Term
| Describe the anatomy of the spinal cord as it descends into the lumbar region. |
|
Definition
| The place where the spinal cord ends is called the conus medullaris. It then branches into a fan like projections called the cauda equina. The conus medullaris is anchored by the filum terminale. |
|
|
Term
| how many vertebrae are there? |
|
Definition
| 7 cervical, but 8 cervical nerves, 12 thoracic, 5 lumbar, 5x fused sacral, 4x fused coccygeal |
|
|
Term
| each vertebrae are seperated by? |
|
Definition
|
|
Term
| name the vertebral ligaments as you enter the spine |
|
Definition
| supraspinous ligament then go into interspinous ligament then the ligament flavum |
|
|
Term
| what is the falx cerebri? |
|
Definition
| a membranous plate that dips between the two cerebral hemispheres along the longitudinal fissure. Above it is the superior sagittal sinus of the dura. |
|
|
Term
| subdural bleeds come from torn what? |
|
Definition
| veins in the space between the arachnoid mater and dural mater |
|
|
Term
| describe role, function location of arachnoid villi |
|
Definition
| Aracnoid villi border the sagital sinus. The sagital sinus is on the superior portion of the brain in an area that separates the two hemispheres. Arachnoid villi protrude through the dural mater into this sinus. They are a one way channel for excess CSF to leave arachnoid space and be recycled into venous system. |
|
|
Term
| Describe the path of CSF flow |
|
Definition
| CSF is produced by choroid plexuses of all four ventricles. The top ventricles are the lateral ventricles. From here CSF drains via gravity and pressure gradients through the foramen monroe to the third ventricle. From third ventricle it travels through the cerebral aquaduct also known as the aqueduct of silvia to the fourth ventricle. In the fourth ventricle it has several choices. It can pass through the two lateral apertures known as foramina of luschka into the pontine cistern or it can go through the midline median aperture known as the foramen of magende . All eventually leads to the subarachnoid space. |
|
|
Term
| what are the two main blood supplies to the brain |
|
Definition
| internal carotids and vertebral arteries. (External carotids go to the face not brain) |
|
|
Term
| what percent of blood flow goes to the brain? |
|
Definition
| 20% or 800-1000mL / minute of Cardiac output. |
|
|
Term
| what three vessels branch off the aortic arch |
|
Definition
1. left subclavian
2. left carotid
3. Brachiocephalic (innominate artery) |
|
|
Term
| baislar artery is formed from |
|
Definition
|
|
Term
| trace the carotid arteries from subclavian to circle of willis |
|
Definition
| Left common carotid comes directly off the aortic arch, right common carotid comes off the brachiiocephalic artery. Both common carotids split into anterior and middle cerebral arteries (B/c post blood supply given by vertebral arteries). then connect to circle of willis. |
|
|
Term
| Artery of Adamkiewicz..explain |
|
Definition
| it is the largerst anterior artery supplying blood to anterior portions of the spinal cord. It most often branches off the aorta in the are of T8-L1. If blood flow decreased to this artery from surgery or stroke can cause anterior spinal syndrome which is loss of motor, intact sensory, loss of bowel and bladder control. |
|
|
Term
| how many vertebrae and how many spinal nerve pairs |
|
Definition
| 33 vertebrae (7C) (12T) (5L fused) (5S fused) (4Cox fused) - but only 31 pairs of spinal nerves |
|
|
Term
| what part of vertebral column does not have plexuses? |
|
Definition
| thoracic is the only one without plexuses |
|
|
Term
|
Definition
1. Cervical plexus C1-C4
2. Brachial Plexus C5-T1
3. Lumbar plexus L1-L2
4. Sacral plexus L5-S5 |
|
|
Term
| what dermatone is your genitals |
|
Definition
|
|
Term
| what dermatone is your anus |
|
Definition
|
|
Term
| what dermatone is your umbilicus |
|
Definition
|
|
Term
| what dermatone is your xiphoid process |
|
Definition
|
|
Term
| what dermatone is your nipple line |
|
Definition
|
|
Term
| what dermatone is your pinky |
|
Definition
|
|
Term
| what dermatone is your thumb |
|
Definition
|
|
Term
| what dermatones make up your hand |
|
Definition
|
|
Term
| whats an easy way to remember which dermatones affect the leg? |
|
Definition
| Spinal cord developed from a four legged animal. So if you are on four legs the anterior portion of your legs is most cephalic and in the same longintudal as your illiac crest. So anterior leg is L2-L3 while posterior leg which is more caudal is S1-S2. Behind that would be your tail but in our case is just genitals/anus. |
