PTA neurology final review Flashcards

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Terms Definitions
Arachanoid granulation
aka Arachanoid villi.
reabsorb CSF back into the blood at a rate equal to formation.
CSF
-CSF filled cavities are known as Ventricles
-Most CSF forms in the lateral ventricles
-Formed by blood filtration.
Choroid plexus
name of the network of capillaries that line the walls of ventricles.
-Produce the CSF by flitrating/pushing blood plasma
3 ways CSF maintains homeostasis
Mechanical protection-shock absorber
Chemical protection-maintains an ionic env for(AP)
Circulation-a medium exchange of nutrients and waste products btw blood and nervous tissue.
Hydocephalus
blood blocked interfering w drainage of CSF from ventricles.
AKA-enlargement of the ventricles
kids-bulging of the head.
Blood supply of the brain
20% oxygen
4 mins or more of interruption of blood flow=permanent damage to the brain.
-Supply by the Circle of willis
-Lysosomes if lack of O2 release enzymes and they destroy neurons.
Can the blood brain barrier store glucose?
NO, so blood supply is important!!
What are of the Brain stores more O2?
Cerebrum
BBB
Blood brain barrier
crosses over and interacts with neurons
Capillaries of the brain r less permeable bc of their endothelial cells.
Astrocytes- stars cells! press against capills and allow specif substances.
Circle of Willis
main trunk that supplies brain. if blood is blocked, can still get to brain.
-is a point where the blood carried by th 2 internal carotids and basilar systems come 2gether and then redistributed by the ant, mid, and pos cerebral arteries.
Falx cerebrix
from the dura mater-separater the hemispheres of the cerebrum.
What are the layers of the brain?
protection layers
Dura mate-outer
Arachanoid-middle
Pia mater-inner most
What produces CSF and where?
secreted by-Choroid plexuses-located in the 4 ventricles
circulates through the brain and enters the superior sagittal sinus.
Arachnoid layer-middle
What is Sensation?
State of awareness pf external or internal conditions of the body.
Info travels via
Conscious relay path
divergent path
and unconscious relay paths.
What 3 ways does sensation get to the brain?
Conscious relay path-discriminative touch
divergent path-aching pain
unconscious relay paths-how I move(cerebellum)
Sensation receptor classifications
Exteroceptors-external/superficial env(nose,eyes,touch,sound)
Visceroceptors or interoceptors- internal.
Proprioceptors- movement-joints ligs,tendons.
What is a mechanoreceptor?
sensory recepts, touch, pressure, stretch,
Thermoreceptor?
temp warm and cold receptors
thermal sensation
Nociceptors?
Pain sensation
sensitive to chemicals released.
Photoreceptors?
eyes
Chemoreceptors?
responds to chemical receptors>O2 levels
taste.
Proprioceptive
aka kinesthetic sense.
info regarding movement and positions.
joint, hair cells, ms spindles, GTO-ms strength.
Sensory intergration
ability of the brain to organize, interpret, and use sensory info. occurs automatically.
-ways to teach kids better.
Sensory Arousal levels or SAL
Alert
Lethargic-drowsy w lessened focus
Obtunded-difficulty to arouse, confused when awake.
Stupor-responce to painful stimuli only. then back to unconscio.
Coma- no arousal by any stimuli
Orientation-
pt's awareness of, TIME, PERSON, PLACE
pt orientate X3
pt orientate X1 (place)
Pt orientate X2 (time and person)
Soap note i.e=O+A X3
Labeled line principle
line going from tongue to brain.
Receptive field
area of skin innervated by a single afferent neuron(sensory)
different types cutaneous, superficial, thermal, ect...
More sensory distally!
Modality sensation
each sense is a modality sensation.
i.e hearing, vision, taste, touch.
Superficial fine touch
smaller receptive fields
Merkels discs
superficial fine touch receptive field.
free nerve endings wraps around base of hair follicle; TOUCH RECEPTOR

detects mechanical movement/touch.
feel me touch the hair
Meissner's corpuscles
in superficial dermis, light pressure. rapidly adapt. RECOGNIZE OF TEXTURE.
Pacinian corpuscles
deep dermis, deep pressure and vibration.
(circle)
Subcutaneous fine touch
larger receptor fields
Ruffinis corpuscles
deep dermis, sensitive to stretch of the skin.
Assist w joint position sense.
Thermal receptors
free nerve endings in dermis, ms, liver.
rapidly adapt.
Warm rec- respond to temps btw 77-113 degrees
Cold recep- respond to temps btw 50-68 degrees F
Nociceptors
scatter about
free nerve endingd w LARGE receptive fields. found in superficial skin, joint caps, periosteum, around walls of b. vessles,
A-fibers-carry fast pain
C-fibers-carry slow burning aching pain
Periosteum-
fiber connective tissue that wraps around ms spindles.
