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243 Cards in this Set

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Where are skeletal motor neurons and preganglionic autonomic neurons derived?
Neural Tube
What form postganglionic autonomic neurons and sensory neurons?
Neural Crest cells
What do all ganglia contain?
(2)
Sensory neurons

or

Postganglionic autonomic neurons

(both from neural crest cells)
Neural crest cells which migrate to the Adrenal Medulla to form postganglionic sympathetic neurons?
Chromaffin cells
What type of defect in development causes an increase in
Alpha-feto protein?
Neural tube defect
Aside from the epidermis, hair and nails, what else does the Surface Ectoderm make?
(5)*
A PILE:

Anterior Pituitary

Parotid gland

Inner ear

Lens of the eye

Enamel of teeth
A PILE
Germ layer that forms the retina, CNS and pineal gland?
Neuroectoderm

(Neural tube)
What (3) systems are formed by the Mesoderm?

What organs from other systems?
(3)
Musculoskeletal
(all bone and muscle);
Cardiovascular
(heart, blood, lymph, vessels);
Reproductive organs

Organs:
Spleen;
Adrenal cortex;
Kidney and ureter
What part of the thyroid is formed by the Neural crest cells?
Parafollicular (C) cells
What germ layer forms every organ aside from the neurological, integumentary, musculoskeletal, reproductive and CV systems (and the spleen, adrenal and kidney)?
Endoderm

(every individual organ aside from those mentioned)
What germ layer makes the dura?
Mesoderm

(others from Neural crest)
Where are the preganglionic neuron cell bodies?
in the CNS

(postganglionic cell bodies are in the ganglion = PNS)
What drives all sympathetic preganglionic neurons?
Hypothalamic fibers
Which is Preganglionic versus Postganglionic: White rami or gray rami?
Pre = White

Post = Gray
The Otic ganglion supplies what nerve to where?
CN-9

to Parotid gland
What ganglion supplies CN-3 to the ciliary muscle and the pupillary sphinctor?
Ciliary ganglion
What are the parasympathetic preganglionic neurons?
(7)
CN-3;
CN-7;
CN-9;
CN-10

S-2;
S-3;
S-4
What are the (5)* secondary vesicles and their adult derivatives from top to bottom?
Todd Detests STYs:

Telencephalon = Cerebral Hemispheres;

Diencephalon = Thalamus;

meSencephalon = Midbrain

meTencephalon = Pons / Cerebellum*;

mYelencephalon = Medulla
Todd Detests STYs
The (4) parts of the Ventricles are derived from which vesicles?
Telencephalon = Lateral

Diencephalon = Third

Mesencephalon = Aqueduct

Metencephalon = Fourth (top)

Myelencephalon = Fourth (bottom)
(3) Differential Dx of ailments that affect the axon in Retrograde Transport
Herpes virus;

Polio;

Tetnus toxin
In Spina Bifida, where is the defect?

What prevents this?
Vertebral arches

prevents it:
Folic Acid
difference b/t Meningocele and Meningomyelocele?
Meningocele = meninges only

Meningomyelocele = meninges and cord
which spinal formation defect is the most severe?
Spina bifida w/ Myeloschisis

(neural tube is open on the back--not covered w/ skin)

also called Rahischosis
Muscular demyelinating dz that affects only the Optic nerve in the CNS?
Multiple Sclerosis
Which CN exits dorsally?
CN-4

Trochlear nerve
CNS cell:

physical support and repair; maintains BBB

what is the cellular marker?
Astrocyte


marker:
GFAP
CNS cell:

lines the ventricles
Ependymal cells
CNS cell:

only supportive CNS cell from the Mesoderm

what is its action?
Microglia

(phagocytosis)
CNS cell:

most common type of glial cell in white matter
Oligodendroglia
CNS cell:

cell associated w/ acoustic neuroma
Schwann cell
Sensory cell:

