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Y3 Neurology Anatomy > Gross Anatomy > Flashcards

Gross Anatomy Flashcards

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1
Q

What is the role of dendrites?

A

Increase surface area

Communicate with adjacent neurones

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2
Q

What is the role of myelin sheath?

A

Coat axons to help speed up action potentials

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3
Q

What is the myelin sheath produced by in the PNS versus the CNS?

A

Shwann cells

Oligodendrocyte

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4
Q

What are the two types of neurones?

A

Multipolar - 2 or more dendrites and cell body in CNS

Unipolar - double process (pseudounipolar) and cell body in PNS

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5
Q

What neurones are classed as multipolar?

A

All motor neurones of SkM and ANS (pre-synaptic)

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6
Q

What neurones are classed as unipolar?

A

Sensory post-synaptic neurones in the ANS

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7
Q

In what direction do efferent impulses move?

A

MOTOR - Exits brain and moves towards body wall, cavity or organ

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8
Q

In what direction do afferent impulses move?

A

SENSORY - impulse Arrives at brain

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9
Q

What is a nerve? What is this referred to in the CNS?

A

Collection of axons surrounded by CT and blood vessels

Tract

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10
Q

What are the two types of nerves?

A

Single modality - one of somatic motor/ sensory, special sensory, sympathetic, parasympathetic or visceral afferent

Mixed modality - somatic motor, somatic sensory and sympathetic all in one nerve

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11
Q

A tract is most likely to be single modality. True/ False?

A

True

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12
Q

Give the first cranial nerve, it’s modality, function and foramen

A

1 (CNI) Olfactory - Cribiform plate (Forebrain) - Sensory (special) - Smell

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13
Q

Give the second cranial nerve, it’s modality, function and foramen

A

2 (CNII) Optic - Optic canal (Forebrain) Sensory (special) - Vision

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14
Q

Give the third cranial nerve, it’s modality, function and foramen

A

3 (CNIII) Oculomotor - Superior orbital fissure (Midbrain) -Motor - 4 extrinsic eye muscles and levator palpebrae superioris
- PS - pupillary sphincter

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15
Q

Give the fourth cranial nerve, it’s modality, function and foramen

A

4 (CNIV) Trochlear - Superior orbital fissure (Midbrain) Motor - Superior oblique

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16
Q

Give the fifth cranial nerve, it’s modality, function and foramen

A

5 (CNV) Trigeminal: PONS
Ophthalmic - Superior orbital fissure - Sensory - Scalp, forehead and nose.
Maxillary - F. rotundum - Sensory - Cheeks, lower eye lid, nasal mucosa, upper lip, upper teeth and palate.
Mandibular - F. ovale

Sensory - anterior 2/3 tongue, skin over mandible and lower teeth.
Motor: muscles of mastication

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17
Q

Give the sixth cranial nerve, it’s modality, function and foramen

A

6 (CNVI) Abducens - Superior orbital fissure (Junction between pons and medulla) - Motor - Lateral rectus

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18
Q

Give the seventh cranial nerve, it’s modality, function and foramen

A

7 (CNVII) Facial - Internal acoustic meatus > stylomastoid f. (Junction between pons and medulla) - Both - Sensory (special): sensation to part of ext. ear., taste from ant. 2/3 tongue, hard and soft palate., muscles of facial expression.
Motor and PS: lacrimal, submandibular, sublingual glands and mucous glands of mouth and nose.

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19
Q

Give the eighth cranial nerve, it’s modality, function and foramen

A

8 (CNVIII) Vestibulocochlear - Internal acoustic meatus - (Junction between pons and medulla) - Sensory (special) - Hearing and balance

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20
Q

Give the ninth cranial nerve, it’s modality, function and foramen

A

9 (CNIX) Glossopharyngeal - Jugular f. (Medulla) - Both:

Sensory: post. 1/3 tongue, nasopharynx, oropharynx, laryngopharynx, palatine tonsil, eustachian tube, ext. ear, and middle ear cavity.,
Special sensory: taste from post. 1/3 tongue(vallate papillae)
VA: carotid sinus receptors and carotid body
Motor: stylopharyngeus
PS: to parotid gland

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21
Q

Give the tenth cranial nerve, it’s modality, function and foramen

A

10 (CNX) Vagus - Jugular f. (Medulla) - Both:

Sensory: ext. ear, larynx and pharynx., larynx, pharynx and, thoracic & abdominal viscera., taste from epiglottis region of tongue
Motor and PS: smooth muscles of pharynx, larynx and most of the GIT

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22
Q

Give the eleventh cranial nerve, it’s modality, function and foramen

A

11 (CNXI) Spinal accessory - Jugular f. (Spinal cord) Motor: trapezius and sternocleidomastoid., a few fibres run with CNX to viscera.

