A&P Exam 3 Material (Final)

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1

A typical bone has these 2 distinct regions of bone

Compact & spongy bone

2

The inside of the bone; important function is hematopoiesis

Marrow cavity

3

Difference r/t hematopoiesis in children vs. adults

Children - all bones make blood cells

Adults - only some parts of certain bones make blood cells

4

Region of long bone:

Head of bone

Epiphysis

5

Region of long bone:

Shaft of bone

Diaphysis

6

Bones found in the limbs

Long bones

7

In the femur, as in the humerus, hematopoiesis occurs only in 1) this region of the bone, which is composed of 2) this type of bone

1. Head & neck (proximal portion)

2. Spongy bone

8

In adult bones that don't participate in hematopoiesis, 1) what change occurs, 2) what is it due to, and 3) where does it occur?

1. Red marrow is replaced with yellow marrow

2. Yellow = fat (red was due to RBC production)

3. Spongy part of the bone

9

Most of bone is encased within this layer, which has 2 sublayers

Periosteum

10

The periosteum, which encases most bone, consists of these 2 layers

1. Tough fibrous outer layer w/collagen

2. Inner cellular layer playing key role in bone formation

11

Layer of periosteum w/collagen fibers

Tough fibrous outer layer

12

Layer of periosteum that plays key role in bone formation

Inner cellular layer

13

The periosteum is replaced by _____ 1 _____ on the _____ 2 _____ of the bone

1. articular cartilage

2. articular surface

14

Articular cartilage, which replaces the periosteum on the articular surface of bones, is composed of this glassy, very smooth cartilage

Hyaline cartilage

15

Glassy, very smooth cartilage that replaces the periosteum on articular surfaces of bones

Hyaline cartilage

16

This type of bone has an orderly structure & contains a series of tunnels

Compact bone

17

Series of tunnels within compact bone; contain blood vessels

Central canals

18

The layer lining the central canals within compact bone

Endosteum

19

2 layers within bone that participate in new bone formation

1. Inner cellular layer of periosteum

2. Endosteum (lining central canals of compact bone)

20

Completely encloses spongy bone

Compact bone

21

-Thin layer

-Accounts for smaller volume of given bone

-Higher density, so 75% of bone by weight

Compact bone

22

What would happen if all of your bone was compact bone?

Too heavy to move or even sit up!!!

23

The circular structure surrounding one central canal; includes rings marked with osteocytes

Osteon

24

Cells in concentric rings within an osteon; trapped inside the matrix of compact bone

Osteocytes

25

1. Where are osteoblasts located?

2. What substance do they secrete?

3. What is this substance?

1. Endosteum & inner cellular layer of periosteum

2. Osteoid

3. Precursor of bone

26

Making the bone matrix (and thus bone formation) is a 2-step process. What are these 2 steps?

1. Secretion of the bone precursor, osteoid, from osteoblasts

2. Crystallization of hydroxyapatite (Ca++, Phosphorus) onto collagen fibers of osteoid

27

Where do the minerals that form hydroxyapatite and complete the 2nd step of bone matrix formation come from?

Osteoblasts - as does the osteoid that comprises the 1st step in bone matrix formation

28

What happens to some osteoblasts that get trapped in matrix?

-Stop secreting osteoid

-Turn into osteocytes

29

What function do the tiny canals that connect osteocytes serve?

Passage of nutrients & wastes

30
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Identify which cells are osteoblasts (depositing osteoid) & which are osteocytes (trapped in osteoid)

1. White layer with 2 cells = osteocytes

2. Cells above white layer = osteoblasts

31

Precursor cells, forming osteocytes; responsible for bone formation

Osteoblasts

32

Multinucleate cells made from fusion of many macrophages; role is bone resorption

Osteoclasts

33

When an osteoblast becomes an osteocyte (normal life cycle), does the activity increase or decrease?

Decreases (structure simplifies as well, since no need for organelles to secrete osteoid)

34

Sequence of events for bone remodeling (3 steps)

1. Osteoclast attaches to bone & secretes acid (H+ ions) to dissolve bone underneath it

2. Osteoclast detaches from bone & moves on

3. Osteoblasts move into pit, secreting osteoid to build new bone

35

Cluster of cells functioning as "Cutting Cones", like Big Bertha; tunneling machine

Osteoclasts

36

Follow behind, zipping up & resealing tunnel left behind (bone formation)

Osteoblasts

37

Can cause significant lag in between bone breakdown & bone formation

Insufficient building blocks (Ca++, phosphorus)

38

Insufficient Ca++/phosphorus, which can create a lag between bone breakdown & formation, can lead to a situation not unlike what disease process?

