Exam 4 Flashcards
(234 cards)
1
Q
Rostral
A
Up and to the front
2
Q
Caudal/caudad
A
Back and down
3
Q
Sagittal plane
A
a cut from anterior to posterior (between the eyes)
4
Q
Coronal plane
A
a cut from right lateral to left lateral (ear to ear)
5
Q
Horizontal plane
A
Separates top and bottom
6
Q
Oblique plane
A
An angled plane
7
Q
Telencephalon
A
- Most advanced part of CNS
- Outer most part of brain (cerebral)
- Where we think, process, and remember
8
Q
Diencephalon
A
- Inner part of brain
- contains hypothalamus (major regulator of sensing what is going on in body)
9
Q
Brian steam location:
and 3 sections:
A
Under diencephalon
Midbrain (superior)
Pons
Medulla oblongata (Inferior)
10
Q
Spinal cord decent ____ of the way down the spinal canal.
A
2/3
11
Q
Sulcus/sulci
A
“grooves” or depressions on surface of brain
12
Q
Gyrus/gyri
A
“lump” on surface of brain
13
Q
Fissure
A
“really deep grooves”
14
Q
4 main lobes of the brain:
A
- Frontal
- Parietal
- Occipital
- Temporal
15
Q
Temporal lobe
A
Inferior to temporolateral fissure.
Processes hearing.
16
Q
Frontal lobe
A
Superior to temporolateral fissure.
Anterior to central sulcus.
Thinking, personality, motor cortex
17
Q
Parietal lobe
A
aka Somatosensory cortex Posterior to central sulcus. Superior to occipital lobe. Primary sensory area. All peripheral sensory information comes here.
18
Q
Occipital lobe
A
aka vision cortex.
Back of brain.
19
Q
Post central gyrus
A
Lump immediately posterior to central sulcus.
Sensory cortex.
20
Q
Pre-central gyrus
A
Lump immediately anterior to central sulcus.
Primary motor cortex (controls skeletal muscle).
21
Q
Premotor cortex
A
Lump immediately anterior to pre-central gyrus.
Thinking and planning of motor event.
22
Q
White matter
A
Sending message part.
Myelinated axons.
More energy efficient than grey matter.
23
Q
Gray matter
A
Decision-making part.
Lots of cell bodies and dendrites.
Some axons.
Requires more energy than white matter.
24
Q
What % of O2 and glucose delivered to the brain is used by grey matter?
A
75%
25
Cingular gyrus
Just above corpus callosum. Involved with pain, emotions, limbic system (feelings)
26
Corpus callosum
cross talk between right and left side of the brain. White matter.
27
Broca's Area
Function: word formation
Location: frontal lobe
28
Wernicke's Area
Function: language comprehension and intelligence
Location: temporal lobe
29
Limbic system
has to do with emotions. Includes cingular gyrus and some parts of temporal lobe.
30
Sensory signals in spinal cord:
Ascending pathways
31
Motor signals in spinal cord:
Descending pathways
32
Anterior median fissure
Wide deep groove in front of spinal cord
33
Posterior median sulcus
Deep groove but not very wide. located in back of spinal cord.
34
Anterior white commissure
Small path of white matter that allows signals to get from one side of spinal cord to another, however most stay on the side they are sent or received from.
35
Lamina X
Small path of grey matter that allows signal in spinal cord to cross from one side to the other
36
Dorsal horns of spinal cord
Grey matter that protrudes into white matter posterior. Sensory input
37
Ventral horns of spinal cord
grey matter that protrudes into white matter anterior. Motor output
38
Rootlets
Small bundles of neurons that are going into the back and coming out the front of spinal cord. They all join together to create spinal nerves
39
Posterior VS anterior rootlets
Posterior rootlets have spinal ganglia and deal with sensory transmission.
Anterior rootlets do not have ganglia (bc the cell bodies are in the spinal cord) and they deal with motor transmission.