|
|
Term
| reference point for the iliac crest to lumbar area ? |
|
Definition
|
|
Term
| what levels are cardioaccelerators? |
|
Definition
|
|
Term
| What levels are vascular tone? |
|
Definition
| T1-L5 (aka thoracolumbar since includes all thoracic and lumbar columns.) |
|
|
Term
| evoked potentials measures what two things |
|
Definition
1. latency (time)
2. amplitude (height/signal strength) |
|
|
Term
| what's the difference between tonic and clonic seizure activity |
|
Definition
| Tonic comes first during which a patient is very rigid (HIGH TONE IN MUSCLES) this is followed by jerking movements known as clonic (Clowning around) |
|
|
Term
| what are the two categories of partial seizures. And describe each |
|
Definition
1. Simple: no impairment of consciousness
2. Complex: impaired consciousness |
|
|
Term
| what is the definition of status Epictetus |
|
Definition
| A unremitting seizure which lasts greater than 5 minutes or mulitple seizures over 5 minutes with no regain of consciousness in between. EMERGENCY!! |
|
|
Term
| what is a jefferson fracture |
|
Definition
| fx to anterior and posterior arches of C1. Can appear as three separate areas of fx. |
|
|
Term
| What is bulbocavernosus reflex (BCR) |
|
Definition
| a useful reflex to indicate intact spinal cord and absence or complete recovery of spinal cord from spinal shock. You tug on a foley and at the same time assess anal sphincter tone. If patient tightens at anus to stimulation then intact reflex. |
|
|
Term
| Spinal shock begins when? Lasts how long |
|
Definition
| starts in 30-60 minutes. Normally dissipates in 24 hours but can be prolonged up to 6 weeks. |
|
|
Term
| bulbocavernosus reflex (BCR) involves what nerves |
|
Definition
|
|
Term
| what is autonomic hyperreflexia |
|
Definition
| A patient with a spinal cord injury around T6 or even T10 is stimulated by bladder, bowels normally causing unmodified sympathetic stimulation. this signal cannot be modified by brain cause damaged cord so body is HTN below injury. The brain senses high SVR and drops HR to compensate causing vasodilation or brady up top of injury. |
|
|
Term
|
Definition
| A disease in which you spine does not form correctly and protect your spine. |
|
|
Term
| what are the three different types of spina bifida. And what are they? |
|
Definition
1. spina bifida oculta: no protrusion but area of defect over spine resulting in hair or mole over skin to mark the spot.
2. meningocele: meneges come out of opening in vertebrae and bulge out but no involvement of spinal cord
3. Myelomeningocele: here spinal cord (myelinated) and meninges come out of opening in deffective vertebrae. |
|
|
Term
| what is the difference between Encephalocele and Anencephaly |
|
Definition
| anencephaly is failure to make bone and brain in cranial vault while encephalocele is protusion of brian out of open non competetent bone areas. You'll see kids with protruding sacs. |
|
|
Term
| What is cerebral palsy and what does it stand for. |
|
Definition
| Cerebral = brain. Palsy = paralysis with involuntary tremors at times. It occurs in |
|
|
Term
| where are most tumors located for children compared to adults |
|
Definition
| most tumors for children are located infratentorial (2/3) compared to adults where majority of tumors are supratentorial |
|
|
Term
| what percentages of childhood cancer are brain tumors? |
|
Definition
|
|
Term
| if you correct your Na too fast what can happen to your brain? What happens? |
|
Definition
| Central pontine mylinolysis where meylin sheeth are damaged |
|
|
Term
| what drug can cause SIADH |
|
Definition
|
|
Term
| what are sx of Central pontine mylinolysis |
|
Definition
| locked in syndrome, paralysis, unconsciousness |
|
|
Term
| the posterior pituitary releases? The anterior pituitary releases? |
|
Definition
1. Posterior pituitary: oxytocin, Vaso
2. Anterior Pituitary: LSH, TSH, FSH, ACTH, GH, prolactin, beta endorphin |
|
|
Term
| which type of diabetes insipidus is more common? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are two differential diagnosis for DI |
|
Definition
1. DM related ketoacidosis
2. Diuretic use |
|
|
Term
| hyperthyroidism is too much??? |
|
Definition
|
|
Term
| the most common cause of hyperthryoidism is? |
|
Definition
|
|
Term
|
Definition
| an autoimmune disease. Body makes antibodies that stimulate thryoid to make too much T3 and T4. |
|
|
Term
| Sx that are unique to Grave's disease? Which gender is more prone to Grave's disease |
|
Definition
Woman more prone to Grave's Disease.