Osteoporosis

39

Induces more bone growth as a response

Chronic stress (i.e. exercise) - whereas a person who leads a sedentary lifestyle would have less bone growth/remodeling

40
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Which femur, left or right, is reflective of an individual who lived a sedentary lifestyle?

Right femur - less use of quads, which are attached to bone's ridge where growth is expansive on left femur

41

Made up of lots of tiny struts of bone; space between struts filled with marrow

Spongy bone

42

Tiny struts that form the composition of spongy bone

Trabeculi

43

Since trabeculi surfaces are covered by endosteum, bone is deposited in __1__ layers, with the __2__ bone being the outermost layer

1. circular

2. youngest

44

How do the trabeculi of spongy bone line up in relation to direction? How is this different in adults vs. infants/toddlers?

-Parallel to the direction of force (i.e. along stress lines)

-Infants/toddlers don't put ambulatory stress on bones until much later in development

45

Bone density condition increasing risk of fractures

Osteoporosis

46

Bone disorder characterized by vitamin D deficiency in children; uncommon in developed countries

Rickets

47

Caused by vitamin D or Ca++ deficiency in adults

Osteomalacia

48

2 bone disorders which can result in bone deformations which aren't reversible

Rickets & osteomalacia

49

Repair of broken bone is similar to bone development, but requires these 2 components

-Blood vessels

-Chondrocytes

50

4 steps of bone remodeling following fracture:

1. Blood forms hematoma - angiogenesis

2. Collagen deposited

3. Osteoblasts deposit temporary bone to stabilize break

4. Blasts & clasts work together to breakdown/rebuild

51

After a fracture, after spongy bone is converted to compact bone, these cells perform the final "editing"

Osteoclasts

52

Even though skeleton is bone, it still requires this as the foundation for its development

Cartilage

53

Type of fracture caused by overuse r/t repetition

Stress FX

54

Type of fracture where bone isn't broken all the way through

Incomplete FX

55

Type of fracture where bone is broken all the way across

Complete FX

56

Type of fracture where 2 pieces are still together

Nondisplaced FX

57

Type of fracture where 2 pieces, or ends, are apart

Displaced FX

58

Type of fracture that is broken or splintered into 3 or more fragments

Comminuted FX

59

List fracture types from least to most severe

-Stress

-Incomplete

-Complete

-Nondisplaced

-Displaced

-Comminuted

60

Most common fracture site in body - due to a medial forceful thrust

Clavicle FX

61
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Note that distal end of clavicle sags, while proximal end is displaced upwards

No information...

62

4 most clinically relevant bones

-Femur

-Vertebrae

-Radius

-Ulna

63

"Porous bone" - disease of the aged; more common in women

Osteoporosis

64

Most common sites of FX's r/t osteoporosis

Neck of femur (hip) & spine

65

DX tool for bone health; can be used to assess bone density for both hip & spine, which can predict risk of future FX's

DEXA scan (Dual-energy X-ray absorptiometry)

66

Excellent DX tool to detect early signs of osteoporosis & estimate risk of future FX's

DEXA scan

67

The World Health Organization (WHO) has adopted standards for bone health, called T & Z scores. While Z scores are measured in a percentile based on age & gender (similar to physical development of children), where having a Z score of 80% is better than 40%, T scores have 4 different classifications. What are these 4 classifications?

1. Normal bone: Better than -1 (w/in 10% of average)

2. Osteopenia: Between -1 & -2.5 (about 10-25% less)

3. Osteoporosis: Less than -2.5 (about 25% less)

4. Established (severe) osteoporosis includes presence of non-traumatic FX

68

Under ideal circumstances, what's the best treatment for osteoporosis? Once diagnosed, what's the treatment regimen?

*Prevention (DEXA scan can show early density issues)

-Diet high in vitamin D & Ca++

-Bisphosphonates (drug)

-Exercise (stress = strength)

69

18-month training program designed to add bone density to hips & vertebrae & strengthen lower extremities, mostly through resistance exercise, education & diet. This will reduce the risk of falls.

Osteo-cise

70

Why does aging result in bone loss?

Balance shifts to bone resorption, & osteoclast activity isn't matched as well by osteoblast activity

71

Abnormal spine curvature r/t compression FX's of multiple vertebrae

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Kyphosis

72
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Normal MRI of spine vs. =>

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MRI of compression FX (see white arrow)

73

Why is osteoporosis more common in women?