40
Ganglia
collection of cell bodies outside CNS (usually like-minded)
41
The peripheral nervous system starts..
..where rootlets come together to create spinal nerves.
42
Cranial meninge layers: (superior to inferior)
- Dura mater
- Arachnoid mater
- Space for CSF and vessels
- Pia mater
43
CSF function and properties:
- provides energy and pH buffer
- carries away waste
- shouldn't contain any RBCs
- may contain a few WBCs
44
Concentration of ions in CSF:
```
[K+] 40% lower than blood
[Cl-] 30% higher than blood
[Na+] about the same as blood
[glucose] 60mg/dL
[HCO3-]
```
45
How long will it take for someone to lose consciousness if their blood flow to the brain were completely cut off?
5-15seconds
46
pH of CSF:
pH 7.31
47
Normal CSF pressure (ICP):
8-12mmHg
48
Normal quantity of CSF:
150mL
49
Normal CSF production rate:
500mL/day
50
Type of glial cells that produce CSF:
Ependymal cells
51
Locations of ependymal cells:
-Primarily in ventricles.
52
Choroid plexus
A tissue made up of a bunch of ependymal cells.
53
Location of Choroid Plexus:
- Lateral ventricles (largest producer of CSF)
| - 3rd/4th ventricles
54
Arachnoid granulations
Where CSF is removed and enters the venous system.
55
Vessel where arachnoid granulations are located:
Superior Sagittal Sinus
56
Foramen Magnum
Hole at the base of the skull where the spinal cord descends into the spinal column.
57
Interventricular foramen (Foramen of Monroe)
Connects and allows CSF drainage from lateral ventricles to 3rd ventricle.
58
Cerebral Aquaeduct (Foramen of Silvius)
Connects and allows CSF drainage from 3rd ventricle to 4th ventricle.
59
Lateral aperture
Extends out laterally from both sides of the 4th ventricle and allows CSF to drain out laterally and around anterior of brain stem.
60
Median aperture
Allows CSF to flow out the back of the 4th ventricle and circulate around the cerebellum.
61
Central Canal
A canal that runs from 4th ventricle down the length of the spinal cord where CSF flows down.
62
Cerebellomedullary cistern (aka cisterna magna)
area that holds a lot of CSF under cerebellum and behind brain stem
63
Venous blood flow through brain:
Superior and Inferior sagittal sinuses --> sinus confluence --> transverse sinuses --> sigmoid sinuses --> jugular veins.
64
Falx Cerebri
Ridged connective tissue that divides the left and right cerebral cortex.
65
Tentorium cerebelli
Ridged connective tissue that separates occipital lobe and cerebellum.
66
Internal carotid artery
Feeds brain.
| Main feed arteries into the circle of willis
67
External carotid artery
Feeds side of face and back of head.
68
Vertebral arteries
Branch off at more lateral and distal point than the carotids. They are carried up through the C-spine and through the foramen magnum.
69
Circle of Willis
Circle of arteries in the brain
70
Basilar artery
is on the anterior surface of the brain stem and feeds the posterior of the C of W. It’s created by the joining of the 2 vertebral arteries.
71
Anterior cerebral artery
One of the main output arteries of the circle of willis.
| Feeds anterior part of cerebral cortex.
72
Middle cerebral artery
One of the main output arteries of the circle of willis. Larger than anterior cerebral artery because it feeds more tissue.
73
Posterior cerebral artery
One of main output arteries of the circle of willis. Provides bulk of blood flow to posterior portions of the brain.
74
Posterior communicating artery
connects posterior cerebral artery with middle cerebral/internal carotid artery.
75
Anterior communicating artery
connects right and left anterior cerebral arteries.
76
3 cerebellar arteries:
- Superior cerebellar artery
- Anteroinferior cerebellar artery
- Posteroinferior cerebellar artery
77
Epidural Hematoma
Bleed outside of dura mater.
