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Case 19 > Anatomy and Embryology > Flashcards

Anatomy and Embryology Flashcards

1
Q

where is the primary motor cortex found?

A

pre-central gyrus

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2
Q

where is the primary somatosensory cortex found?

A

post-central sulcus

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3
Q

where is the primary auditory cortex found?

A

superior temoral gyrus

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4
Q

where is the auditory association cortex found?

A

middle temporal gyrus

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5
Q

where is the primary and association visual cortex found?

A

occipital lobe

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6
Q

where is the pre-frontal cortex found?

A

frontal lobe in front of pre-motor cortex

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7
Q

what are the layers of the cerebral cortex?

A
  1. molecular (plexiform) layer- apical dendrites of pyramidal cells, large no. synapses
  2. outer granular layer- stellate cells, small pyramidal cells, can project to other cortical areas
  3. outer pyramidal cell layer- pyramidal cells (medium), axons to molecular layer, input from wide areas, association and commissural fibres
  4. internal granular layer- closely packed stellate cells, main input layer- particularly from thalamus and cortex
  5. inner pyramidal cell layer- large pyramidal cells, main output area
  6. multiform cell layer- fusiform calls, outputs to thalamus and other cortical areas
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8
Q

what are the different cortical connections?

A

association fibres- link gyri in same hemisphere
commisural fibres- link gyri across hemispheres, lots found in corpus callosum
projection fibres- link gyri to other CNS structures (brainstem, cerebellum, spinal cord), corticospinal tract contains lots of projection fibres

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9
Q

what is the neuropathology of motor neurone disease?

A

death of motor neurones (can be UMN or LMN or both). cause not fully understood could be many mechanisms:

  1. dysfunction of RNA transport of metabolism
  2. problems with protein recycling
  3. impaired DNA repair
  4. mitochondria dysfunction causing free radicals
  5. death of supporting cells- oligodendrocytes
  6. neuroinflammation
  7. defective axon or vesicular transport
  8. excitotoxicity
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10
Q

what is the neuropathology of multiple sclerosis?

A

death of oligodendrocytes leading to demyelination.
microglial cells are activated which produce chemicals which degrade the blood brain barrier, more immune cells enter brain and produce cytokines which attack myelin and damage oligodendrocytes. inflammation drives the pathology: chronic inflammation (increased reactive oxygen species), energy deficiency, loss of oligodendrocytes, ion channel redistribution, excitotoxicity

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11
Q

what is Pierre robin sequence?

A

neural crest cell defect causing craniofacial abnormalities including abnormalities in the mandible, tongue and pharynx

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12
Q

what is teacher collins syndrome?

A

1st and 2nd pharyngeal arch neural crest defect resulting in underdevelopment of bones of the face. results in bilateral hypoplasia of zygomatic bone and mandible, external ear malformations, facial clefts, downward sloping eyes

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13
Q

what is 22q11.2 deletion syndrome?

A

neural crest defect caused by deletion on chromosome 22. causes variable craniofacial and cardiovascular defects

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14
Q

what head and neck structures do the germ layers contribute to?

A

ectoderm- neural crest cells (face, jaw, neck, palate, heart), pharyngeal ectoderm (palatal structures)
mesoderm- paraxial mesoderm (posterior skull), lateral plate mesoderm- splanchnic (cardiac), somatic (pharyngeal arch core, tongue)
endoderm- contributes to pharyngeal organs

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15
Q

how many pharyngeal arches are there?

A 
5 arches (1,2,3,4 and 6)- arch 5 is transient (disappears)
the 1st arch is divided into mandibular and maxillary processes.
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16
Q

what are the pharyngeal arch recesses called?

A

the external recesses are clefts and the internal recesses are pouches

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17
Q

what are the structures within the pharyngeal arch core?