Light discriminatory touch on hairless skin (palms, soles, fingers)
Meissner's corpuscles
Sensory cell:

deep cell involved in pressure, coarse touch, vibration and tension
Pacinian corpuscle
Sensory cell:

in dermis of fingertips, hair follicles and hard palate for light, crude touch
Merkel's corpuscles
which peripheral nerve layer is the permeability barrier and must be rejoined in microsurgery for limb attachment?
Perineurium
What cells make the CSF?
Choroid plexus
What is the path of CSF to the Subarachnoid space?
(8)
LM3 S4 LMS:
Lateral ventricle ->
Monroe (foramen) -> Third ventricle ->
Sylvius Aqueduct -> Fourth Ventricle ->
Luschka and Magendie foramen ->
Subarachnoid space
LM3 S4 LMS:
Which is always abnormal in CSF:
Monocytes
Lymphocytes
PMNs
PMNs

(bacterial meningitis)
Dx:
Excessive dilation of ventricles
Hydrocephalus
At what level does the spinal cord end?

Subarachnoid space?

Where is lumbar puncture performed?
Cord ends: L2

meninges end: S2

puncture: L3 - L5
which part of the spinal cord is sensory versus motor?
Dorsal = Sensory

Ventral = Motor
in the spinal cord, where are the ascending and descending tracts versus the cell bodies?
White matter = Tracts

Gray = Cell bodies
Which horn of the spinal cord participates in reflexes?
Dorsal horn
Where is pressure, vibration, touch and proprioception in the spinal cord?
Dorsal columns
Where is the voluntary motor section of the spinal cord?
Lateral corticospinal tract
Where is the pain and temperature section of the spinal cord?
Spinothalamic tract

(anterior to the ventral horns)
Where are the cell bodies of an Upper Motor Neuron?
UMN = Brain stem and Cerebral Cortex
What connects the two hemispheres?
Corpus Callosum
Where is it in cortex?

Vision
Occipital lobe
Where is it in cortex?

Hearing
Temporal lobe
Where is it in cortex?

Taste
Insula

(below postcentral gyrus)
Where is it in cortex?

Reading and writing
Angular gyrus
Where is it in cortex?

Primary Motor
Precentral gyrus
Where is it in cortex?

Primary Sensory
Postcentral gyrus
Where is it in cortex?

Wernicke's area
Temporal lobe, superior gyrus
Where is it in cortex?

Broca's area
Frontal lobe near lateral fissure
What structures does the needle go thru in a lumbar puncture?
(7)
Skin -> Ligaments -> Epidural space -> Dura mater -> Subdural space -> Arachnoid -> Subarachnoid space (for CSF)
What is different if a lesion on the corticospinal tract occurs above versus below the pyramidal decussation (medulla)?
Above = Contralateral side weakness


Below = Ipsilateral side weakness
If you ask a patient to place their feet together and close their eyes, and the patient sways (positive Romberg sign), where is the lesion?
Dorsal columns

(if swaying w/ eyes open = cerebellar damage)
where does neuron 1 end in the Dorsal column-medial lemniscus pathway?
Ipsilateral nucleus cuneatus or gracilis in Medulla
Which of the major tracts crosses at the level of the entering first neuron?
Spinothalamic tract
where is the lesion anywhere along the spinothalamic tract in the cord or brainstem?
Contralateral to signs
where is the first synapse in the spinothalamic tract?

where does the second neuron cross?
Ipsilateral Dorsal gray matter at the entry level of the neuron

Second neuron crosses on the same level in the white commissure and ascend laterally
What is the Babinski sign?
Dorsiflexion of big toe and fanning of the others
Landmark for a pudendal nerve block
Ischial spine
Landmark for lumbar puncture
Iliac crest
CN responsible for:

movement of the face muscles
CN-7

Facial
CN responsible for:

sensation of the face
CN-5

Trigeminal
CN responsible for:

taste from anterior 2/3 or tongue
CN-7

Facial
CN responsible for:

taste from posterior 1/3 or tongue
CN-9

Glossopharyngeal
CN responsible for:

Tongue movement
CN-12

Hypoglossal
CN responsible for:

Mastication
CN-5

Trigeminal
CN responsible for:

Crying
CN-7

Facial
Exit from the skull of the 3 parts of the Trigeminal nerve
Standing Room Only:

V-1: Superior Orbital Fissure

V-2: Rotundum (foramen)

V-3: Ovale (foramen)
Which cross-section of the spinal cord has:

1. greatest amount of Gray matter

2. Lateral horns
1. Lumbar


2. Thoracic
Dx:

LMN symptoms bilaterally, including flaccid paralysis
Polio
Dx:

lesion in white matter of cervical spine due to demyelination; scanning speech, intention tremor, Nystagmus
Multiple sclerosis

its a SIN to have MS:
Scanning speech,
Intention tremor;
Nystagmus
Dx:

Bilateral dorsal column signs below lesion; positive Romberg; locomotive ataxia; reactive to accomodation but not light; shooting pain
Tabes Dorsalis

(syphillis)

(accomodation but not light = Argyll Robertson pupils)
Dx:

Everything gone except the dorsal columns
Ventral Artery occlusion

(Anterior Spinal Artery)
Dx:

Bilateral loss of pain and temp in upper extremities but still has touch
Syringomyelia

(enlargement of central canal of spinal cord)
Dx:

Combined upper and lower motor neuron deficits w/o any sensory deficit
ALS

(Amylotrophic Lateral Sclerosis)
Dx:

demyelination of dorsal columns, lateral corticospinal tract; ataxic gait; hyperreflexia; impaired position and vibration
Vitamin B-12 neuropathy

(Friedrich's ataxia)
Dx:

Non-fluent aphasia w/ intact comprehension
Broca's aphasia

(BROken speech)

(Nonfluent/Expressive/Motor)
Dx:

Fluent aphasia w/ impaired comprehension
Wernicke's aphasia

(Wordy; Wernickies = "What?")

(Fluent/Receptive/Sensory)
Dx:

Sudden flailing of one arm

where is lesion?
Hemiballismus

lesion:
Contralateral Subthalamic Nucleus
Dx:

Slow, writhing movements, especially in fingers

where is lesion?
Athetosis

lesion:
Basal Ganglia
Dx:

Sudden jerky purposeless movements

where is lesion?
Chorea

lesion:
Basal Ganglia
(7)* functions of the Hypothalamus
TAN HATS:
Thirst and water balance;
Adenohypophysis;
Neurohypophysis;
Hunger;
Autonomic regulation / Circadian rhythm;
Temperature;
Sexual urges and emotions
TAN HATS
Nucleus in Hypothalamus:

Thirst and water balance
Supraoptic


(holding a pee makes you feel water up past your eyeballs)
Nucleus in Hypothalamus:

Destruction leads to Anorexia
Lateral

(destroying "Lateral" makes you thin)
Nucleus in Hypothalamus:

Destruction leads to hyperphagia and Obesity
Ventromedial

(destroying makes you grow ventrally and medially)
portion of Hypothalamus:

Regulates Parasympathetics

what else does it regulate?
Anterior

also: Cooling when hot

[Wear a CAP when you are hot]
(Cooling - Anterior - Parasymp)
portion of Hypothalamus:

Regulates Sympathetics

what else does it regulate?
Posterior


also: Heat when cold
Nucleus in Hypothalamus:

Destruction leads to Rage;
normally leads to pleasure
Septal nucleus

(Septal = Sexual urges)
Which nucleus for ADH and Oxytocin?
ADH = Supraoptic

Oxytocin = Paraventricular
Portion of Thalamus:

Visual
Lateral Geniculate Nucleus
(LGN)

(Lateral for Light)
Portion of Thalamus:

Auditory
Medial Geniculate Nucleus
(MGN)

(Medial for Music)
Portion of Thalamus:

Body sensations - pressure, touch, vibration
Ventral Posterior Lateral
(VPL)

V = Vibration
P = Pressure
L = Light touch
Portion of Thalamus:

Facial sensation
Ventral Posterior Medial
(VPM)

[Very Pleasant Mug (face)]
Portion of Thalamus:

Motor
Ventral Lateral/Anterior nuclei
(VL/VA)

[Volumes of Lifting and Aerobics]
Major relay for ascending sensory info that ultimately reaches the cortex
Thalamus
Portion of the brain responsible for Feeding, Fighting, Feeling, Flight and F-cking
Using "LIMBS" for all 5 F's:

Limbic system
Portion of the brain tha is important for voluntary movements and making postural adjustments
Basal Ganglia
Where does the Direct and Indirect pathway of DA from Substantia Nigra go to first?
Second?
Third?
First:
both to Putamen

Second:
Direct (+) = Globus Pallidus Internal (GPi)
Indirect (-) = GPe

Third:
GPi -> Thalamus or Pedunculopontine nucleus in spine
GPe -> GPi or Subthalamic Nucleus (to GPi)
Numbered areas of Brain:
1. 1,2,3
2. 4
3. 6
4. 8
1. Sensory

2. Motor

3. Premotor

4. Frontal eye fields
Numbered areas of Brain:
1. 17
2. 22
3. 41, 42
4. 44, 45
1. Principal Visual cortex (occipital)

2. Assoc Auditory (Wernicke)

3. Primary Auditory

4. Motor Speech (Broca)
Lesion:

lack of social judgement
Frontal lobe
Brain Vessel:

Leg and foot area of the motor and sensory cortices; medial surface of the brain
Anterior Cerebral artery
Brain Vessel:

supplies the trunk, arm and face of the motor and sensory cortices; Wernicke and Broca's areas; Lateral aspect of the brain
Medial Cerebral artery
Brain Vessel:

may cause visual field defects; most common Circle of Willis aneurysm
Anterior Communicating artery
Brain Vessel:

causes CN-3 palsy
Posterior Communicating artery
Brain Vessel:

division of middle cerebral artery; "arteries of stroke"; supply internal capsule, caudate, putamen, globus pallidus
Lateral Striate
what would a stroke in the anterior part of the circle of willis give?
sensory and motor dysfunction;
aphasia
How would a stroke in the posterior part of the circle of willis present?
(3)
cranial nerve deficits, coma, ataxia
Main vein return of the CSF
Superior Sagittal sinus
what protects a clavical fracture from a brachial plexus injury?
Subclavius muscle
Initial sign of an acute appendicitis appears in what dermatome?
T-10

(at the belly butTEN)
what nerve refers gall bladder pain to the right shoulder?
Phrenic nerve
dermatome for the Inguinal Ligament
L1 = IL
what monitors muscle length?

muscle tension?
Length = muscle Spindles

Tension = Golgi Tendon organs
What are the Thenar and Hypothenar muscles?
(3 each)
Thenar = Thumb
OAF (Oppose, Abduct, Flex)
POLLICIS

Hypothenar is pinky
OAF
DIGITI MINIMI
(4)* muscles that the Radial nerve innervates
BEST ("great extensor nerve"):

Brachioradialis;

Extensors of wrist and fingers;

Supinator;

Triceps
BEST
(3) Vagal Nuclei and their function (and any assoc CN)
nucleus Solitarius = Sensory of viscera (incl taste)
CN-7, 9, 10

nucleus aMbiguus = Motor of pharynx and esophagus
CN-9, 10, 11

Dorsal Motor = Parasymp to heart, lungs and UGI
What cranial nerves have exits through the sphenoid bone?
CN-2 to CN-6
what cranial nerves pass through the Cavernous Sinus?
(5)
eye muscle nerves (CN-3, 4, 6)

and

V-1 and V-2
What vessel passes through the cavernous sinus?