Usually from crush injury or fx skull.
Common in MVAs.
78
Subdural hematoma
Too much fluid/bleeding between dura and arachnoid layers.
79
Subarachnoid hematoma
Bleeding in arachnoid space.
| Very difficult to fix because clot becomes one with neural tissue.
80
Upper limit autoregulation (ULA)
The point at which brain blood vessels can't constrict any further, as a response to high BP
81
lower limit autoregulation (LLA)
The point at which brain blood vessels can't relax any further, as a response to low BP.
82
If we can't auto regulate profusion in the brain we risk...
over perfusion with high BP and under perfusion with low BP.
83
Over perfusion of brain can cause..
increases in ICP.
84
Auto-regulation is important in the brain as well as the...
spinal cord and kidneys.
85
Normal volume of cerebral blood flow:
750-900ml/min
86
If we have a drop in pCO2 of 4mmHg, what precent drop do we have in brain blood flow?
20%
87
An increase in metabolism of the brain results in an increase CO2 level which will cause the brain blood vessels to....
relax (increase ICP).
88
A decrease in metabolism of the brain results in a decrease CO2 level which will cause the brain blood vessels to...
constrict (decrease ICP).
89
How many Cervical vertebrae are there?
7
90
How many Thoracic vertebrae are there?
12 (same number of ribs)
91
How many Lumbar vertebrae are there?
5
92
How many Sacral vertebrae are there?
In adults, 1 sacral made of 5 fused sacral vertebrae (fused by age 18)
93
How many coccygeal vertebrae are there?
In adults, 2 coccygeal vertebrae (started with 4, then 3 fused together)
94
Lordosis
curved anteriorly (convex)
95
Kyphosis
curved posteriorly (concave)
96
Curvature of C-spine
Lordosis
97
Curvature of T-spine
Kyphosis
98
Curvature of L-spine
Lordosis
99
Curvature of sacral spine
Kyphosis
100
Pathologic Lordosis
Usually of the L-spine (sever arched lower back)
| Can be C-spine
101
Pathologic Kyphosis
Usually of T-spine (hunchback)
102
Kyphoscoliosis
Kyphosis and scoliosis
103
New born curvature is more..
kyphotic
104
Vertebral body
Large boney structure of vertebrae.
supports weight.
Bodies are small at top of spine and larger at bottom.
105
Vertebral arch
U-shape boney structure the sticks off vertebral body and protects spinal cord.
106
Pedicle
Anterior part of vertebral arch
107
Lamina
Posterior part of vertebral arch
108
Transverse process
Boney projection off the lateral sides of the vertebral arch
109
Spinous process
Boney projection off the posterior side of vertebral arch
110
Superior articular process
Boney structure sticking off vertebral arch that allows the vertebrae to connect to the vertebrae ABOVE it
111
Inferior articular process
Boney structure sticking off vertebral arch that allows the vertebrae to connect to the vertebrae BELOW it
112
Facet joint
Joint where a process surface and cartilage (facet) come together with another facet.
113
Vertebral foramen
Where spinal cord passes through vertebrae.
114
Occipital condyle
Projections from the base of the skull that connect skull to C1
115
Superior articular facet of C1
place on C1 where occipital condyle connects.
116
C1
Atlas
Only vertebrae without a vertebral body.
Has anterior and posterior tubercles.
Has facet of dens.
117
Facet of Dens
on the anterior side of the spinal canal and is where the dens on C2 connects to C1
118
Transverse foramen
holes in the transverse processes of the C-spine where the vertebral arteries pass through.
119
C2
Axis
| Dens projects from anterior of vertebrae.
120
Dens (odontoid process)
a projection unique to C2 that comes off anterior part of C2 and connects with anterior tubercle of C1
121
Anterior articular facet of C2
place on the Dens where it connects with the facet of dens on C1
122
What is a bifid process?
| What vertebrae are they located on?
A split spinous process.