Sx:
1. Antibodies trigger thryoid and it grows too. An enlarged thryoid = goiter
2. exophthalmos
3. pretibial myxedema. Thick, patchy pink skin over tibia. |
|
|
Term
| List all causes of hyperthyroidism |
|
Definition
1. Grave's disease
2. Thyroiditis (inflammation of thyroid/infeciton)
3. Iodine intake is high
4. some pregnancies
5. Nodules on thyroid |
|
|
Term
| what is the difference between the adrenal medulla and cortex |
|
Definition
Adrenal cortex: The adrenal cortex—the outer part of the gland—produces hormones that are vital to life, such as cortisol (which helps regulate metabolism and helps your body respond to stress) and aldosterone (which helps control blood pressure).
The adrenal medulla—the inner part of the gland—produces nonessential (that is, you don’t need them to live) hormones, such as adrenaline (which helps your body react to stress). |
|
|
Term
| what are chromaffin cells? |
|
Definition
| Chromaffin cells are neuroendocrine cells found mostly in the medulla of the adrenal glands (90%)They release catecholamines: ~80% of Epinephrine (Adrenaline) and ~20% of Norepinephrine. Chromaffin cells of the adrenal medulla are innervated by the splanchnic nerve. |
|
|
Term
| what's the difference between phentolamine and Phenoxybenzamine. What are they used for? |
|
Definition
| Both used to treat pheocytochroma. Both are nonselective alpha antagonist. Phenoxybenzmine is irreversible while phenotlamine can be reversed. |
|
|
Term
| Pheochromocytoma can also be found outside the adrenal gland...such as? |
|
Definition
| sympathetic chains, distal aorta, ureter, within the bladder, |
|
|
Term
| what CCB can be used instead of phenoxybenzamine or phentolamine? |
|
Definition
|
|
Term
| where are the four curves in the spine |
|
Definition
|
|
Term
| How many processes are there in the lumbar spine. Name them |
|
Definition
| 7 processes. 4x articulating processes (2x inferior and 2x superior) 2x transverse process and 1x spinous process |
|
|
Term
| all vertebrae share these three common things |
|
Definition
1. Vertebral Arch
2. 7x spinous processes
3. Vertebral body |
|
|
Term
| The parasympathetic system involves what nerves |
|
Definition
CN 3,7,9,10 and S1-S4.
Occulomotor, facial, hypoglossal, vagus |
|
|
Term
| what category of the nervous system is our voluntary muscle control |
|
Definition
|
|
Term
| What landmark on a person indicates where you place your needle for an epidural |
|
Definition
|
|
Term
| where are there no intervetebral disks |
|
Definition
| none inthe sacral or coccygeal areas. |
|
|
Term
| what is the name for the padding between discs |
|
Definition
|
|
Term
| how many bones in the cranium |
|
Definition
|
|
Term
| what are the two layers of the dura |
|
Definition
| there is the periosteum and inner dura |
|
|
Term
| the choroid plexus are anchored in what layer |
|
Definition
|
|
Term
| torn bridging veins in space between dura and arachnoid is known as a _____ hematoma |
|
Definition
|
|
Term
| primary regulator for CNS blood flow is? |
|
Definition
| CO2.. hence why we can hyperventilate brain injuried patients. |
|
|
Term
| venous drainage from brain follows what path |
|
Definition
| from superficial to deep at the sagittal sinus and then into the jugular veins. |
|
|
Term
| 75 % of blood supply to cord comes from what artery |
|
Definition
|
|
Term
| how does anterior spinal artery syndrome occur |
|
Definition
| from occlusion to artery of adamkiewicz which supplies 2/3 of anterior spinal cord blood supply. This artery branches from T7-T9. |
|
|
Term
| There are no plexuses at what area on the spinal cord |
|
Definition
| No plexuses on thoracic area |
|
|
Term
|
Definition
|
|
Term
| Sacral plexus is located? |
|
Definition
|
|
Term
| myotomes is a group of muscles innervated by the motor fibers of a Single/multiple nerve routes? |
|
Definition
|
|
Term
| dermatones for groin is? Dermatone for anus is? |
|
Definition
| Groin is S2-S3 and anus is S4-S5 |
|
|
Term
| anterior leg dermatones is? While posterior legs is? |
|
Definition
L2-L4 = anterior legs
S1-S2 = Posterior Legs |
|
|
Term
|
Definition
|
|
Term
|
Definition
| https://www.youtube.com/watch?v=rKiTwagLYck&index=2&list=PLuRO6G6fFC-1sB6fsIPouCLTiov2OCUiP |
|
|
Term
| cardioaccelerators are T?? to T?? |
|
Definition
|
|
Term
| what is the difference between simple and complex seizures |
|
Definition
| simple seizures consciousness is maintained while complex siezures consciousness is lost. |