Which is the only "free floating" cranial nerve in the cavernous sinus?
Internal carotid


CN-6
Definition:

takes venous blood from the eyes and superficial cortex to the internal jugular; also houses the pituitary
Cavernous sinus
(3) muscles that close the jaw
M = Munch:

Masseter;

teMoralis;

Medial pterygoid
muscle that lowers the jaw

what are all muscles of mastication innervated by?
Lowers = Lateral pterygoid


Innervated: V-3
What are the "glossus" muscles innervated by?
all except PALATOglossus are innervated by the hypoGLOSSal nerve (Palat = vagus)

Palat = vagus
-glossus = hypoglossal
What are the "palat" muscles innervated by?
all except Tensor veli Palatini are innervated by the Vagus (Tensor = V-3)

Palat = Vagus

TENSor was too TENSE and is V-3
what innervates each of the eye muscles?
LR6 SO4 R3:

Lateral Rectus = CN-6

Superior Oblique = CN-4

Rest = CN-3
Movement of following eye muscles:
1. Superior Oblique
2. Superior Rectus
3. Inferior Oblique
4. Inferior Rectus
1. DOWN nasal
2. up lateral
3. UP nasal
4. down lateral

Rectus = Lateral (like LR)
Oblique = Opposite direction
CN and nuclei involved in a normal pupillary light reflex
CN-3 -> Pretectile nuclei ->

Edinger-Westphal nuclei
Sounds and CN used to test:

1. palate elevation

2. tongue

3. lips
1. Kuh-kuh (CN-10)

2. La-la (CN-12)

3. Mi-mi (CN-7)
Extraocular eye movements during REM is due to what area of the brain?
Paramedian Pontine Reticular Formation
(PPRF)
Aphasia w/ poor repitition and good comprehension; fluent speech
Arcuate Fasciculus

(connects Wernicke to Broca)
Dx:

Hyperorality, hypersexuality, disinhibited behavior

where is lesion?
Kluver-Bucy syndrome

lesion:
bilateral Amygdala
Where is lesion?

Spacial neglect syndrome
Right parietal lobe
Where is lesion?

Tremor at rest, chorea, athtosis
Basal Ganglia
Where is lesion?

Truncal ataxia, dysarthria
Cerebellar Vermis

(Vermis is central and affects Central part of body)
Where is lesion?

Coma
Reticular Activating system
what type of amyloid is w/ alzheimers?

what chromosome/allele w/ familial form?
(2)
Beta-amyloid

Chrom 1, 14, 19 - APOE4 allele

Chrom 21 - p-App gene
Dx:
dementia, aphasia, parkinsonian aspects

what is sign/protein problem?

where is problem in brain (lobes)?
Pick's Dz

Pick bodies = TAU protein

Frontal or temporal lobes only
MCC of dementia in elderly?

2nd MCC?
MCC = Alzheimers

2nd MCC = Multi-infarct dementia
Dx:

chorea, dementia

what part of brain is atrophied?
what chromosome problem?
what NT problem?
Huntington's Dz

CAG repeats on chrom 4 =
Caudate (C) loses ACh (A) and GABA (G)
Dx:
Tremor at rest, Rigidity, Akinesia, Postural instability

what is sign in brain?
Parkinson's
(TRAPped in body)

sign: Lewy Bodies
Dx:
"floppy baby", tongue fasciculations, median age of death is 7 months

where is problem?
Werding-Hoffmann Dz

prob: degeneration of Anterior horns
Dx:

CSF has lymphocytic pleocytosis w/ slight protein elevation. Virus is recovered from stool or throat
Poliovirus
classic triad of Multiple Sclerosis
SIN:

Scanning speech;