-Lower starting bone density

-Loss of estrogen following menopause reduces bone deposition

74

What 2 features complicate vertebral compression FX's?

1. Tilts superior vertebrae anteriorly (most common)

2. Ligaments adjust to shortened vertebrae, cinching down & locking it into place

*Only SX can correct this

75

The majority of vertebral FX's are located where?

Lumbar region

76

As recent as 25 years ago, this FX was tantamount to a death sentence r/t how it was treated

Hip FX

77

In a bad ankle sprain, this ligament is almost always the first to rupture

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Anterior Talofibular Ligament (ATL)

78

Ligaments do what when rested (opposite of muscles)? This means initially we'll passively rest, & then actively rest by doing resistance training in the foot (muscles & tendons of foot are strengthened, taking "load" off ligaments)

Shorten

79

A ligament in this state, which usually occurs following injury, places the person at greater risk of another sprain

"Lax" ligament (loose, not allowed to shorten back to normal thru rest)

80

3 of these; attach to ischial tuberosity; can avulse from bone (usually not all 3 due to amount of force required) at high speeds & with rapid acceleration & deceleration

Hamstrings

81

Bone d/o of young adolescents; chronic injury characterized by painful lump just below knee; usually resolves w/rest

Osgood-Schlatter

82

If you're considering Osgood-Schlatter as a DX, but a patient's symptoms are acute, what else must you consider?

Avulsion injury (Osgood-Schlatter has slow onset)

83

Painful condition from irritation of the anterior tibia region; can involve posterior tibialis muscle; rapid increase in activity level increases risk, & rest is the treatment

Shin splints (medial tibial stress syndrome)

84

What's the stress FX continuum?

Progression from chronic tendinitis => stress reaction => stress FX => bone FX (if S/S are ignored)

85

Approximately 85% of body's metabolic activity & heat production come from these

Muscles

86

Muscle repair is __1__ controlled and __2__ directed

1. Hormone

2. Blood

87

Hormones involved in muscle remodeling

-GH (initiates repair)

-Insulin-like growth factor-1 (IGF-1): finalizes repair

88

Prime mover; muscle primarily responsible for given joint's action; if more than one muscle is involved, this is supplying the most force

Agonist (muscle)

89

Muscle that opposes prime mover (agonist) at a joint

Antagonist (muscle)

90

Muscle that works w/agonist to further muscle action

Synergist

91

This muscle type is found on the opposite side of a limb or the body

Antagonist (muscle)

92

Muscles must overcome these 3 forces

1. Gravity

2. Inertia

3. Force of opposing muscle group

93

How is a joint, say the knee, stabilized during exercise or activity?

Agonist & antagonist muscles cooperate to stabilize it

94

How do muscles show efficiency of patterned movement, such as when running?

Quads are first activated when running, then hamstrings

*Cooperating by not getting in each other's way

95

What are the 3 types of skeletal muscle?

Type I: Slow twitch

Type IIa: Fast twitch endurance (FO)

Type IIb: Fast twitch power (FG)

96

Between the 3 skeletal muscle types (ST/FO/FG), give the size of each

ST: small

FO: medium

FG: large

97

1. Which of the 3 skeletal muscle types would be called upon for minimal work?

2. What about for a heavy load or when other fibers are fatigued?

1. Slow twitch (ST)

2. Fast twitch power (FG)

98

Attach muscle to bone

Tendons

99

Attach bone to bone

Ligament

100

Why does healing take so long with ligament/tendon damage?

Blood vessels absent or sparse

101

A muscle tear; usually graded

Strain

102

Injury to a ligament r/t overstretching

Sprain

103

Classic tendon structure

Tendon => muscle => tendon

104

What's the name for a mild Achilles injury? What's the treatment?