A

central skeletal rod (cartilage surrounded by muscle)- mesodermal in origin, differentiates into skeletal structures (bone, cartilage, skeletal muscle)
pharyngeal arch artery- mesodermal in origin, some give rise to important vessels
cranial nerves- derived from neural crest cells, each arch has a different cranial nerve

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18
Q

what skeletal structures does each pharyngeal arch form?

A

1st arch: meckel’s cartilage (mandible), bones of the middle ear
2nd arch: styloid process
3rd arch: hyoid bone
4th and 6th arch: neck cartilages

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19
Q

what cranial nerve is pharyngeal arch associated with and what do they innervate?

A

1st arch: trigeminal nerve (V)- muscles of mastication
2nd arch: facial nerve (VII)- muscles of facial expression
3rd arch: glossopharyngeal nerve (IX)- stylopharyngess muscle
4th arch: superior laryngeal branch of the vagus nerve (X)- muscles of pharynx and soft palate
6th arch: recurrent laryngeal branch of the vans nerve (X)- muscles of larynx

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20
Q

what does the 1st pharyngeal cleft, pouch and membrane form?

A

1st cleft- external auditory meatus
membrane between the clef and such forms the tympanic membrane
1st pouch- tympanic cavity and auditory tube

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21
Q

what do the 2nd, 3rd, and 4th pharyngeal pouch and cleft form?

A

the 2nd, 3rd and 4th clefts combine and are internalised and then regress to form the cervical sinus or disappear completely
2nd pouch- palatine tonsil
3rd pouch- inferior parathyroid gland and thymus
4th pouch- superior parathyroid gland

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22
Q

what are the germ layer origins of the clefts and the pouches?

A

clefts- ectoderm

pouches- endoderm

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23
Q

what is a branchial cyst?

A

cervical sinus fails to obliterate and fills with fluid. it remains stationary on swallowing unlike other cysts/lumps found in the neck

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24
Q

how do the lips and nose form?

A

lips- fusion of right and left maxillary processes and the right and left mandibular processes forms the upper and lower lip
nose- ectodermal nasal placode covers the frontonasal process. nasal placode indents to form the nasal pits which form the nasal cavity

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25
Q

how does the palate develop?

A

involves fusion of 3 structures:left and right lateral palatal processes (maxillary processes) and the primary/ primitive palate (continuation of maxillary process and nasal septum of frontonasal processes). failure to fuse causes different forms of cleft palate

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26
Q

what are the pharyngeal arch origins of the tongue and their innervation?

A

anterior part- 1st arch- nerve (branch of mandibular division of trigeminal nerve)
middle part- 3rd arch- glossopharyngeal CNIX
posterior part- 4th arch- superior laryngeal branch of vagus nerve (CNX)

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27
Q

what are the borders of the anterior triangle of the neck?

A

superior- inferior border of the mandible
laterally- anterior border of SCM
medially- imaginary saggiata line down midline of neck

28
Q

what are the borders of the posterior triangle of the neck?

A

anterior- posterior border of SCM
posterior- anterior border of trapezius
inferior- middle 1/3 of the clavicle

29
Q

what are the layers of the fascia of the neck?

A 
superficial facia- contains platysma, just deep to the skin 
3 layers of deep fascia 
invensting fascia 
prevertebral 
pretracheal
30
Q

what is the investing fascia?

A

most superficial layer of deep fascia, surrounds neck like collar, invests to surround SCM, infra hyoids and trapezius

31
Q

what is the prevertebral fascia?

A

covers the cervical vertebra and prevertebral muscles. forms the floor of the posterior triangle

32
Q

what is the pretracheal fascia?

A

surrounds trachea, thyroid and pharynx/oesophagus. deep to infra hyoids.
attaches to hyoid bone. inferiorly continues into thorax to blend with fibrous pericardium

33
Q

what are the muscles of the anterior triangle?

A

suprahyoids- stylohyoid, digastric, mylohyoid, geniohyoid

infrahyoids- omohyoid, sternohyonid, thyrohyoid, sternothyroid

34
Q

what is the origin, insertion, action and innervation of the digastric muscle?

