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BS IV, Module II > 1. Cervical Plexus, Accessory Plexus > Flashcards

1. Cervical Plexus, Accessory Plexus Flashcards

1
Q

Each pair of spinal nerves is formed by the convergence of nerve roots arising from the dorsal and ventral aspects of an individual SEGMENT of the cord

Arising from each segment are the which supply, respectively:
GSA & GSE fibers which supply, respectively:

A specific area of body wall, the ____

and a specific muscle mass, the ____

A

dermatome

myotome

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2
Q 
Dorsal (Posterior) Root comprised of
somatic
\_\_\_\_
fibers carrying information
from the periphery TO the CNS

“Mixed” spinal nerve in an ____

Ventral (anterior)
root
comprised of somatic ____ fibers carrying Information FROM
the CNS to the periphery

A

afferent
iv foramen
efferent

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3
Q

Ventral rami of spinal nerves…

  • Innervate the skin of the ____ and both extremities
  • Innervate ____ muscles derived from the hypomeres of the ____ of the somites
  • Often converage to form ____ where fibers are exchanged and give rise to named ____ (i.e. brachial and lumbosacral plexuses)• Today we’ll focus on the cervical plexus formed between C1-C4 ventral rami
A 
anterolateral body wall
hypaxial
myotomes
plexuses
peripheral nerves
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4
Q

Note first that while there are SEVEN cervical vertebrae, there are ____ cervical spinal nerves

The C1 spinal nerves pass between the ____ and
the ____ to leave the vertebral canal

The C2 spinal nerves exit the intervertebral foramina between the ____ and ____

The C8 spinal nerves exit the intervertebral foramina between ____ and ____

A 
eight
skull
atlas
atlas
axis
C7
T1
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5
Q

So…with the exception of the C8 spinal nerves, each cervical nerve is numbered
according to the number of the vertebra contributing to the ____ margin of the intervertebral foramen thru which is emerges.

In contrast… ____ and ____ spinal nerves are numbered according to the number of the overlying vertebra, as shown at left.

A

inferior
thoracic
lumbar

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6
Q

The cervical plexus arises with contributions from the ____ ventral rami

We’ve already met a number of the MUSCULAR BRANCHES of the cervical plexus that innervate anterior and prevertebral cervical musculature

A

C1-C4

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7
Q

Recall that most of the infrahyoid “strap” muscles are innervated by branches of the ____…
… with the exception of the ____, which is innervated
directly by ____ fibers

The ansa cervicalis is formed by the contributions from ____ “roots”

A

ansa cervicalis
thyroid
C1
two

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8
Q

Ansa Cervicalis

The superior root or ____ arises from ____

The inferior root arises from ____ and ____

A

descendens
hypoglossi
C2
C3

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9
Q

The PHRENIC nerves
Arise ____ with contributions from
The ____, ____ and ____ ventral rami…

____ - provides most of the fibers that are contained in the phrenic nerve

…and descend through the neck On the ____ muscles to reach the ____

A 
bilaterally
C3
C4
C5
C4

anterior scalene
superior thoracic aperture

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10
Q

GSE fibers innervate the ____

GSA fibers innervate the \_\_\_\_
lining the thorax,
and portions of
the \_\_\_\_ surrounding the heart:
	• \_\_\_\_ lining the pulmonary cavities
	• \_\_\_\_ surrounding the heart
	• \_\_\_\_ lining the underside of the peritoneum
A 
diaphragm
parietal pleura
pericardium
parietal pleura
pericardium
parietal periotoneum
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11
Q

Four sets of
____
arise from the cervical plexus

Note the cutaneous innervation of the posterior scalp and posterior neck by branching of ____

A

cutaneous nerves

cervical dorsal rami

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12
Q

Lesser occipital: ____
Supraclavicular: ____
Great auricular: ____
Transverse cervical: ____

A

C2
C3, C4
C2, C3
C2, C3

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13
Q

C4 afferents
Referred diaphragmatic pain
Is perceived in the ____ region - in the ____

Diaphragm

A

“shoulder pad”

C4 dermatome

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14
Q

Two branches of cervical plexus join with branches of CN ____, the ____, in providing the cutaneous innervation of the face

Lesser occipital
Great auricular

Particularly in females, the pain of ____ may be referred to the skin overlying the angle of the ____

A

V
trigeminal nerve
myocardial infarction
mandible

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15
Q

These nerves may be anaesthetized by
an injection at
____
Aka the ____

Why might an ipsilateral shoulder drop result from on the injection at this location?

