human phys (higher yield)

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if given a clinical coordinate: know it ex. EKG,EEG, Blood pressure monitors
where do sympathetic enter/exit
Know anything cardiovascular or airway
Cranial nerves- the anesthesia reflex
know any cranial nerves overlap
learn cranial nerves by which is visceral and which is somatic- in groups
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Terms in this set (60)
-spinal cord with higher centers
-voluntary control of body muscles
-touch sensation from body
-pain from body
connects cerebellum as well to the rest of the nervous system
essential for smooth coordinated movements
Basic life support
-cardio respiratory centers
-maintan consciousness

Cranial Nerves
balance,hearing taste
sensory and motor for face
parasympathetic innervation
somatic motor(innervating striated muscles)
brachial motor(developed from brachial arches)
Visceral motor=autonomic=parasympathetic since were in brainstem

General Sensory(i.e fine, touch, pain) eq. of the DC/ML system and the ALS system carrying similar info from the body
Visceral Sensory(this includes general sensations such as pain as well information from e.g., the carotid body.) in addition, it includes the special visceral sensation of taste

Special sense- (for brainstem, this includes hearing and balance) note that smell and sight, with cranial nerves 1 and 2

Key point: in the brainstem, each functional component is handled by a different nucleus
CN 1 and 2 do not attach to brainstem
3-oculomotor. most eye muscles: medial rectus,superior rectus,inferior rectus, inferior oblique eye: adduction, elevation,depression,extorsion
oculomotor deals with Ptosis(inactivation of the levator palpebrae,Down and Out(unopposed left superior oblique and lateral rectus muscles)
4-trochlear-supeior oblique-eye: intorsion
6- abducens-lateral rectus-abduction(it can not abduct so instead of going away it goes inside)
12-hypoglossal-tongue muscles-tongue movement to aid in speaking and swallowing
medial rectus-adduction
5-trigeminal nerve- innervates masseter, temporalis,pterygoids-function is for chewing
7-facial- orbicularis oculi, frontalis,zygomaticus,anglui ori-function is for facial expression
9-Glossopharyngeal-> stylopharyngeus->function is swallowing, phonation
10-Vagus->pharynx,larynx-> swallowing,phonation
Visceral Sensory nerves7-Facial-anterior 2/3 rd of tongue 9-Glossopharnygeal-post 1/3 of tongue-taste 10-vagus-pharynx,larynx,heart,lungs,abdominal viscera->taste,cardiac,respiratory rhytm, digestionSpecial sensory/motor: Olfactory,Optic, and Accessory (1,2,6)1->ollfactory(sensory)->smell, found in olfactory epithelium in nasal cavity terminate in olfactory bulbs, and no assosc brainstem nuclei; project directly to cortex 2->Optic(sensory)->vision; non image forming behaviors, projects to thalmus (LGN) and many other places 11->Spinal Accessory Nerve(motor)->nucleus in cervical cord and innervates sternocleidomastoid1->olfactory nerve->sensory->sense of smell 2->optic nerve->sensory->vision 3->oculomotor nerve->motor->eye movements,pupillary constriction and accomodation; muscle of upper eyelid 4->trochlear nerve->motor->eye movements(intorsion),downward gaze 5->trigeminal nerve->sensory and motor->somatic sensation from face,mouth,cornea,muscles of mastication(chewing) 6->abducens nerve->motor->eye movements(abduction and lateral movements) 7->facial nerve->sensory and motor->controls the anterior 2/3 of tongue and lacrimanl and salivary glands 8->vestibulocochlear nerve->sensory->hearing and balance 9->glossopharyngeal nerve->sensory and motor->posterior 1/3 of tongue and for carotid baroreceptors and chemoreceptors 10->Vagus nerve->sensory and motor->gut autonomic functions of gut and cardiac inhibition for larynx and pharynx for vocal cords 11->spinal accessory nerve->motor->shoulder and neck muscles 12->hypoglossal nerve->motor->movements of tongueArousal levels during induction, maintenance, and emergence decrease/become absent with ______level of sedation/unconsciousnessincreasingvestibulocochlear reflex(oculocephallic) or CN 7,6,3 has compensatory eye movements in response to _______vestibular hair cell activation in inner ear(semicircular canals)coronal reflex works by using sensory and motor from trigemenal nerve and CN 7 facialblinking reflex resulting from