-Peritendinosis

-Ice & grabbing cord from base & pulling up several times to break up adhesions

105

Longest tendon of the body

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IT band (connects from hip to lateral knee)

106

Tendons with wide, sheet-like attachments in which the attachment of a broad, flat muscle occurs over a wide area; found primarily in the lower back, ABD wall, skull, palms of hands & soles of feet

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Aponeuroses

107

Muscle that acts to flex the spine; important for posture; encased in a sheath formed from 3 aponeuroses

Rectus abdominus

108

Prime flexor of the elbow; contributes most force to flexion

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Brachialis

109

Synergistic flexor of elbow; supinates forearm

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Biceps brachii

110

Extensor; extends elbow

Triceps brachii

111

Muscle group (4); extend knee & flex hip

Quadriceps

112

The quads are innervated solely by this nerve

Femoral nerve

113

Muscle group (3); flex knee & extend hip

Hamstrings

114

The __1__ is the prime move of plantar flexion, while the __2__ is the prime mover when the knee is extended

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1. Soleus (right)

2. Gastrocnemius (left)

115

Prime mover of dorsiflexion; flexes big toe; sometimes source of shin splints

Tibialis anterior

116

What's the concept of "remote control" in relation to muscles, and what are some examples?

-Muscles having role in multiple joints

-TFL, plantaris, & peroneus longus

117

Leading cause of lateral knee pain

IT Band Syndrome

118

Two muscles which become one (level of the femur); strongest of muscles that flex hip

Iliacus & psoas (iliopsoas - hip flexors)

119

Muscle that sits over sciatic notch that causes sciatica when inflamed

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Piriformis (middle right attaching to mid-sacrum)

120

Longest nerve in body - extending from hip to foot

Sciatic nerve

121

What are some causes of back pain resulting from straining the paraspinal muscles?

-Lifting/twisting

-Poor fitness

-Overuse

122

1. Piriformis syndrome can lead to this

2. Treatments include...

1. Sciatica (lower back pain)

2. RICE, NSAID's, rolling out area, ultrasound TX

123

Thin membrane lining joint cavity; nourishes & lubricates articular cartilage

Synovial membrane

124

Deepens socket (labrum) or acts as wedges for a better fit between bones

Fibrocartilage

125

Fluid-filled sac that cushions space between tendons & bones

Bursa

126

Sleeve-like, loose fibrous layer attached to articulated surfaces

Capsule

127

Provides GLASSY surface to reduce friction between bones

Articular cartilage

128

"Shrink-wrapping" tissue which prevents tendons from bowstringing away from bone

Retinaculum

129

Arrangement of ligaments along most joints for directional support

Cross-stitch

130

Perforating fibers of periosteum, which penetrate bone & help attach tendon

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Sharpey fibers (under flap)

131

When bursa are wrapped around a tendon, what are they called?

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Tendon sheath

132

Bursitis is most common in this joint

Shoulder

133

Increased amount of joint fluid in response to infection, inflammation, crystals, or increased friction is called:

Effusion

134

Consists of fibrous connective tissue; lined inside with synovial membrane

Capsule

135

Large class of inflammatory disorders in synovial joints

Arthritis

136

Chronic degenerative disease caused by loss of articular cartilage; distinguished by its lack of inflammation, despite the "itis" suffix

Osteoarthritis

137

TX for bursitis

RICE, NSAID's (ABX if infection present)

138

Carpal tunnel TX

-Wrist brace to limit movement

-Cortisone injections

-SX (last resort)

139

Joint designed for ROM, not stability

Shoulder

140

Clinically significant joint; very mobile, yet unstable, gets dislocated often

Glenohumeral joint (shoulder)

141

Strongest joint of the body

Hip joint (more than 1/2 of femoral head in acetabulum)

142

A shoulder dislocation occurs when the __1__ comes out of its __2__ socket; 95% of the time, the shoulder is dislocated __3__; treatment is a __4__, followed by immobilization (sling) and rest

1. Humerus

2. Glenoid

3. Anteriorly

4. Reduction (replacing arm in shoulder joint)

143

Largest, most complex joint in body; strength depends mostly on ligaments, muscles, and tendons

Knee (femur & tibia - not fibula)

144

This bone is a sesamoid bone, meaning it's within a tendon

Patella

145

How can you test for an ACL injury?

Move tibia forward (drawers test)

146

"Unhappy triad" of ACL injuries

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Tear of ACL, tibial collateral ligament, & medial meniscus

147

Articular cartilage & bone wear away; common in weight bearing joints, distal finger joints, & hips

Osteoarthritis (OA)

148

1. What activities reduce symptoms r/t osteoarthritis?

2. What medications are helpful?

1. Exercise - such as swimming & aquajogging

2. Embrel (cytokine inhibitor) and/or NSAID's

149

Autoimmune form of arthritis

Rheumatoid arthritis (RA)

150

The ligaments that stabilize the __1__ joint stretch during pregnancy due to secretion of __2__