Because the ____ crosses the posterior triangle to reach the ____

A

Erb’s point
puncta nervosum
spinal accessory nerve
trapezius

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16
Q

Though somewhat unique from an anatomical perspective, the
____ offers us the
opportunity to begin an in-depth consideration
of the 12 pairs of
CRANIAL NERVES
that will dominate this module

A

accessory nerve (CN XI)

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17
Q 
From a functional perspective, the
ACCESSORY NERVE (CN XI) is relatively simple, comprised exclusively
of \_\_\_\_ fibers which, you will recall, innervate two large, superficial \_\_\_\_
A

GSE

cervical muscles

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18
Q

POSTERIOR CRANIAL FOSSA

FORAMEN MAGNUM
transmits the ____ root of CN XI ____ the posterior cranial fossa

JUGULAR FORAMEN
Transmits CN ____, plus ____ and ____ out of the posterior cranial fossa

A 
spinal
INTO
XI
IX
X
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19
Q

“SPINAL ROOT” carrying axons of Lower Motor Neurons in the ____
within the lateral ventral horns of the ____ cord segments

  • Nucleus ambiguus
  • “Cranial root”
  • Vagus
  • SCM
  • Trapezius

Note the ____ fibers projecting to upper cervical spinal nerves

A

accessory nucleus
C1-C5
GSA

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20
Q

CN XI is vulnerable to lesion as it crosses the ____ … often ____
e.g. with radical neck dissection

A

posterior cervical triangle

iatrogenic

21
Q

Peripheral Nerve Injuries (lesions) I

  • Irritative
    • Caused by acute or chronic mechanical trauma or inflammation (i.e. ____, constriction, or ____)
    • May initiate impulses in sensory or motor fibers
  • – If sensory fibers are stimulated… ____ or ____ results.
  • – If motor fibers are stimulated… ____ or ____ results.
A 
compression
stretching
pain
parasthesia (altered sensation)
muscle spasm
twitching
22
Q 
So with the accessory nerve, an \_\_\_\_ lesion of the fibers of the spinal root in any
of the following locations
• \_\_\_\_
• posterior cranial fossa
• \_\_\_\_
• below the skull base
may cause \_\_\_\_

Characterized by uncontrollable ____ and ____ spasms of SCM and trapezius

A

irritative
vertebral canal
jugular foramen
neurogenic spasmodic torticollis (cervical dystonia)

clonic (jerky)
intermittently tonic (sustained)
23
Q

Peripheral Nerve Injures (lesions) II

  • Destructive
    • May result from ____ or ____
    • Motor symptoms (muscle [____] or ____)
    • Sensory symptoms (____ or ____)
A 
trauma
neuropathy
paralysis
paresis (weakness)
cutaneous anesthesia
hypesthesia (diminished sensation)
24
Q

Destructive Lesions
of CN XI (right)

Ipsilateral “shoulder drop”
____ paresis

Weakness in contralateral rotation of head and C-spine against resistance
____ paresis

A

trapezius

SCM

25
Q

Mindful of the fact that the first and second “cranial nerves” are in fact extensions of the CNS, the remaining nerves (with the exception of CN ____) may be seen
exiting from the ____, ____, or ____

A

CN XI
midbrain
pons medulla

26
Q

There are six
major components of the CNS, five of which develop from the ____ of the neural tube

(The spinal cord extends inferiorly from the medulla but is not derived from a ____)

A

secondary vesicles

secondary vesicle

27
Q 
Mesencephalon, Metencephalon, and
Myelencephalon
give rise to
\_\_\_\_, \_\_\_\_, and
\_\_\_\_ respectively, the three parts of the
\_\_\_\_

The brainstem also contains a core of diffusely organized nuclei known as the ____ playing a crucial role in maintaining behavioral arousal and ____
Also plays a role in ____

A 
midbrain
pons
medulla
brainstem
reticular formation
consciousness
pain modulation
28
Q

In the brainstem,
____
giving rise to the efferent fibers (GSE, SVE, GVE) in cranial nerves are located
in the ____ group of cranial nerve nuclei

A

lower motor neurons motor

29
Q

Primary sensory neurons
giving rise to
____ fibers
in cranial nerves are usually located in ganglia outside the ____ which in turn project to secondary neurons in the ____ of the brain stem

A

afferent
CNS
dorsal gray

30
Q

Cranial Nerve Components

  • In addition to GSE, GSA, GVE or GVA fibers, cranial nerves may also contain:
  • ____
  • ____
  • ____
A

special somatic afferents
special visceral afferents
special visceral efferents

31
Q 
SVE
- Innervate \_\_\_\_ derived from the pharygneal arches
\_\_\_\_
VII
\_\_\_\_
X
A

skeletal muscle
V
IX

32
Q

SVA
- Convery information realted to those ____ associated with the ____ of food

  • Smell: ____
  • Taste: ____, ____, ____
A 
special senses
ingestion
CN I
CN VII,
IX
X
33
Q

SSA
- Convey information pertaining to those ____ which relate the body to the ____

  • Vision: from ____ (and ____)
  • Sound: from ____
  • Equilibrium: from labyrinth of the ____
A 
special senses
external environment
retina
CNII
cochlea
inner ear
34
Q

Functional components of the Cranial Nerves

Know these eventually!