A

origin- anterior belly: digastric fossa, posterior belly: mastoid notch
insertion- attachment of tendon between the two bellies
action- anterior belly:lowers mandible, raises hyoid, posterior belly: pulls hyoid up and back
innervation- ant. belly: mandibular nerve, posterior belly: facial nerve

35
Q

what is the origin, insertion, action and innervation of the stylohyoid muscle?

A

origin- styloid process
insertion- body of hyoid (can split into two over the tendon of the diagastric muscle)
action- pulls hyoid up
innervation- facial nerve

36
Q

what is the origin, insertion, action and innervation of the mylohyoid?

A

origin- mylohyoid line on mandible
insertion- body of hyoid and fibres of opposite muscle
action- support and elevation of floor of mouth, elevates hyoid
innervation- mylohyoid nerve from the inf. alveolar branch or the mandibular nerve (V3)

37
Q

what is the origin, insertion, action and innervation of the geniohyoid?

A

origin- inferior mental spine of mandible
insertion- body of hyoid, deep to mylohyoid
action- elevates and pulls hyoid forward or pulls mandible down
innervation- branch from anterior rams of C1 (carried along hypoglossal nerve)

38
Q

what is the origin, insertion, action and innervation of the omohyoid?

A

origin- inferior border of scapula
insertion- lower border of body of hyoid
action- depresses and fixes hyoid
innervation- anterior rami of C1 to C3 through ansa cervicalis

39
Q

what is the origin, insertion, action and innervation of the sternohyonid?

A

origin- posterior aspect of sternoclavicular joint
insertion- body of hyoid
action- depresses hyoid
innervation-anterior rami of C1 to C3 through ansa cervicalis

40
Q

what is the origin, insertion, action and innervation of the sternothyroid?

A

origin- posterior surface of manubrium
insertion- oblique line of thyroid cartilage
action- draws larynx down
innervation-anterior rami of C1 to C3 through ansa cervicalis

41
Q

what is the origin, insertion, action and innervation of the thyrohyoid?

A

origin- oblique line of thyroid cartilage
insertion- greater horn and body of hyoid
action- depresses hyoid, raises larynx when hyoid is fixed
innervation- fibres from anterior ramus of C1 carried along the hypoglossal nerve (XII)

42
Q

what are the muscles of the posterior triangle?

A

platysma, SCM, trapezius, splenius capitis, levator scapule, anterior scalene, middle scalene, posterior scalene

43
Q

what is the innervation of the platysma?

A

facial nerve (VII)

44
Q

where does the common carotid bifurcate?

A

carotid triangle at the level of C4

45
Q

which branch of the common carotid gives off branches in the neck?

A

the external carotid

46
Q

what are the branches of the external carotid?

A
  1. ascending pharyngeal artery- ascends on the pharynx
  2. superior thyroid artery
  3. lingual artery
  4. facial artery
  5. occipital artery
  6. posterior auricular artery
    external carotid branches into a superficial temporal branch and maxillary branch
47
Q

where do the thyrocervical trunks originate from?

A 
the right and left sublclavian arteries give rise to thyrocervical trunks which give off branches in the neck:
inferior thyroid artery 
ascending cervical artery 
transverse cervical artery 
suprascapula artery
48
Q

what are the veins responsible for venous drainage of the neck?

A

external jugular

anterior jugular and internal jugular

49
Q

what are the folds of the cerebellum called?

A

folia

50
Q

what separates the left and right cerebellar hemispheres?

A

falx cerebelli

51
Q

what are the cerebellar peduncles?

A

the main connections of the cerebellum to the brainstem.
superior- midbrain
middle- pons- largest
inferior- medulla

52
Q

what are the regions of the cerebellum and their functions?