1. Sacroiliac (SI) joint

2. Relaxin

151

This huge, superficial group of 3 muscles are the common site of back strains r/t heavy lifting, twisting, or sudden movement

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Erector spinae

152

Technical name for "runner's knee"

Patellofemoral Syndrome

153

The peripheral nervous system consists of these 2 components

-Nerves (bundles of axons)

-Ganglia (groups of neuronal cell bodies)

154

A neuron consists of these 3 parts

-Dendrite (receives input from other neurons)

-Axon body

-Axon terminal (releases neurotransmitter)

155

Part of neuron that receives information from other neurons

Dendrite

156

Part of neuron that releases neurotransmitter

Axon terminal

157

The message being transmitted by neurotransmitters is a mix of these two types of messages

Excitatory & inhibitory

158

What determines whether a neuron will fire?

Sum of excitatory & inhibitory neurons (more excitatory = fire)

159
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Locate the following:

-Thalamus

-Hypothalamus

-Midbrain

-Pons

-Medulla

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In order of descending colors (hypothalamus is under & to right of thalamus - colored green)

*Lateral view to right is also descending, but hypothalamus not pictured - so skip

160

Relays information to cerebral cortex; a left & right side, which are completely independent of each other

Thalamus

161

Deals with "housekeeping"; temp control, BP, thirst/appetite, sex drive, & lactation

Hypothalamus

162

The brainstem is divided into these 3 parts

-Midbrain

-Pons

-Medulla

163

Posterior & inferior to cerebral cortex; mostly involved in motor control

Cerebellum

164

Largest part of brain

Cerebral cortex

165

Depression or fissure in the surface of the brain

Sulcus

166

Ridge on the surface of the brain

Gyrus

167

This colored matter forms the exterior of the cerebral cortex

Gray matter surrounds white matter

168
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ID the following:

-Frontal lobe

-Parietal lobe

-Occipital lobe

-Temporal lobe

-Central sulcus

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Frontal: Purple opposite side of cerebellum

Parietal: Orange behind frontal

Occipital: Purple above cerebellum

Temporal: Green under frontal/parietal

Central sulcus: Crease between frontal & parietal

169
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Locate the limbic lobe

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Surrounds corpus callosum

170
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Locate the hippocampus

*What lobe is it part of?

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Inferior portion of limbic lobe that swings back & under corpus callosum towards cerebellum

171

Generally considered the part of the cortex most susceptible to seizures

Hippocampus

172

Responsible for forming long-term memories (not storing!)

Hippocampus

173

Tube embedded in temporal bone; filled with fluid; receives sound waves which excite auditory receptor cells (hair cells)

Cochlea

174

Therapy for total deafness; excite auditory neurons in the auditory relay nucleus (cochlea) directly

Cochlear implant (hearing aid)

175

Where does auditory information go once it's received by the cochlea & transferred to CN VIII?

-Sent to nucleus at junction of pons & medulla

-Travels up to Thalamus

-Then to both left & right primary auditory cortices (AI)

176

Why would a person suffering damage to one hemisphere of the auditory cortex (left or right) not necessarily experience deafness in either ear?

Signals from each side are collected bilaterally, so damage to the right wouldn't stop information from left reaching right cortex

177

Essential for language comprehension (spoken or written); damage here causes _____'s aphasia, resulting in inability to comprehend language, although individual can still speak

Wernicke's area (Wernicke's aphasia)

178

Type of aphasia resulting in patient being unable to comprehend language, although they're still able to speak

Wernicke's aphasia (lesion to Wernicke's area)

179

Essential for language production (speech or writing); damage here will result in speech production being limited, from modest deficits in sentence generation to complete inability to speak

Broca's area (Broca's aphasia)

180

Probably more r/t language comprehension than production; located posterior & superior to Wernicke's area

Angular gyrus

181
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ID the following:

-Wernicke's area

-Broca's area

-Angular gyrus

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Wernicke's area: Green (temporal lobe)

Broca's area: Purple (frontal lobe)

Angular gyrus: Orange (parietal lobe)

182

These areas are found only in the left hemisphere in almost all right-handed people & about 70% of left-handed people

Wernicke's, Broca's, Angular gyrus

183
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A person with a lesion in this region may suffer from what disorder?

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Anomia - patient can't remember names of common objects or famous people

184

If a person suffering from anomia (caused by lesion of temporal lobe), and they were shown a comb, how would they describe it?

They'd be able to describe what it's used for, but not be able to remember its name

185

Where's the primary visual cortex (VI) located?