touch/pressure stimulation to cornea controlled by CN 5,7 circuitpupillary light reflexpupil constriction in repsonse to light shined in eye connected by CN 2,3 circuitANSautonomic nervous system- portions of the peripheral nervous system arent somatic or enteric it functions as a series of integrated motor activities for unconscious control of internal organs -respiration -cardiovascular activity -digestive function -coughing,sneezing,vomiting,urination and defecation,sexual activity modulated by diverse set of the CNS structures and interacts with enteric nervous system and somatic PNSautonomic nervous systemsmooth muscle,cardiac muscle,and gland effectors which make up sympathetic and parasympatheticenteric nervous system makes upnerve plexuses,stretch, and chemoreceptors in digestive tractsomatic makes upskeletal muscle effectorssomatic ishas one neuron effector is muscles function is voluntary spinal cord region is entire tonotopical/spatial organization- rigid/logical, dermatome,myotomeautonomic nervous system hastwo neurons(pre and post ganglionic) viscerall organs and structure such as heart,lungs,glands involuntary-function localized spine region diffuse means referred painANS: Sympatheticthoracolumbar division preganglionic neurons in lateral gray horns of spine segments T1-L2 ganglia near spinal cord preganglionic fibers relase Ach near spinal cord to stimulate ganglionic neurons Target organs-> most postganglionic fibers release NE at neuroeffector junctions which then stimulate fight or flight responseANS: Parasympatheticparasympathetic (craniosacral division)- preganglionic neurons in brain stem and in lateral portion of anterior gray horns S2-S4 sent to ganglia near target organs then the pre ganglionic fibers release ACh stimulating ganglionic neurons target organs release ACh at neureoeffector junctions to have rest and response similarity is the preganglionic fibers release ACh difference is at sympathetic it is releasing NE and T1-L2 Parasymp. release ACh at post ganglionic at symp. the pre-ganglionic fibers near spinal cord but para the pre gang. is sent to ganglia in or near target organsAutonomic toneit is both para and symp. and it is continously active and each will dominate at different times when symp ANS is dominant the patient has sympathetic tonefive duties of NSsensation,perception,emotion,thoughts,and actions goal of NS is to adapt to changes in external and internal envirenmentscentral autonomic networkbrain receieves various sensory information from receptors localized throughout the body. information is brought into brain via cranial or spinal nerves network of brain structures that integrates visceral sensory info. with input from other sensory modalities increases/decreases level of arousal or restores homestasis to adapt accordingly to internal/external stimuli hypothalmus and reticular formation are the CRITICAL PLAYERSreticular formationacts as a filter/relay of incoming sensory information to modulate arousal/consciousness/attention medullary reticullar formation= 1 of 2 brain regions that contain non adrenergic (n.e) neurons +regulate cardiac,respiratory bladder,sexual,and vomitting reflexes arousal through thalmic and cortical connections bilateral damage of midbrain reticular formation results in coma or deathhypothalmusintegrates info from the forebrain,brainstem,spinal cord,and various chemosensitive neurons governs a diversity of homeostatic function in the body -blood flow -energy metabolism -reproductive activity arousal(via hormone release) recieves sensory and contexual information. which it compares to biological set points and then activates relevent visceral motor,somatic motor, and neuroendocrine to restore homesostasisAffects of anesthetic on arousal centerspropofol enhances mediated inhibtion in the cortex, thalmus, and brainstem reticular formation overall inhibition in these brain regions will lower neural activity in arousal centers net effect= loss of consciousness GABAa= mimics gaba agonistsClinical tools to assess arousal statesEEG=useful for assessing adequacy for anesthetic depth or cerebral perfusion during specific surgery with loss of consciousness= appearance of slow delta or delta+ alpha oscillations different anesthetics= diff EEG signatures= diff molecular and neural circuit mechanisms Beta is awakeCardiac and