C2-C5
sometimes C6
not on C7
123
Anterior longitudinal ligament
Runs along the anterior side of the vertebral bodies and spans the entire length of the spine.
124
Posterior longitudinal ligament
Runs along the posterior side of the vertebral bodies and spans the entire length of the spine.
125
Inter-transverse ligament
Runs along the tips of the transverse processes.
126
Supraspinous ligament
Connects all the spinous process together.
127
Interspinous ligament
Is directly deep to supraspinous ligament. Runs between each spinous process and is not continuous down the whole length of spine.
128
Lamina Flava
- Runs between each lamina of the vertebral arch, not continuous down the spine.
- Made up of different, more stretchy tissue than other ligaments.
129
Nuchal ligament
the expanded part of the supraspinous ligament from the base of the skull through the c-spine.
130
Anterior and posterior Atlanto-occipital ligaments
connect C1 to base of skull one at anterior part of spine and the other at the posterior part of spine.
131
Inter-vertebral foramen
openings on the side of the spine where the spinal nerves exit
132
Inter-laminar foramen
opening on posterior side of spine between the lamina of adjacent vertebrae.
133
Costal facets:
superior, inferior, and costal facet on transverse process.
| location where rib connects to vertebrae of T-spine.
134
3 parts of sternum:
- Manubrium
- Body
- Xiphoid process.
135
Sternal angle
connection between manubrium and body of sternum.
136
Which rib connects to both the manubrium and the body of the sternum?
Rib 2
137
Costal tubercle
part of the rib that connects to the transverse process.
138
Spinal nerves location according to their parent vertebrae
C1-C7 spinal nerves exit just above the vertebrae they are named after.
C8 spinal nerve exits between C7 and T1.
From T1 spinal nerve down, the nerves exit just below the vertebrae they are named after.
139
Transverse line
location on sacral where vertebrae fused.
140
Promontory
round spot at top of sacral where L5 sits.
141
Sacral canal
Located behind the promontory.
Created by the vertebral foramen after fusion of the 5 vertebrae.
Goes through to the bottom of the sacrum.
142
Sacral hiatus
opening of the sacral canal at the bottom of the sacrum.
143
Anterior and posterior sacral foramina
4 openings on each side of the sacrum. Anterior or posterior depending on the direction you are looking
144
What is unique about the sacral spinal nerves?
In other spinal nerves the dorsal and ventral roots are fused and come out at the side.
In sacral spinal nerves, part of the nerves exits the posterior sacral foramen and part exits the anterior sacral foramen.
145
Coccygeal nerves
exit the sacral hiatus
146
Median sacral crest
result of fusion of the spinal processes in the sacrum.
147
Lateral sacral crest
the result of fusion of the transverse processes. One on each side of the sacrum.
148
Medial sacral crest
the result of fusion of the superior and inferior articular processes.
149
Sacral cornu
small bumps on each side of the sacral hiatus
150
Coccyx
Consist of 2 vertebrae.
Top vertebra is largest.
Bottom vertebra consist of the fusion of 3 vertebrae.
151
iliac crest
top of pelvis
152
If we draw a horizontal line at the level of the iliac crest, what vertebra would be at that line?
L4
153
Common place for CSF draws or epidural placement?
L3-L5
154
Posterior superior iliac spine
on pelvis medial and inferior to the iliac crest. Can be palpated
155
What does the posterior superior iliac spine help us locate?
go 1 cm midline and 1 cm inferior to Posterior Superior Iliac Spine, we are at S2 posterior sacral foramen
156
Anterior superior iliac spine
front and top of pelvis
157
Inguinal ligament
connects Anterior Superior Iliac Spine and pubic tubercle. Should be able to palpate regardless of someone’s BMI
158
Pubic symphysis
Cartilage in between pubic tubercles where pelvis comes together.
159
Vertebral Prominens
C7 most prominent cervical spinous process.