Coarse touch
free nerve endings throughout skin,
detect crudely localized touch/pressure/tickle/itch.
Deep sensory receptors
in ms, tendons, joints
GAMMA motor neurons fiber.
Ms spindles
intrafusal fibers parallel to extrafusal fibers.
monitor changes in ms length n velocity.
motor learning!
Golgi tendon organ
in tendons. monitor tension in a ms.
Golgi-protective, 2 relax ms w/in a tendon.
will inhibit contracting.
deep sensory receptors
Free nerve endings
w/in fascia of a ms. respond to pain/pressure/vibration
Pacinian corpuscles
in tendons/around joints. respond to deep pressure and vibration. circle!
Golgi
type nerve ending- receptors in ligs. detect rate of joint movement.
Ruffini endings
in joint caps and ligs.
joint receptor. respond to direction of joint movement.
Dorsal column
sensory axon enter the SC via dorsal horn.
Fast conducting fibers.

two-point discrimination. Lager fibers.
Discriminative touch.
skin,joints,
Sensory receptors-
are located at the distal end of an afferent nerve fiber.
Anterolateral spinothlamic
Anterior-carry info regarding crude touch.
Lateral-pain and temp.

SMALL conducting fibers.
Mechanoreceptors, thermo, and nociceptors. Afferent fibers that slowly conduct.
Dyscalculia-define-
difficulty calculating.
Barognosis
regcognition of weight
Graphethsia
traced figure ID.
like letters
Stereognosis
id a common object w/out site.
key,pen,
2 point discrimination
aesthesoimeter or circular disk measures distance on skin that 2 points are felt.
Kinesthesia
PROM. where is joint moving? up or down?
Proprioception
move joint then stop. eyes closed.
Quantitative
sensory testing
Varicella zoster
shingles.
infection of senory root cell body.
Define Pain
pain is objective.
peripheral nociceptors r found through out skin and internal tissues, cept tissue of the brain.
Ischemia
deficiency of blood. resulting in deficiency of )2 (hypoxa)
Cramp pain
ms's tighten up and squeezing caps. which decrease blood. then pain-stimi chems accumulate. BUT if u apply heat=dialtes blood, increasing blood flow/O2=less pain.
a-delta fibers
fast carrying pain info. myelinated axons.
C-fibers
slow carrying dull aching pain. on unmyelinated axons. synapse on neurons in dorsal horn.
to the limbic system(emotional response) and reticular-wake up! turn towards pain.
Somatosensory cortex
pain perception or localization.
Gate theory
(non pain)if alpha-beta fibers are stimulated more then the alpha-delta fibers(pain fibers)then the pain is inhibited in the dorsal horn. 'closing the gate'
rubbing the pain inhibits the T-cells=stopped the pain!
Alpha-beta fibers
non-nociceptors(non pain receptors)carry info from mechnoreceptors
What does lower levels of serotonin mean?
increased pain!
so increased levels of serotonin and dopamine in brain means = inhibit pain!
Neurotransmitter
Counterirritant theory
pressure stimulates mechanoreceptor afferent branches, which attivate interneurons that release Enkephalin, which decreases the release of Substance P(chronic pain nt)
Antinociception
suppression of pain
Neuromodulators
produced in brain. enkephalin, beta-endorphin
can inhibit pain
Peripheral pain
aspirin can inhibit pain
Brainstem descending tacts
become activated, and inhibit pain by increasing the release of serotonin in the dorsal horn, which increases enkephalins.
Hormonal system
pituitary gland and adrenal medulla release enkephalin during acute stress.
thats y ppl walk away w a broken leg.
Cortical
ihibits pain by distraction, placebo, excitement.
Pronociception
edema- endogenous chems-sunburn
anxiety-can increase pain. increased levels of norepinphrine can increase pain.
Multiple ways to shut down pain
Neurotransmitters-increased serotonin
Doral horn-TENS
Hormonal- stress
Types of pain
Acute, referred, Chronic

Chronic pain-Nociceptive- continuing stimulation all the time
Chronic pain neuropathic- a disease. pain continues after stimi is gone.
Chronic pain-Nociceptive
Chronic pain-Nociceptive- continuing stimulation all the time bc of cancer or tumor. takes less stimi to generation AP.
Chronic pain neuropathic-
a disease. pain continues after stimi is gone.
Symptoms of neuropathic pain
paresthesia-painless. abnorm sensation.
Dysethesia-unpleasant. abnorm sensation. burning, shooting pain.