blood pressure monitorselicitied pain in body or viscera will trigger changes in HR and BP more painful=greater stimulation of A or C fibers= activates neurons in medulla=signal carried to heart or blood vessels via vagus nerve or sympathetic chain nerves to heart and blood vessels H.R increase, heart force of contraction increases, blood vessels constrict to raise B.PWhere do sympathetic neurons leave/enter the spinal cord? thoracolumbar outflowExit/enter between T1 and L2 preganglionic nerves can travel up or down before synapsing pre ganglionic fibers synapse in ganglia onto post ganglionic neuronseye,heart,and lungs stems fromsympathetic nervessympathetic neurotransmitters and receptorsall sympathetic pre ganglionic neurons are cholinergic. release ACh onto nACHR located on adrenergic post-synaptic neurons, dendrites, or soma adrenergic sympathetic ganglionic neurons innervate and release N.E onto various targets organs target organs contain adrenergic receptors that are activated upon N.E binding to affect activity of tisssue cholinergic receptors(ligand gated) adrenergic receptors a1 and a2 b1,b2, and b3 (G-protein coupled)Adrenrgic receptors can beexcitatory or inhibitory and the drug affinity differs across receptorsalpha receptors havevasoconstriction and alpha 2 inhibits neurotransmitter releasebeta 2 isvasodilation and bronchodilationbeta 1 increasesmyocardial strengthphysiologic response to sympathetic activationmass discharge and here it constricts,contract, and accel. (increase H.R and relaxes airways) 2. increase blood flow to active muscles concurrent with decreased blood flow to organs such as the GI tract and the kidneys that are not needed for rapid motor activity 5.increased glycolysis in liver and muscle 6. increase muscle strength 7. increase mental activity all this is for mass dischargePhysiological response in tissue/organ to sympathetic activation "isolated discharge"heat regulation= sympathetic control and sweating and blood flow without affecting other organs innervated by the sympathetics local reflexes=involve sensory afferent fibers travel down centrally in the peripheral nerves to the sympathetic ganglia and spinal cord cause highly localized reflex responsesWhere do parasympathetic neurons leave/enter the Spinal cord?:exit/enter via cranial nerves and sacral cord preganglionic nerves travel further before synapsing in ganglia that are closer to target organ post ganglionic fibers innervate all the same tissues/organs as sympathetic (have longer preganglionic nerves and only in brain stem)Parasympathetic neurons are are cholinergic and adrenergic on target organs compared to sympathetic is only adrenergicpara just releases ACh not N.E and heart has muscarinic AChRsmuscarinic isG protein coupled m1,m2,and m3adrenergic and muscarinic can be excitatory or inhibitorynicotinic receptor has noG protein and it is ionotropic mostly parasymp. target and fastm1 is Gq and m3 is Gqm1(slow) is smooth muscles and glands only of gut m3 is smooth muscle and glands of all targetsm2 is for GI and smooth and cardiacreduces heart rate and smooth muscle contractionParasympathetic ishighly specific and controls functions For example, parasympathetic cardiovascular reflexes usually act on the heart only to increase or decrease its rate of beating with little direct effect on its force of contraction. Secretion mainly by the mouth glands, and in other cases, secretion is mainly by the stomach glandsfor parasympathetic the center is in themedullaGlossopharyngeal nerve haschemoreceptor afferents and these receptors attach to carotid body-increase BP and HRVagus nerve deals withbaroreceptors and attaches to the heart and decreases BP and HRenteric nervous systemmyenteric plexus regulates gut smooth musclesubmuccous plexus-monitors chemical and glandular secretionModulating the ANS: Sympathomimetic drugs-bind to receptor and mimic n.e at the synapse or increase the production and release of n.e from post ganglionic fibersSympatholytic drugsblock n.e from binding used to treat cardiovascular disease block by allowing blood vessels to dilate or keeping h.r from increasingparasympathomimetic drugsenhances cholinergic effects -PilocarpineAnticholinergic drugsinhibit cholinergic effects atropinealpha 1 is beta 2 isalpha 1 is phenylephrine and n.e beta 2 is propanolol and albuterol