160
Transumbilical plane
horizontal line at naval, level of L3-4
161
An adult Larynx should be around the level of what vertebra?
C5
162
For an infant, the larynx should be around the level of what vertebra?
C4
163
For a pre-term infant, the larynx should be around the level of what vertebra?
C3
164
Nucleus pulposus
```
Gel part of disk located in the center of vertebral disk.
Can shift (herniation)
```
165
Anulus fibrosis
Fibrous layer surrounding nucleus pulposus.
| Has crossing fiber system on anterior side that makes it strong.
166
Hyaline cartilage end plate
Thin layer of cartilage between the disks and the vertebral bodies
167
At what level of the spine does the spinal cord end?
L2
168
Targets in spine for infusion of drugs:
- Interlaminar foramen of L3-L4-L5
- Sacral hiatus
- Posterior S2 foramen
169
External occipital protuberance
notch on back of occipital lobe that is a point of fastening for the supraspinous ligaments
170
Around the spinal cord, the largest amount of CSF is located..
..in the subarachnoid space.
171
Conus medullaris
point of termination of the spinal cord (L2)
172
2 points of enlargement of spinal cord:
- Cervical (upper limbs) (C3-6)
| - Lumbar (lower limbs) (T11-L1)
173
Cuada equina
spinal roots that come off the base of the spinal cord.
174
Location of conus medullaris in newborns:
L3
175
Lumbar cistern
aka dural sac
wrapping that contains large amount of CSF and spinal roots.
In an adult, it extends down to S2.
176
Internal filum terminale
Anchors neural tissue to inside base of dural sac
177
External filum terminale
Anchors dural sac to the sacral hiatus and coccygeal vertebrae
178
layers to go through for epidural placement:
skin--> subcutaneous tissue--> spinous ligament--> intraspinous ligament--> ligamentum flava--> epidural space
179
Phrenic nerve
top of C-spine.
| Motor output to lungs.
180
High points of spine if patient is laying supine:
| for epidural considerations
Lumbar (L3)
| C-spine
181
Low points of spine if patient is laying supine:
| for epidural considerations
Sacrum
| T-spine (T5-6)
182
Ascending pathways
Sensory
| Afferent
183
Descending pathways
Motor
Efferent
aka Corticospinal tract
aka pyramidal pathway
184
There are more ascending or descending pathways?
Ascending
185
Dorsal column medial lemniscus system:
| location
Medial posterior afferent pathways that sit between the 2 dorsal horns.
186
Dorsal column medial lemniscus system:
| sends what kind of signals
Sends sensory information including pin prick, fine vibrations, fine pressure, and things we can consciously feel. ex: tickled by feather.
187
Dorsal column medial lemniscus system:
| neurons
```
large myelinated (A-alpha fibers)
Fast
```
188
Dorsal column medial lemniscus system:
| where does crossover happen
Lemniscus of the Medulla (bottom part of the medulla)
189
Dorsal column medial lemniscus system:
| single pathway from periphery to brain
Dorsal root (and ganglia)--> dorsal ascending column--> up cord--> crossover at lemniscus of medulla--> up to thalamus--> to somatosensory cortex
190
Fasciculus Gracilus
Part of the DCML pathway that contains lower limb sensory information
(medial part of DCML, depending on level of spinal cord)
191
Fasciculus Cuneatus
Part of the DCML pathway that contains upper limb sensory information
(lateral parts of DCML)
192
Ventrobasal complex
specific part of the thalamus that routs singals to where they need to go
193
Lateral corticospinal tract
Primary descending motor pathway
| Carries >80% of motor signals
194
Steps in signal pathway through lateral corticospinal tract starting in brain:
Motor cortex--> Internal capsule--> Medulla pyramids--> cross over at pyramidal decussations--> down spinal cord
195
Anterior Corticospinal tract
Secondary descending motor pathway
196
Difference in crossover of the lateral and anterior corticospinal tracts:
LCT crosses over at pyramidal decussations
| ACT crosses over at the level of the spinal cord where the signal is sent out.