A

vestibulocerebellum- vermis and nodule, involved in balance
spinocerebellum- paravermal region (possibly anterior lobe too)- muscle tone, stability, ongoing movement regulation
cerebro/ponto/neocerebellum- anterior and posterior lobes (possibly just posterior)- initiation and planning of movements, motor leaning

53
Q

what are the layers of the cerebellar cortex?

A
  1. outer, fibre rich molecular layer
  2. intermediate Purkinje cell layer
  3. inner granular layer
54
Q

what is the pathway of fibres through the cerebellar cortex?

A

fibres enter the cerebellum through the cerebellar peduncles and proceed to the cerebellar cortex as mossy fibres (or climbing fibres) which branch to supply several foila and end in the granular layer synapsing with granular cells. granular axons extend into the cortex forming parallel fibres which synapse with Purkinje cell dendrites. Purkinje cell axons are the only axons to leave the cerebella cortex and travel to the cerebellar nuclei or to the brainstem

55
Q

what are the cerebellar nuclei?

A

collections of cell bodies associated with specific parts of the cerebellum, receive and give outputs to other parts of the CNS.
dentate- largest, associated with cerebrocerebellum
globose and emboliform=interposed, functionally grouped together. associated with spinocerebellum
fastigal- associated with the vestibulocerebellum

56
Q

what is the attachments, action and innervation of the SCM?

A

two heads- sternal head- attaches to the manubrium
clavicular head- medial 1/3 of the clavicle
superior attachment- mastoid process and superior nuchal line
action- rotation and flexion of head
innervation- accessory spinal nerve (XI) and branches from anterior rami of C2 to c3/4

57
Q

what is the origin, insertion, action and innervation of the trapezius?

A

origin- superior nuchal line, external occipital putuberance, spinous processes of C7-T12
insertion- lateral 1/3 of the clavicle, acromion and the spine of the scapula
action- elevate and prostate scapula, adduct scapula, depress scapula
innervation- accessory nerve (XI)

58
Q

what is the origin, insertion, action and innervation of the splenius capitis?

A

origin- lower half of ligament nuchae, spinous processes of C7 to T4
insertion- mastoid process and superior nuchal line
action- bilateral contraction-draws head back, unilateral contraction- draw and rotate head to one side
innervation- posterior rami of middle cervical spinal nerves

59
Q

what is the origin, insertion, action and innervation of the levator scapulae?

A

origin- transverse process of C1 to C4
insertion- upper part of medial border of scapula
action- elevates scapula
innervation- cervical spinal nerves C3 and C4 , dorsal scapula nerve (C4/5)

60
Q

what is the origin, insertion, action and innervation of the anterior scalene?

A

origin- transverse process of C3 to C6
insertion- scalene tubercle of 1st rib
action- elevation of 1st rib and flexes head
innervation- anterior rami of C4 to C7

61
Q

what is the origin, insertion, action and innervation of the middle scalene?

A

origin- transverse process of C2 to C7
insertion- upper surface of 1st rib
action- elevation of 1st rib, flexes neck
innervation- anterior rami of C3 to C7

62
Q

what is the origin, insertion, action and innervation of the posterior scalene?

A

origin- transverse process of C4 to C6
insertion- upper surface of rib 2
action- elevates rib 2, flexes neck
innervation- anterior rami of C5 to C7

63
Q

what are the inputs and outputs of the vestibulocerebellum?

A

input- proprioceptive information via the vestibular nucleus and dorsal spinocerebellar tract
output- vestibular and reticular nuclei in brainstem, to reticulospinal and vestibulospinal tracts

64
Q

what are the inputs and outputs of the spinocerebellum?

A

inputs- dorsal and ventral spinocerebellar tracts

outputs- red nucleus (rubrospinal tracts)

65
Q

what are the inputs and outputs of the cerebro/ponto/neocerebellum?

A

input- cerebral cortex via pontine nuclei

output- premotor cortex, supplementary motor area and motor cortex via the thalamus

Case 19 (3 decks)

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