A

YA!

35
Q 
CN V contains two functional components:
\_\_\_\_
Afferents mediate general sensation from:
Skin of the \_\_\_\_ and \_\_\_\_
Most dura Cornea and
conjunctiva Nasopharyngeal
mucosa
Oral, nasal and
paranasal \_\_\_\_ 
Lingual body mucosa
\_\_\_\_, gingivae and periodontal tissues
As well as \_\_\_\_ and \_\_\_\_ from \_\_\_\_ arch muscles and the \_\_\_\_

The nerve emerges
from the lateral
aspect of the
____ within the posterior cranial fossa as a ____ and a ____

A 
GSA
face
anterior scalp
muscoa
mucosa
pain
proprioception
first
TMJ

midpons
large sensory root
smaller motor root

36
Q

CN V

SVE
Branchial motor

Recall that SVE fibers are limited to the ____ division of CN V

Branchial ____ innervate eight muscles derive from the ____ pharyngeal arch

A

mandibular

first

37
Q

Borders between V1, V2, and V3 dermatomes
are ____, unlike those of
____ dermatomes

A

sharpe

spinal nerve

38
Q

CN V

GSA fibers project to the ____ nucleus of CN V

TRIGEMINAL GANGLION Afferent neurons similar to ____ cells

____
Proprioception

____
Touch sensation from the face

Spinal trigeminal tract & nucleus
____
This nucleus also receives ____ inputs from CN ____, ____ and ____

A 
sensory
DRG
mesencephalic nucleus
pontine trigeminal (principal sensory) nuceus
pain and temperature
GSA
VII
IX
X
39
Q

The ____ has 3 components that begin at the point of entry of CN V in the ____ and extend caudally through the length of the ____

The ____ part of the spinal nucleus is an extension of the principal sensory nucleus and also receives ____ from the face, scalp, oral cavity, and nasal cavity.

The ____ part is in the rostral medulla and responds to ____ sensations from the tooth pulp.

The ____ part extends through the caudal medulla to upper cervical spinal cord and responds to ____ sensations from face, scalp, oral cavity, nasal cavity, and supratentorial dura

A 
rostral pons
brainstem
oral
tactile inputs
interpolar
pain and temperature
caudal
pain and temperature
40
Q

Face Pain and temp

The ____ is somatotopically organized with a concentric “onion skin” topographic representation.

A

caudal nucleus

41
Q

SVE
fibers (V3)

Arise from lower motor neurons in the ____ or ____ nucleus of CN V in the ____ of the pons

A

motor
masticator
tegmentum

42
Q

The cell bodies of
____ sensory neurons concerned with proprioception are found in the ____ (derived from ____)

Fibers arising in the
MOTOR NUCLEUS
are found only in ____

The pontine and spinal trigeminal nuclei contain ____ neurons receiving input from primary neurons in the ____
Tapping the mandible at a downward angle just below the lips at the chin when the mouth is slightly open may induce a ____ as masseter contracts

A

primary
mesencephalic nucleus
neural crest
V3

secondary neurons
trigeminal ganglion
jaw jerk reflex

43
Q

The jaw-jerk reflex is a true ____ STRETCH REFLEX initiated by stimulation of muscle spindle proprioceptors

The reflex is normally absent or weakly present, upon a response to a stimulus

An exaggerated and brisk response suggests an ____ neuron lesion above the ____

A

monosynaptic
upper motor
mastication nucleus

44
Q

TRIGEMINAL GANGLION
sits in the ____ on the floor of the middle cranial fossa in the dural ____

V1 - ophthalmic division
____

V2 - maxillary division
____

V3 - mandibular division
____

A

trigeminal impression
meckel’s cave

superior orbital fissure
foramen rotundum
foramen ovale

45
Q

MIDDLE CRANIAL FOSSA

SUPERIOR ORBITAL FISSURE transmits CN V1
Into the ____

FORAMEN ROTUNDUM transmits CN V2
Into the ____

FORAMEN OVALE transmits CN V3
Into the ____

A

orbit
pterygopalatine fossa
infratemporal fossa

46
Q

Like CN III, CN IV and CN VI, CN V1 and V2 course through the ____ en route to leaving the middle cranial fossa

A

cavernous sinus

47
Q

All three divisions contribute MENINGEAL BRANCHES… .. innervating dura of the ____ and ____ cranial fossae.. As well as the ____ and ____

A

anterior
middle
falx cerebri
tentorium cerebelli

48
Q

Testing the integrity of the three divisions of CN V

____
____

A

light touch

pain

49
Q

Recall that the four
____ of the head are all suspended from branches of CN V and all send postganglionic fibers via terminal branches of the nerve to reach their targets

A

parasympathetic ganglia

BS IV, Module II (9 decks)

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