Occipital lobe

186
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What sensory cortex is part of this lobe?

Primary visual cortex & higher-order visual cortex (occipital lobe)

187

Sheet of neurons lining 2/3 of the eye

Retina

188

Outermost layer of the retina

Rods & cones

189

Innermost layer of the retina

Relay neurons whose axons form the optic nerve

190

Where is the first visual relay in the brain?

Thalamus

191

Where do axons cross in the visual pathway?

Optic chiasm

192

Optic nerve axons (50%) that cross the optic chiasm send information to this cortex

Contralateral visual cortex

193

Optic nerve axons (50%) that don't cross the optic chiasm send information to this cortex

Ipsilateral visual cortex

194

Rule for visual system:

1. Information from the right half of the visual field goes to what half of the brain?

2. Info from the left half of visual field goes to what half?

Right visual => left half brain

Left visual => right half brain

195

Sees right visual field

Left visual cortex (occipital lobe)

196

Sees left visual field

Right visual cortex (occipital lobe)

197

1. What would happen if a lesion occurred along the optic nerve prior to the optic chiasm?

2. What if the lesion occurred after the optic chiasm (closer to visual cortex in occipital lobe)?

*Picture on reverse side

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1. The side of the lesion would be blind

2. If the left tract had a lesion, the right half of each eye's field of vision would be gone

198

Caused by atherosclerotic-like deposits that build up behind the retina on the central region; responsible for high visual acuity (foveal vision) needed to read books, look at pictures, & other fine detail activities

Macular degeneration

199

While the spinal cord is part of the CNS, its projections, the _____ _____ _____, are part of the peripheral nervous system

Dorsal root ganglia

200

The spinal cord is shorter than the vertebral column:

1. What's the space inferior to the spinal cord called?

2. What's it useful for?

1. Lumbar cistern

2. Injecting drugs or drawing CSF for testing

201

Color of the outer layer of the spinal cord

White matter surrounding gray matter

202

Part of peripheral nervous system containing cell bodies of somatosensory neurons

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Dorsal root ganglion (just before dorsal roots connecting to spinal cord)

203

The central axonal branch of each __1__ neuron runs up the spinal cord in the __2__ matter; these axons make up a tract called the _____ 3 _____

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1. Touch

2. White

3. Dorsal columns (pink highlights between dorsal horns)

204

How does touch pathway convey information?

1. One axonal branch to skin detects touch

2. One axonal branch through white matter to brain stem (medulla)

3. Goes to 2nd relay in thalamus

4. Cross on way primary somatosensory cortex (SI)

205

Touch information from the left side of the body will terminate where?

Right primary somatosensory cortex (SI) - pathway crosses after thalamus

206
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1. What's the red area?

2. What's the blue area behind it?

3. What separates the two?

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1. Primary motor cortex (red)

2. Primary somatosensory cortex (SI - blue)

3. Central sulcus

207

As the touch relay pathway travels up the axonal branch in the white matter of the spinal cord, what 2 relay points does it hit before reaching the primary somatosensory cortex (SI)?

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1. Relay nucleus in brainstem (medulla)

2. Relay nucleus in thalamus

208

Pathway for touch relay pathway is same for face with one exception - touch neurons have cell bodies in the __1__ ganglion, and the 1st relay occurs in the __2__ of the brainstem, not the __3__

1. Trigeminal

2. Pons

3. Medulla

209
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1. What's the image on the left depicting?

2. If this is an anterior view, what would happen if a lesion occurred where "leg" is mapped?

1. Somatotopic "touch" map for SI (primary somatosensory cortex)

2. This would depict right side of SI, so there would be touch deficit in left leg

210

Deficits resulting from a lesion in the primary somatosensory cortex (SI), which would be localized to opposite side using somatotopic "touch" map (i.e. leg, arm, GI, etc.), would produce what potential deficits?

