nasal... hyperthyroidism

Front 654

Tonic/Adie's pupil is __, __, ___

Back 654

large, reactive, unilateral

Front 655

Argyll Robertson pupils ___ but do not __

Back 655

accomodate....react to light

Front 656

esotropia is when the pupil is too ___, exotropia is when the pupil is too ___

Back 656

medial...lateral

Front 657

corneal reflex is if you touch the cornea, pt will ___. Tests CN __ and ___

Back 657

blink....V...VII

Front 658

Gag reflex is for CN __ and __

Back 658

IX...X