|
|
Term
| how does pH and ventilation change your seizure threshold? |
|
Definition
| Increase ventilation means increase pH = alkalosis. = decrease CBF = Decrease seizure threshold. So if you are alkalotic or hyperventilating your patient they are at more risk for seizing! |
|
|
Term
| Would a person with a pH of 7.2 or 7.6 be more at risk for seizures? Why? |
|
Definition
| person at 7.6 is at more risk for seizing since this pH = alkalotic and if they are hyperventilating as the cause they will seize due to decrease CBF. |
|
|
Term
| what induction agents have some anti-seizure properties |
|
Definition
|
|
Term
| what narcotic increases our risk for seizures and why? |
|
Definition
| meperidine increases risk to seize due to a active metabolite normeperidine which is a CNS stimulant. |
|
|
Term
| Why does ephedrine increase your risk for seizures? |
|
Definition
| It is an indirect acting sympathomimetic therefore it increases CNS stimulation |
|
|
Term
| A CPP < ___ is high risk for ischemic damage |
|
Definition
|
|
Term
| Normal oxygen extraction from the blood in the brain is? So there is some room for increase cerebral metabolic needs therefore the goal of internal jugular venous O2 % is? |
|
Definition
| Normally the brain only extracts 20-25% of O2 from blood. So there's room for increase metaoblic needs. The parameter for internal jugular O2% is to be 55-70%. (THEREFORE the max extraction of the brain is never more than 45%. |
|
|
Term
|
Definition
|
|
Term
| What phase does ICP increase? What phase does body vasoconstrict to decrease BF and ICP |
|
Definition
| PHase 3 the ICP icnreases. Phase 2 the body vasoconstricts to decrease BF to pereseve ICP. |
|
|
Term
| what percent of your CO is dedicated to your brain |
|
Definition
|
|
Term
| A normotensive individual without disease can autoregulate MAPs from __ to ___ in order to maintain cerebral blood flow of ____ mL/100g per minute |
|
Definition
| 50-150 mmHg to ensure 50mL/100 g per minute |
|
|
Term
| normal kid cerebral blood flow is ? Compared to adults is? |
|
Definition
Kids: 100mL/100g/min
Adults 50mL/100g/min |
|
|
Term
| is the highest blood flow to gray matter or white matter? |
|
Definition
|
|
Term
| CO2 dilates the vessels to ___ and Vasoconstricts ____ |
|
Definition
| CO2 dilates vessels to brain and vasoconstricts lungs |
|
|
Term
| What is the relationship of PaO2 with cerebral blood flow |
|
Definition
| PaO2 < 50 will cause massive vasodilation of cerebral blood vessels. To high PaO2 has no significant effect. |
|
|
Term
| There is a ___ % change in CMRO2 for every ___ degree change in temperature |
|
Definition
| 7% change in CMRO2 for every 1 degree change in temp. |
|
|
Term
| An ICP any greater then ____ Will cause significant changes in cerebral blood flow |
|
Definition
| ICP >33 mmHg will cause drastic decreases in cerebral blood flow. |
|
|
Term
| what are the four types of cerebral edema |
|
Definition
Types of Cerebral edema:
1. vasogenic: BBB disrupted, protein leak. 2. cytotoxic: toxins. H20 follow Na 3. ischemic: from CVA. causes vasogenic and cytoxic 4. interstitial: non-comm hydrocephalus |
|
|
Term
| what is the difference between communicating and non-communicating hydropcephalus |
|
Definition
| communicating means the CSF can get outside the ventricle system but gets stuck elsewhere. While non-communicating is that CSF cannot get outside ventricles. So there's something getting in the way more internally. |
|
|
Term
| TIA criteria for time/duration |
|
Definition
| TIA has to last for approx 15 min but no more than 24 hours. |
|
|
Term
| what is the difference between saccular and fusiform aneurysms |
|
Definition
| Sacular aka berry aneurysms bulge on only one side of vessel wall while fusiforms have bulges on all sides of vessel. |
|
|
Term
| what type of aneurysm is caused by bacterial emboli? |
|
Definition
|
|
Term
| Cushing's triad is a very late sign of ICP. At this point the ICP is usually >?? |
|
Definition
|
|
Term
| Goal of hyperventilation is to get Pco2 to? |
|
Definition
|
|
Term
| what vasodilator is contraindicated during neuro cases until the dura is opened? why? |
|
Definition
| Nitro is contraindicated until the dura is open because it will decrease CPP |
|
|
Term
| What is the name for cervical 2 of the pointy object that sticks out? What is another name for C2? |
|
Definition
| C2 also referred to as Axis. Has a pointy object known as the dens (odontood process) that the atlas sits ontop and rotates on. |