-Lose ability to accurately locate touch/pinprick

-Lose ability to ID objects by feel

-Lose ability to ID a letter/number drawn by an examiner on hand

211

Most of the axons in the pain/temperature pathway are of this variety

Nociceptive

212

Believed to be the major pain-processing area in the cortex

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Insula

213

1. All pain/temp neurons in the face & head have cell bodies in what ganglion?

2. Where does information travel to from this ganglion?

3. What's different from touch relay pathway?

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1. Trigeminal

2. Thalamus (not same part as touch pathway)

3. Some info goes to SI for general pain location, but most goes to insula to process pain

214

Whereas the face/head nociceptors have their cell bodies in the trigeminal ganglion, the body's nociceptors house their cell bodies in the _____ ganglia

Dorsal root

215

1. First "relay nucleus" for body's pain reception

2. Message then travels along this highway

3. The highway ends here

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1. Dorsal horn (yellow)

2. Spinothalamic tract (through entire brainstem)

3. Thalamus

216

Dull pain nociceptors are activated by strong mechanical stimulation, intense heat/cold, & these substances

-Histamine

-Prostaglandin

-Serotonin

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When a dull pain nociceptor is activated, it not only fires spikes, but also releases a peptide, __1__ from its own endings; this peptide stimulates __2__ cells, producing __3__. Substances (histamine, prostaglandin, serotonin) further stimulate nociceptor, which continues to fire even after stimulus is gone; this is why dull pain nociceptors generate prolonged pain & contribute to inflammation

1. Substance P

2. Mast cells

3. Histamine

218

A person with a herniated disc will have these 2 kinds of pain

1. Low back pain from trauma/inflammation of local connective tissue (ligaments, etc.)

2. Pain radiating down associated dermatome (squeezing causes axons to fire - brain interprets as pain from dermatome)

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Why do narcotic drugs relieve pain?

Mimic pain suppression neurotransmitters coming from midbrain, which inhibit nociceptors in dorsal horn (neurotransmitters similar to opiates)

220

"Unhealthy" pain; not caused by tissue injury, but CNS changes, such as damage to part of pathway; chronic & not easily controlled

Neuropathic pain

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All motor neurons send their axons out to where?

Skeletal muscles (cause contraction)

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Cell bodies of motor neurons are located where?

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Ventral horn of the spinal cord (blue)

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How are motor neurons arranged in the spinal cord?

In groups - each group corresponds to a particular muscle

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Motor neurons that control muscles of the face/head have their cell bodies in the __1__; their axons go out to their muscle targets via _____ 2 _____.

1. Brainstem

2. Cranial nerves

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The descending motor pathway crosses over to the contralateral side of the spinal cord just below this structure

Medulla (bottom of brainstem)

226

Corticospinal tract carrying signals from the right motor cortex will run through the spinal cord on which side?

Left side

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A patient with damage to their left motor cortex will have motor symptoms appear on what side of their body?

Right side of body (opposite)

228

There is an elaborate mechanism in the brainstem & cortex for controlling eye movements. The master controller in the brainstem is a large bulge on the dorsal surface of the midbrain, called the:

Superior colliculus

229

Information from vestibular hair cells, located in the otolith organs, send information to brainstem via 1) what ganglion, and 2) where do they travel?

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1. Scarpa's ganglion

2. Vestibular nuclei (purple - middle)

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This reflex cancels out the unintended head rotation that results from activities such as walking (foot strikes ground), causing eyes to rotate in opposite directions to stabilize image on retinas; suppressed during intentional head rotation

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Vestibulo-ocular reflex

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Damage to cerebellum causes what type of problems?

Motor (largest input by far to cerebellum is from gray matter forming base of pons - which deals heavily with motor response)

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An information loop exists between the motor cortex & cerebellum; since the motor cortex is a crossed system, but the cerebellum isn't, how many times do the connections in the loop cross the midline?

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Twice

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Damage to the medial portion of the cerebellum, or vernis, may cause this motor problem

Instability when standing (i.e. swaying when stationary, or when eyes are closed, patient unable to stay upright)

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1. What test, when performed, will yield these results if positive?

-Movements too large

-Patient has intentional tremor - hand oscillates with extension, but no tremor at rest

-Movement broken down into smaller movements (sequential)

2. What is the probable diagnosis?

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1. Asking patient to alternately touch provider's finger & then own nose

2. Cerebellar ataxia (bottom of pic)

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Patient's with cerebellar disease will exhibit what characteristic r/t their gait?

Wide-base with staggering & reeling

236

The function of this brain region is to encourage or strengthen movements - gives a "boost" to commands from motor cortex, lest they miss this area & be weak/feeble

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Basal ganglia

237

The substantia nigra, part of the basal ganglia, enhances movement through exciting the striatum (and other parts of basal ganglia). Its neurons use __1__ as its neurotransmitter, and in __2__ disease, these neurons mostly die, resulting in difficulty moving and weakness; slow & progressive

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1. Dopamine

2. Parkinson's disease

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ID the following:

-Left lateral ventricle (right hidden)

-4th ventricle

-3rd ventricle

No information

239

CSF flow starts in the __1__ ventricles, then thru the __2__ ventricle & into a tube that leads to the __3__ ventricle, also called the _____ 4 _____; it then exits to bathe the brain & spinal cord

1. Lateral

2. 3rd

3. 4th

4. Cerebral aqueduct

240

Which 2 routes of blood into the brain are essential for it to function?

