Neurophysiology

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kidbraindoc
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150321
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Neurophysiology
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2012-05-14 13:24:37
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neurophys
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Neurophysiology board review
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  1. Which organs receive only sympathetic innervation?
    • 1) sweat glands
    • 2) piloerector muscles
    • 3) most small blood vessels (well technically not organs).
  2. What is the organization of the PNS and SNS?
    • - cell bodies in the brain stem or spinal cord
    • - efferent axons leave these cell bodies and synapse on ganglia-->axons from these second order neurons then synapse on the target organ. (except the adrenal medulla).
  3. How is the adrenal medulla innervated?
    directly by SNS preganglionic fibers.
  4. Where are the SNS cell bodies located?
    intermediolateral cell column of the spinal cord from T1 to L2 (thoracolumbar system).
  5. Where are the cell bodies for the PNS?
    CN nuclei 3,7,9 and 10 and the IML cell column at S2-S4 (craniosacral system).
  6. PNS Ganglia:
    CN 3 has ganglion _____ and is destined for the _______ and _______
    ciliary; ciliary muscle and sphincter pupillae
  7. PNS Ganglia:
    CN VII _____ganglion with destination of ____ and ______ganglion with destination of ______ and _____
    sphenopalatine; lacrimal gland

    submandibular; submandibular and sublingual glands
  8. PNS Ganglia:
    CN IX has _______ ganglion with destination ______
    otic; parotid gland
  9. PNS ganglion:
    CN X ______ ganglion with destination ____, ____, ____, ____, ____
    multiple; heart, larynx, trachea, lungs, GI tract.
  10. What is the neurotransmitter for all preganglionic fibers in the autonomic nervous system?
    Acetylcholine.
  11. THE SNS postganglionic fibers except for the sudomotor fibers use ____as the neurotransmitter.
    NE
  12. Which nervous system is responsible for urine storage?
    sympathetic
  13. Which neurotransmitter is needed to relax the detrusor muscle and contract the internal sphincter?
    NE
  14. What is the Quantitative Sudomotor Axon Reflex Testing (QSART)?
    • test of postganglionic sudomotor function.
    • - can identify postganglionic sympathetic failure which can be seen in small fiber neuropathies.
    • - can identify excess sweating which can be found with reflex sympathetic dystrophy.
  15. What are some tests of sympathetic vasomotor function?
    • - tilt test (checking for HR and BP changes)
    • - Valsalva (changes in BP)
    • - Checking for BP changes with stressors such as exercise and cold
  16. What are the findings in Valsalva that would indicate sympathetic and parasympathetic dysfunction?
    • - absence of the usual BP overshot in phase 4 suggest sympathetic NS dysfunction
    • - HR usually drops following phase 4 due to increased vagal tone. lack of this reflex bradycardia suggests parasympathetic dysfunction.
  17. What are the characteristics of Chaga's Disease?
    - autonomic neuropathy; orthostatic hypotension, bradycardia, megaesophagus, megacolon and congestive cardiomyopathy.
  18. What is the cause of Chaga's disease?
    Trypanosoma cruzi, a parasite found in Central and South AMerica
  19. What are some autonomic nervous system abnormalities that can be seen in patients with diabetes?
    • - postural hypotension
    • - resting tachycardia
    • - nocturnal diarrhea
    • - delayed gastric emptying
    • - impotence
    • - distal anhydrosis
    • - miotic pupils with a slow light reflex
  20. What is typically seen in patients with dopamine B-hydroxylase deficiency?
    lack of norepinephrine
  21. What chromosome has the gene for dopamaine B hydroxylase deficiency?
    9q34
  22. What is seen in neonates with dopamine B hydroxylase deficiency?
    • - hypothermia
    • - hypoglycemia
    • - hypotension
  23. What is seen in adults with dopamine B hydroxylase deficiency?
    ptosis and orthostatic hypotension
  24. How can you treat postural hypotension in pts with Dopamine B hydroxylase deficiency?
    with L-Dops which is DL-threo-dihydroxyphenylserine that is decarboxylated by dopa decarboxylase to NE.
  25. What are the characteristics of Fabry's Disease?
    hypohidrosis, decreased tear and saliva production, gastrointestinal dysmotility and impotence.
  26. What can also be seen in Fabry's Disease?
    - angiokeratoma, abdominal pain, lancinating pain in the extremities due to small fiber neuropathy and renal failure.
  27. What is Fabry's disease?
    x- linked recessive sphingolipidosis due to alpha-galactosidase deficiency.
  28. What is common to all Hereditary Sensory and Autonomic Neuropathies (HSAN)?
    lack of sensitivity to pain
  29. What is Riley-Day Syndrome?
    • - Familial Dysautonomia (HSAN III)
    • - autosomal recessive condition frequently found in Ashkenazi Jews.
    • - due to a mutation in IkappaB kinase complex associated protein)
    • - chromosome 9q31
  30. How does Riley-Day syndrome present?
    at birth with hypothermia, hypotonia and poor feeding.
  31. Distinctive PE finding in HSAN III (Riley Day)?
    absence of fungiform papillae on the tongue (lateral and tip) and lack overflow emotional tears.
  32. What is Lambert Eaton Myasthenic Syndrome?
    • NM jxn d/o due to ABs directed against P/Q type voltage gated ca channels.
    • may be due to an underlying malignancy like small cell lung ca.
  33. Lamber Eaton symptoms:
    dry mouth, constipation, proximal muscle weakness, especially the thighs and decreased reflexes. strength may improve after exercise.
  34. In what situations should hyperventilation with EEG not be performed?
    • - hx of cerebrovascular disease
    • - sickle cell disease or trait
    • - CF
    • - CHD
    • - asthma
    • - Moyamoya disease
  35. In what situations can prolonged slowing occur?
    • - hypoglycemia
    • - hypoxia
  36. What is delta frequency?
    < 4 hz
  37. what is theta frequency?
    4-<8hz
  38. what is alpha frequency?
    8-13 hz
  39. what is beta frequency?
    >13 hz
  40. What are Kappa waves and when do they occur?
    low amplitude waves in the temporal regions of alpha or theta frequency. They occur during cognitive tasks/thinking
  41. what are lambda waves and when do they occur?
    positive sharp transients in the occipital area seen during visula scanning.
  42. what is mu rhythm?
    7 to 11 hz activity seen best over the centroparietal regions. it is attenuated by movement or thoughts of movement of the contralateral body.
  43. What drugs can cause seizures in people who don't have epilepsy?
    • clozapine
    • meperidine overdose
    • bupropion
  44. What is the cause of Subacute Sclerosing Panencephalitis?
    Measles
  45. What are the states of SSPE?
    • I: personality changes
    • II: myoclonic jerks and further intellectual deterioration
    • III: stupor, extrapyramidal signs, autonomic instability, ridigity, hyperactive reflexes
    • IV: chronic vegetative state
  46. What will the EEG show in stage II of SSPE?
    high amplitude periodic sharp wave complexes every 4 to 15 seconds, usually generalized.
  47. What are the EEG requirements for brain death?
    • - at least 8 electrodes need to be used
    • - sensitivity should be set for 2 microvolts
    • - interelectrode distance should be at least 10cm
    • impedance should be between 100 and 5000 ohms
    • - low frequency filter should be set for < 1 hz
    • - high frequency filter should be set for > 30 hz
    • - duration of the study should be at least 30 minutes
  48. For EMG: latency reflects:
    the fastest conducting motor fibers
  49. the amplitude in an EMG reflects:
    the number of muscle fibers
  50. the duration in EMG reflects:
    the synchrony of muscle fiber firing.

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