Allodynia-norm non-painful touch produces pain.
Secondary hyperalgesia-fibromyalgia pain. normal touch feels painful!
Secondary hyperalgesia
fibromyalgia pain. normal touch feels mildly painful!
Allodynia-
norm non-painful touch produces pain.
paresthesia
painless. abnorm sensation. (tickle)lesions
Dysethesia-
unpleasant. abnorm sensation. burning, shooting pain.
PNS neuropathic pain
injury or disease of peripheral nerve.
Ectopic foci- myelin damage make AP w/out stimi. Ectopic develop at nerve stump ends and tapping induces pain AKA Tinels sign!
Tinels sign
Ectopic foci- myelin damage produces AP w/out stimi. this develops at stump nerve ends and when tapping=induces pain- TINELS sign.
Mononeuropathy
PNS- one nerve
median or ulna nerve compression
Polyneuropathies
PNS- more than one nerve. like diabetic neuropathy and guillain barre.
CNS neuropathic pain
if peripheral sensory info in completely absent.(sensory info coming in) then CNS neurons in the pain pathway become abnormally active!
Deafferentation
CNS neuropathic pain
avulsion of afferent roots (MVA)(cutting off dorsal roots)
causes burning pain in area of sensation loss
Phantom limb pain
CNS neuropathic pain
Pain matrix malfunction
Antinociception is decreased and pronociception is increasesd.
Fibromyalgia, Complex regional pain syndrome.
Complex regional pain syndrome
abnormal response to trama leading to limb disuse. excessive sweating, edema, red/pink skin,
Chronic pain syndromes
migraine, chronic low back pain-never stops.
Simple descriptive pain scale
a line....no pain,mild, moderate, severe,-max pain tolerable
VAS-visual analog scale
a line...no pain-max.
Pain estimate (scale)
a line---0-100 or 0-10
Face pain scale
faces for kids
Mcgill pain questionnaire
20 categories of descriptive words.
pain clinics use this a lot.
1-10 sensory
11-15 affective
number 16 evaluative
Caregiver checklist
list of demonstrated pain behaviors for pt's who cant communicate.
Observe-
gait, posture, skin, ROM, ms strength, sensation.
Disorders of Vascular supply
Anerism- dislocation of wall, abnormal widening.
TIA-stroke
Angedogphy -X-ray pictures of the inside of blood vessels.
Hemerage- thin wall vessles
What makes up the CNS?
brain and sc
PNS
31 SP-pairs nerves
12 pairs-cranal.
Subdivision-ANS
CNS-all nervous systems ARE encased in Vertebral column. (brainstem, SC, skull)
Neuroglia cell types-Astrocytes, Oligodendrocytes, microglia, ependyma.
No Neurolemma-> NO REGENERATE!
Oligodendrocytes-myelinate.
Mulitple Sclerosis)
Has nucleus and PNS
PNS-all nervous systems NOT encased in bone
Have ganglia,carry info to and from CNS.
Neurolemma AKA Schwann Cells->mylinate -regeneration
Guillian-barre
Divided into 2 systems- Somatic-voluntary-motor control ability.ANS-involuntary2 subdiv
sympath+
PNS-two systems
ANS-sympathic s-fight or flight. and Parasympathic s-restful.
Somatic-voluntary. contraction of ms. motor control.
Afferent fibers
sensory. info to the CNS.
somatic afferent-to CNS-skin, skeleton, joints,
Efferent fibers
Motor-leaves CNS
Somatic efferent-skeletal ms's.
Viseral efferent fibers- heart, smooth ms, glands, to autonomic sys.
Neurons
Dendrites receive, Axons conduct.
Node of Ranvier
space btw mylein
exposed 2 extracelluar fuild.
Where the gates open!!
Spinal cord-how long and how many nerves?
31 pairs of nerves
runs to medulla-L1/L2
18"
Gray matter inside-unmyleinated axon. cell bodies.
Sensory coming in from where?
Dorsal roots gangila.
Motor coming out-Ventral.
Reflex arch?
quick response.
Lateral spinothalamic tract
pain/temp
Lateral Corico tract*
BIG AIS motor-distal-
UMN vs LMN
UMN-synapse w.inhibitory
hyper reflexia, hypertonia (babinski)

LMN-directly to Ms. Hypotonia.
Flaccid-
no resistance,
Cranial nerve VIII
Vestibulocochlear
balance, auditory sensations from inner ear.
Cranial nerve XII
Hypoglossal
motor to tongue
X cranial nerve
Vagus nerve-only cranial nerve to descend below neck. autonomic. throacic and abdom organs.