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1. Vertebral arteries (threaded through cervical vertebrae)

2. Internal carotid

241

This vessel is clinically important because a rupture of one of its branches may result in a hematoma, which can compress the cortex

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Middle meningeal (main artery of dura covering lateral & superior part of cerebral cortex)

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This pathology is characterized by slow, oozing accumulation of blood with vague, nonspecific symptoms such as headache, cognitive impairment, unsteady gait

Subdural hematoma

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Most common, and catastrophic, cause of this pathology is an aneurysm; can cause an extremely severe headache ("thunderclap")

Subarachnoid hemorrhage

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Characterized by a "thunderclap" headache

Subarachnoid hemorrhage

245

Common location of an aneurysm

Where middle cerebral artery arises from internal carotid

246

These substances can get past the blood-brain barrier

-Glucose

-Amino acids

-Some ions

-Lipid soluble substances (i.e. ETOH)

247

Form blood-brain barrier; provide structure & sustenance in CNS

Astrocytes

248

Make glia wrapping (myelin sheath) in CNS

Oligodendrocytes

249

Autoimmune disease where myelin wrappings in some regions of white matter are attacked; these regions are subsequently termed "plaques"; plaques heal, but there remains unhealed damage that adds up over time; eventually patient may not be able to walk

Multiple Sclerosis (MS)

250

1. What difference would you see if you cut both an axon in the CNS & an axon in the PNS?

2. Why?

1. CNS - no regeneration

PNS - regenerates (very slowly)

2. Glia in CNS hostile to axonal regrowth, but Schwann cells (glia of PNS) actively promote axonal regrowth

251

Glia in this region are special; have been used to culture & grow more for injection into the spinal cord for regenerative purposes

Olfactory bulb

252

The peripheral nervous system can be divided into these 2 parts

Somatic & autonomic nervous systems

253

Nervous system that innervates skeletal muscles; r/t motor controls, such as voluntary movements & involuntary reflexes (i.e. patellar reflex, or knee jerk)

Somatic nervous system

254

In addition to innervating skeletal muscle for motor purpose, the somatic nervous system also has __1__ nerve fibers that are responsible for communicating __2__ information to the CNS, such as touch, temperature, & pressure

1. Afferent

2. Sensory

255

The autonomic nervous system is further divided into these 3 systems

-Sympathetic NS

-Parasympathetic NS

-Enteric NS

256

This nervous system is self-governed; innervates viscera (i.e. smooth muscle, cardiac) to adjust their functions

Autonomic nervous system

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The __1__ coordinates ANS function with both the __2__ & __3__ systems, and circadian rhythmic activity (i.e. sleep-wake cycles)

1. Hypothalamus

2. Endocrine

3. Limbic (emotional)

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What does this picture represent?

Sympathetic nervous system in spinal cord (projecting lines represent nerves going out to sympathetic ganglia)

259
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What does this picture represent?

Parasympathetic nervous system in brainstem & spinal cord

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Where do the cell bodies of neurons belonging to the ANS reside?

Outside brain & spinal cord (mostly)

261

Organ involved in "sympathetic activation"

Adrenal gland (epinephrine)

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BP is monitored by __1__ located in an enlarged part of the _____ 2 _____; information is sent to the __3__ center in the __4__

1. Baroreceptors

2. Carotid artery

3. Vasomotor

4. Medulla

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If BP is too high, the __1__ nerve transmits __2__ activity to the heart to slow rate & reduce force; if BP is too low, signals from __3__ center go to __4__ cells in the spinal cord, which are then relayed to neurons in the _____ 5 _____, which accelerate HR & increase force of contraction

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1. Vagus

2. Parasympathetic

3. Vasomotor

4. Sympathetic

5. Sympathetic chain (picture above)

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Orthostatic hypotension is caused by these 2 factors

-Venous pooling

-Decreased venous return

265

Viral disease of spinal ganglia; dermatomally distributed skin lesions

Herpes Zoster (herpes virus)

266

Patients most at risk of developing a subdural hematoma

Young & elderly