Intention tremor / Incontinence

Nystagmus
Tx for MS
Beta-interferon
Dx:
demyelinating dz seen w/ AIDS

what virus?
Progressive Multifocal Leukoencephalopathy
(PML)

virus: JC virus
Dx:
symmetric ascending muscle weakness due to demyelination of PNS; diplegia, CV irregularities; papilledema

Causes (2)
Gullian-Barre syndrome

causes:
Herpesvirus;
Campylobacter infection
Tx for Gullian-Barre
(2)
First line:
Respiratory support

also:
plasmapheresis
Seziure type:

Consciousness intact
Simple Partial
Seziure type:

Blank stare
Absent (Petite mal)
Seizure type:

Quick, repetitive jerks
Myoclonic
Seizure type:

Alternating stiffening and movement
Tonic-Clonic (Grand mal)
Seizure type:

Stiffening
Tonic
Seizure type:

"drop" seizures
Atonic
Intracranial hemorrhage:

CT shows "biconcave disk" not crossing suture lines
Epidural hematoma

(middle meningeal artery)
Intracranial hemorrhage:

CT shows crescent-shaped hemorrhage that crosses suture lines
Subdural hematoma

(bridging veins)
Intracranial hemorrhage:

"worst HA of life", bloody spinal tap
Subarachnoid hemorrhage

(berry aneurysm)
(3) Dx assoc w/ berry aneurysms
APKD;

Ehlers-Danlos;

Marfan's
what are clinical presentations of brain tumors due to?
Mass effects

(seizures, dementia, etc)
MCC brain tumor in adult
Glioblastoma multiforme
Dx:

"butterfly glioma" - can cross the corpus callosum
Glioblastoma Multiforme
Dx:

"Pseudopalisading" tumor cells boarder the areas of necrosis and hemorrhage
Glioblastoma Multiforme
Dx:

spindle cells concentrically arranged in whorled pattern of this brain tumor; psammoma bodies; arises from arachnoid cells; on surface
Meningioma
Dx:

"fried egg" cells - round nuclei w/ clear cytoplasm in frontal lobes
Oligodendroglioma
Dx:

childhood brain tumor; diffusely infiltrating; posterior fossa; Rosenthal fibers - eosinophilic corkscrew appearance
Pilocytic Astrocytoma
Dx:

childhood brain tumor; rosettes or pseudorosettes; radiosensitive; neuroectodermal origin
Medulloblastoma
Dx:

perivascular pseudorosettes; rod-shaped blepharoplasts; MC in ventricles
Ependymoma
Dx:

childhood brain tumor w/ foamy cells and high vascularity

what is it assoc with?
what is the ectopic production?
Hemangioblastoma

assoc w: Von Hippel-Lindau

ectopic: EPO -> polycythemia
Dx:

benign childhood tumor from Rathke's pouch and can cause bitemporal hemianopsia
Craniopharyngioma
Dx:

Ipsilateral loss of all sensation; contralateral loss of pain and temp
Brown-Sequard syndrome
Dx:

Ptosis, anhidrosis, miosis of face

Can be associated w/ spinal cord lesion above what level?
Horners syndrome

(PAM is Horny)

w/ spine above T-1
Nerve w/ site of injury:

Shaft of humerus
Radial
Nerve w/ site of injury:

Supracondyle of humerus
Median
Nerve w/ site of injury:

Medial epicondyle
Ulnar
Nerve w/ site of injury:

Surgical neck of humerus
Axillary
Dx:

loss of triceps brachii, brachioradialis, extensor carpi radialis longus
Radial nerve injury

(Radial = wRist drop)
Dx:

no loss of power in any arm muscles; loss of forearm pronation, wrist flexion, finger flexion, several thumb movements, thenar atrophy
Median nerve injury

("Pope's Blessing" = cross in the median)
Dx:

impaired wrist flexion and adduction, and impaired adduction of the thumb and last two fingers
Ulnar nerve injury

(Claw hand)
Dx:

Anterior shoulder dislocation; loss of deltoid action
Axillary nerve injury
Dx:

difficulty flexing elbow; loss of function of coracobrachialis, biceps, and brachialis muscles (and biceps reflex)
Musculocutaneous nerve injury
Bracial plexus is assoc w/ what 5 spinal nerves?
C5, C6, C7, C8, T1
what is the order of the (5)* main nerves as they come off the brachial plexus (top to bottom)?
CAMel RUn:
musculoCutaneous;
Axillary;
Median;
Radial;
Ulna
CAMel RUn
Dx:

limb hangs at side, medially rotated and forearm is pronated
where is problem?
what is common cause?
Erb-Duchenne Palsy
("Waiter's Tip")

C5 and C6 (upper trunk) injury

occurs as delivery trauma
What innervates the lateral and anterior foot?
PED = Peroneal Everts and Dorsiflexes

Deep Peroneal = Anterior

Superficial Peroneal = Lateral
What innervates the posterior foot and plantar flexes?
TIP = Tibial Inverts and Plantarflexes

(can't stand on TIPtoes)
what nerve corresponds to L3-L4?
Femoral
Dx:
delivery causes atrophy of thenar, hypothenar and interosseous muscles, sensory deficit on medial forearm, dissapearance of radial pulse w/ movement of head to opposite side

what is compressed?
(2)
Thoracic Outlet Syndrome

(Subclavian artery and inferior Trunk (C8, T1) of brachial plexus)
Which is the only sympathetic that secretes ACh?
Sweat gland
How do you tell where a CN-12 lesion is?
(3 steps)
1. have person stick tongue out to determine if flaccid or spastic paralysis

2. look to which side it deviates

3. LMN (flaccid) deviates toward side of lesion; UMN (spastic) deviates away from side of lesion

(Lmn = Lick your wound (same side))
what/where is Deviation of CN-5 lesion?
Jaw towards lesion side
Test for unilateral lesion of cerebellum?
Rhomberg - patient falls Toward side of lesion
Deviation of CN-10?
Uvula deviates AWAY from side of lesion
Deviation of CN-11?
(2)
Shoulder droop on side of lesion

weakness on turning head to contralateral side
what (2) CN have UMN and LMN symptoms if there is a lesion?
CN-7

CN-12
which CN problem?

Palatal sagging and vocal cord paralysis
CN-10
(4) nuclei associated w/ CN-9

which deals w/ the gag reflex?
Spinal V

Solitarius (tongue)

Inf. Salvitory (Parotid)

Ambiguus (gag reflex)
A tumor of the internal jugular at the petrosus temporal bone would have an effect on what CN?
CN-9, 10, 11
what ganglion / nerve does a right turn inside the skull?
Geniculate ganglion of the Facial nerve
Dx:

brain tumor causing truncal ataxia, wide-based gait, projectile vomiting
Meduloblastoma
in a Webber hearing test, how do you tell what type of problem it is if the sound localizes to one side?
Ipsilateral = Conduction loss

Contralateral = Sensorineural loss
what is the specific ganglia for the tear-producing part of CN-7?
Pterygopalatine ganglion


(spit = submandibular gang)

(all 3 originally from Superior salivary nuclei)
how do you know if patient has UMN or LMN CN-7 lesion?
UMN - contralateral LOWER face only

LMN - Ipsilateral UPPER and LOWER face
(Bells Palsy)
what Dx can you see Bell's Palsy?
(5)*
ALexander BELL w/ STD
AIDS;
Lyme dz;
Sarcoid;
Tumors;
Diabetes
ALexander BELL w/ STD
Herniation syndromes:

can compress cerebral artery
Cingulate herniation

(under falx)
Herniation syndromes:

Coma and death can result when it compresses brainstem
Central Transtentorial herniation
Herniation syndromes:

medial, temporal lobe herniation
Uncal
Herniation syndromes:

herniates into foramen magnum
Cerebellar tonsillar
Dx:

contrlateral hemiparesis, ipsilateral dilated pupil, ipsilateral gaze preference, caudal displacement of brainstem (Duret hemorrhages)
Uncal herniation
where is lesion for a Left homonymous hemianopia
right optic tract
Where is the substantia nigra and VTA located?
Midbrain
how can you tell if CN-4 lesion is on the nerve or the nucleus?
Nerve = head-tilt away from lesion


Nucleus = head-tilt towards lesion
Dx:

small irregular pupil that does not react to light but does to accomodation

what to Dx is it seen in?
Argyll-Robertson the diabetic hooker w/ syphillis:

"Accomodates but does not react"

seen in:
Diabetes;
Syphillis
visual field defect:

right temporal lobe lesion or Meyer's loop
Left upper quadrantic anopsia
visual field defect:

right upper (cuneate) calcarine fissure
Left lower quadrantic anopsia
(w/ macular sparing)
visual field defect:

right occipital lesion
Left hemianopia w/ macular sparing
Dx:

person cannot move right eye to left lateral but can converge both eyes to center
what muscle and CN involved?

what Dx is it commonly seen in?
lesion of Medial Longitudinal Fasciculus (MLF)

(medial rectus palsy, normal w/ convergence; CN-3, CN-4)

MLF w/ MS
NT changes:

Anxiety
(3)
Inc NE

Dec GABA

Dec 5-HT
NT changes:

Depression
(2)
Dec NE

Dec 5-HT
NT changes:

Alzheimer's
Dec ACh
NT changes:

Huntington's Dz
(2)
Dec GABA

Dec ACh
If you shine a light in patient's right eye and both pupils constrict, then shine it in left eye and they both dilate, where is the lesion?
Left Retinal outflow tract of Optic nerve
Difference b/t MRI T1 and T2
T1 = Black water

T2 = white water
Order of deep cerebellar nuclei from lateral to midline
(4)*
Dont Eat Greesy Food

D
E
G
F
Dont Eat Greesy Food
In the cerebellum:

where are the parallel fibers?

Dendrites of Purkinje cells?
Parallel = Granular layer

Dendrites of Purkinje = Molecular layer
Bridge b/t thinking brain and emotional brain
Cingulate
regulates placement and memory
Hippocampus
Regulates reward system; important in drug addiction
Nucleus Accumbens
where is the most likely place of a lesion for Aphasia?
Temporal lobe
What is the electrolyte flow for depolarization of hair cells in the cochlea?
K+ into the cell depolarizes
What receptor measures steady pressure on the skin?
Ruffini endings
What receptor measures vibration on the skin?
Pacinian corpuscle
what tracts are in the Inferior (3), Middle (1) and Superior (2) cerebellar peduncles?*
DIBs On TVS in the PM:

Inferior - Dorsal (cord); vestiBulocerebellar; Olive

Superior - Tectocerebellar; Ventral

Middle - Pontocerebellar
DIBs On TVS in the PM
when a person moves his head to the right, what happens in the semicircular canal?
(2)
both (R and L) bend away from the Kinocilium;

Cupula moves to opposite side
when light strikes the eye, what are the steps?
(6)
Light -> CIS changes to TRANS ->
Inc Rhodopsin -> Inc Transducin ->
Dec cGMP -> Dec Na+ -> Hyperpolarization
if nystagmus is a symptom of a cerebellar lesion, where is the lesion?
Flocculonodular lobe
what is the equation for intensity of hearing?
Intensity = 20 x log (sound/threshold)
what are two places in the ear that hear high-frequency sounds?

example of a low-frequency place?
Base:

Oval window

Round window

(Apex - Helicotrema - hears low sounds)
what occurs with the biceps and triceps regarding Ia and Ib fibers when flexing the biceps?
Flex biceps:

Bicep -
Ia Dec firing (compressed);
Ib Inc firing (tension/contract);

Triceps -
Ia Inc firing (stretched);
Ib has no change