Cranial nerve IV
Trochlear- motor for chewing
area of brain which has cardiac, vasomotor, and respiratory centers.
Medulla
Hypothalmus is which part of the brain?
Diencephalon
Area of brain which can modify the respiratory phythmicity center and contains 4 nuclei?
PONS
Cognitive, problem solving, are functions of what area of the brain?
Parietotemporal ass cortex
Crutch palsy is from compression of which nerve?
radial
Primary motor area is where?
frontal lobe and is the source of most of the corticospinal tract neurons.
Brocas area is
area of the cerebral cortex which provides motor control of the mouth, tongue, and larynx for speech.
Wrenicke's are is?
comprehension of spoken language
The primary somatosensory area receives info regarding?
touch, pain, temp, proprioception
Cerebellum
compares intended movement with actual movement.
adjusts UMN activity.
helps w balance and coordination
Gyri are
Convolutions
Sulci are
shallow grooves
The longitudinsal fissures separates
the cerebral hemspheres; the transverse.
Taste is interpreted in what lobe?
parietal lobe
Cerebral cortex
outer 2-5mm of the cerebrum. contains 75% of all neuron cell bodies.
Prefrontal association area deals with
executive function and goal oriented behavior
Thoracic plexus
is not considered a nerve plexus
Commissural (cerebral white fiber)
cross to the opposite cerebral hemisp
Association fiber
Stay w in same hemisphere
Projection fiber
leave the cerebrum and descend towards spinal cord.
LMN
cell bodies in SC or brainstem
communicate directly w skeletal ms.
Loss of reflexes-LMN
Hyperreflexia-LMN
Hypertonia-LMN
UMN
Cell bodies in the cerebral cortex or brainstem. (rubrospinal tract)
UMN can inhibit LMN or modify them.
Fasiculation
quick twitches of ms fibers visible under skin.
Rigidity
type of hypertonia..
amt of resistance to passive stretch dont matter of velocity
Hyperreflexia
ms spindle stretch leads to overactivity of lmn's
Clasp-knife
strong resistance to stretch and then sudden give.
Basal gangial masses of what kind of matter?
Gray matter
can adjust descending tracts activity
can provide subconscious control of ms tone and coordination.
What neurotransmitter is lacking in Parkinsons?
Domonphine
Auto immune disease that kills basal ganglia cells, leading to hyperkinesia?
Huntington's
What gland scretes melatonin?
pineal gland
Large tract of commissural fibers in brain?
Corpus collum
Afferent
toward CNS
Efferent
away CNS
AP-
refers to a wave of charge that propagates alone axon of neuron til its reaches axon terminal.
Microglia cell
a neuroglia cell of the CNS that breaksdown pathogens.
Absolute refractory period
the cell cant respond to other stimi at this time.
it coincides w the ap and lasts for 1 millisecond.
the parasympathic system is responsible for energy conservation
the sympathic sys is responsible for expenditure of energy.
how long does the relative refractory period last?
10-15 millisecs after an AP
-90mV
hyperpolarization
Acetycholine
is a neurontransmitter is the PNS that is a big conveyor of info and is always excitstory at th neuormuscular juction.
Divergence
1 pre-synptic neuron synapsing w MANY post syn.
Sodium potassium pump, pumps sodium
out and potassium into the cell
Neuroblastoma is
cancer of neurons
Where are the abundant voltage gated Na+ and K+ channels?
at the axon and node of ranvier.
Filum terminale
is ct from the end of the sc to the S2 level
Which horn houses sensory endings and cell bodies of 2nd order sensory neurons?
dorsal horn
dorsal root consists of afferent fibers
anterior/ventral roots consists of what fibers?
efferent
Decussation pyramids
many sensory or motor tracts cross over here
Perineurium
is a ct that wraps around a fascicle of nerve fibers (axons)
Tectospinal
controls movements of the head in response to visual/auditory stimi.
Spinocerebellar
unconscious proprioception
upper truck, neck, vibration, kinesthesia,
Fasiculus cuneatue
lateral spinothalamic
pain/temp
lateral corticospinal
precise contraction of distasl extremities
Rubrospinal
contralateral UE flexors and gross postural tone
Vestibulospinal
regulates ms tone in response to head movement, balance.
Anterior spinothalamic
crude touch and pressure
Circle of willis info
There are some watershed areas in the brain located at the ends of the vascular sys. Problems with blood supply r here,
Blockages in the water shed areas can cause transcortical aphasia
transcortical aphasia
from lesions outside of Broca's area or Wernicke's area of the cerebral cortex.
aphasia
Loss of ability to understand or express speech, caused by brain damage
Resting membrane potential?
-70mV
Hyperpolerization threshold?
-90mV
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