|
|
Term
| what is a jefferson fx? Most common from? |
|
Definition
| 3x fx areas along the axis (C2). Most commonly associated with diving accident. |
|
|
Term
| the first reflex to return after spinal shock is? What nerves involved in this? |
|
Definition
| Vulvocavernosus reflex first to recover and indicate recovery. Involves Sacral nerves 1,2,3. |
|
|
Term
| neurogenic shock is most likely associated with injuries at or above ____ |
|
Definition
| T6. Remember this is the area of cardioaccelerators! Also vascular tone is T1-L2. |
|
|
Term
| neural tube normally closes ___ Days after fertilzation |
|
Definition
|
|
Term
| what kind of things can lead to defects of neural tube closure |
|
Definition
1. folate def
2. DM
3. Antiseizure meds
4. High temp |
|
|
Term
| what is the tentorium cerebelli |
|
Definition
| it seperates the cerebellum and cerebrum. It is a dividing line between these large different structures. |
|
|
Term
| how do babies self regulate temp |
|
Definition
| brown fat which is a form of thermogenesis |
|
|
Term
| direct surface contact and loss of heat is known as ___ heat loss |
|
Definition
|
|
Term
| heat loss through air or liquid currents |
|
Definition
|
|
Term
| why do old people have issues with temp regulation compared to kids with temp regulation |
|
Definition
| old people have poor circulation and poor vasoconstriction to converseve heat, they also has decrease metabolisms and their sensory is effected to even know the difference. While kids can produce adequate heat but don't have a lot of fat to hold it in and their body surface area is large to loose it. |
|
|
Term
| malignant hyperthermia has a mortality of? |
|
Definition
|
|
Term
| Malignant hyperthermia is what kind of genetically passed on disease |
|
Definition
|
|
Term
| nerve injury and seizures occurs with temp of? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| hypothermia is defined as a body temp of < |
|
Definition
| Hypothermia = Temp <35.5 cel |
|
|
Term
| the oxyhemoglobin curve shifts to the right or left? With hyperthermia? |
|
Definition
| right shift, more O2 dissassociates into blood and less on hemeglobin |
|
|
Term
| medical term for excessive movement |
|
Definition
|
|
Term
| describe tardive dyskinesia |
|
Definition
1. involuntary movement of face, trunk, extremities (lip smacking, facial grimacing)
- associated with parkinson's disease or as a side effect of phenothiazine drugs like haldol and droperidol. |
|
|
Term
| what disease has choreiform movements of face and arms..what is choreiform mean? |
|
Definition
| huntington's disease. Issue with basal ganglia and frontal cerebral cortex.choreiform movement (plural choreiform movements). repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated; |
|
|
Term
| parkinson disease involves pathology to? |
|
Definition
substantia nigra, which is invovled with dopaminergic nigrostriatal pathway. Results in cogwheel rigidity, postural instability, resting tremor.
Cogwheel rigidity is jery movement after passive rearrangement of an extermity. |
|
|
Term
| what drugs do you avoid with a parkinson's patient? |
|
Definition
| AVOID DOPAMINE ANTAGONIST WITH PARKINSON'S PATIENTS!! Since this disease destroys they're normal levels of dopamine. |
|
|
Term
| Leading cause of neurlogic disability in young adulthood is? |
|
Definition
|
|
Term
| this disease is caused by central demyelination of nervous system |
|
Definition
|
|
Term
| peripheral nervous disorders can include these two |
|
Definition
1. guillain barre syndrome: peripheral dymyelination
2. amyotrophic lateral sclerosis (ALS): destruction of motor neurons |
|
|
Term
| this disease is the peripheral dymeylination of nervous system |
|
Definition
|
|
Term
| in this disease motor paralysis begins from legs and works its way rostral |
|
Definition
|
|
Term
| what disease affects upper and lower motor neurons of the cerebral cortex, brain stemp, and spinal cord? |
|
Definition
|
|
Term
| what is an example of a neuromuscular disorder? |
|
Definition
|
|
Term
| myasthenia gravis is caused by? |
|
Definition
| an autoimmune disease caused by IgG that attacks acetylcholine receptors. |
|
|
Term
| how does myasthenia gravis present? |
|
Definition
| by easy fatigue of eye muscle sand throat, so you see difficulty swallowing, diplopia and ptosis. Trt with anticholinesterases. |
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|