197
Spinothalamic tract
aka Anterolateral system
Pain transmission
2 parts: Anterior and lateral
198
Numbering system for lamina:
Rexed's Laminae
199
Name of Lamina 1
Lamina Marginalis
200
Name of laminae 2 and 3
Substantia Gelatinosa
201
Mechanoreceptors have connections at what laminae?
Laminae 1-6
202
Which lamina is associated with lateral grey matter horns if they are present?
Lamina 7
203
Name of Lamina 7
Intermediolateral Nucleus
204
2 Tracts that carry mechanoreceptor signals to cerebellum:
Dorsal spinocerebellar tract
| Ventral spinocerebellar tract
205
Dorsal spinocerebellar tract:
Carries what kind of signal?
Where does it take the signal?
Mostly muscle spindle feedback.
| Inferior cerebellar peduncle.
206
Ventral spinocerebellar tract:
Carries what kind of signal?
Where does it take the signal?
Mostly golgi tendon feedback
| Superior cerebellar peduncle.
207
Proprioception
stretch sensors tell us where our body is at in space through a-beta fibers
208
Slow pain:
| Type of fiber
C-Fiber
209
Slow pain:
| location of cross over
Anterior white commissure
210
Slow pain:
| Ascending pathway
Anterior spinothalamic tract
| aka paleospinothalamic tract
211
Slow pain:
| Lamina connections
Laminae 2, 3, 5
212
Why is slow pain "slow"?
- myelination state of fibers
| - neurotransmitters used to transmit pain
213
Slow pain neurotransmitters
CGRP, Glutamate, and substance P
214
Lamina 5 is also associated with what kind of pain?
Visceral pain (organ)
215
Where does most slow pain terminate?
```
reticular formation (in the brain stem) or
periventricular nuclei
```
216
Fast pain:
| Type of fiber
A-
217
Fast pain:
| location of crossover
Lamina X
218
Fast pain:
| ascending pathway
lateral spinothalamic tract
| "Neospinothalamic tract"
219
Fast pain:
| Lamina connections
Lamina 1
220
Fast pain:
| neurotransmitter
glutamate
221
What happens to fast pain signals when it reaches the brain?
It goes to the ventrobasal complex in the thalamus where it is distributed with other sensory information (from DCML) to the somatosensory cortex.
222
Descending Inhibitory Complex (DIC) pathway
periventricular and periaqueductal gray --> enkephalin neuron --> Raphe Magnus (in pons) --> serotonergic neuron--> enkephalin neuron--> pain transmission at dorsal horn shut down
223
2 Classes of glutamate receptors:
Metabotropic- GCPR
| Ionotropic- ion channels
224
Ionotropic glutamate receptors:
| 3 classes
AMPA-R
NMDA-R
Kainate-R
225
Astrocytes
Glial cell
helps recycle glutamate
helps pull glutamate away from synapse so it doesn't continue causing a signal.
226
AMPA-R is selective for what ions?
Na+ and K+
227
NMDA-R is selective fore what ions?
Na+, K+, and Ca++
228
Magnesium gets stuck and prevents which receptor from opening? AMPA-R or NMDA-R
NMDA-R
229
In slow pain transmission, PKC can activate..
1) COX2--> arachidonic acid--> PG-->PG-R on nociceptor-->increases glut., sP, and CGRP
2) NOS--> NO to nociceptor--> increases glut., sP, and CGRP
3) push more NMDA-R to cell wall
230
Long-term potentiation (LTP)
"wind up"
positive feedback
process of adding NDMA-R on pain signaling neurons
231
Autoregulation pressure limits for spinal cord:
50-125
232
A-alpha fibers
motor neurons
233
A-beta fibers
muscle spindle and golgi tendon
234
A-delta fibers
fast pain