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23
Q

Give the twelth cranial nerve, it’s modality, function and foramen

A

12 (CNXII) Hypoglossal - Hypoglossal canal (Medulla) Motor: Intrinsic and extrinsic tongue muscles (except the palatoglossus).`

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24
Q

There are 31 pairs of spinal nerves, how are they divided in the spinal cord?

A 
Cervical (C1 - C8)
Thoracic (T1 - T12)
Lumbar (L1 - L5)
Sacral (S1 - S5)
Coccygeal (Co1)
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25
There are 8 cervical spinal nerves, but how many vertebrae are there?
7
26
Where are spinal nerves found at the vertebrae, and what do they branch into?
Intervertebral foramina | Anterior (supply larger anterolateral body wall) and posterior ramus (smaller posterior wall)
27
What is the route taken by all sensory axons to the horn of the spinal cord?
Posterior root --> rootlets ---> horn
28
What is the route taken by all motor axons to the spinal nerve?
Anterior horn of the spinal cord --> rootlets --> root --> spinal nerve
29
What is the function of the dorsal root ganglion?
Location of cell bodies of primary afferent neurones
30
Roots/rootlets are ____ modality and ramii are ____ modality
Single | Mixed
31
What three types of nerve supply does a spinal nerve supply to unilateral area of the body?
General sensory to all structures Somatic motor to skeletal muscle Sympathetic to skin and smooth muscle of arterioles NOT PARASYMPATHETIC
32
What is a dermatome?
Area of skin supplied with sensory innervation from a single spinal nerve
33
What is a myotome?
SkM supplied with motor innvervation from single spinal nerve
34
In the dermatome map, what level is the male nipple at?
T4
35
In the dermatome map, what level is the umbilicus at?
T10
36
In the dermatome map, what level is the posterior scalp, neck and shoulder at?
C2-C4
37
In the dermatome map, what level is the upper limb at?
C5-T1
38
In the dermatome map, what level is the lower limb, gluteal region, perineum at?
L2-Co1
39
What is a nerve plexus?
Intermingled anterior rami from a number of adjacent spinal nerves
40
What levels is the cervical plexus, and what does it supply?
C1-C4 | Posterior scalp, neck and diaphragm
41
What levels is the brachial plexus, and what does it supply?
C5-T1 | Upper limb
42
What levels is the lumbar plexus, and what does it supply?
L1-L4 | Lower limb
43
What levels is the sacral plexus, and what does it supply?
L5-S4 | Lower limb, gluteal region, perineum
44
Sympathetic outflow from the brain enters the spinal cord at what levels? What is this known as?
T1 - L2 | Thoracolumbar outflow
45
What is the route taken by sympathetic nerves to the area it is supplying?
Lateral horns of T1-L2 ---> sympathetic chain ---> spinal nerves ---> anterior and posterior rami ---> hitch a ride with arteries ---> supply sweat glands, skin arrectors, arterioles
46
What are the four nerve routes taken by sympathetic outflow in all spinal nerves?
Heart Lungs Abdomniopelvic organs Adrenal medulla
47
What allows a sympathetic axon to pass onto a paravertebral ganglion of the sympathetic trunk?
Rami communicans
48
Where do sympathetic presynaptic axons in the heart synapse?
Synapse in T1 or cervical paravertebral ganglia
49
What is the route taken by sympathetic postsynaptic axons in the heart?
Pass in cardiopulmonary splanchic nerves to the SA and AV nodes and myocardium
50
Where do sympathetic presynaptic axons in the lungs synapse?
Synapse in upper thoracic paravertebral ganglia
51
What is the route taken by sympathetic postsynaptic axons in the lungs?
Pass in cardiopulmonary splanchic nerves to bronchiolar SM and mucous glands
52
Where do sympathetic presynaptic axons of the abdominopelvic organs synapse?
In one of the prevertebral ganglia
53
List the sympathetic prevertebral ganglion associated with abdominopelvic organs for the foregut, midgut and hindgut respectively
Celiac ganglion of celiac plexus (FOREGUT) Superior mesenteric ganglion of SM plexus (MIDGUT) Inferior mesenteric ganglion of IF plexus (HINDGUT AND PELVIC/PERINEAL ORGANS)
54
List the sympathetic prevertebral ganglion associated with abdominopelvic organs, in this case for the kidney
Aorticorenal ganglion
55
Where are these sympathetic prevertebral ganglion located anatomically?
At named artery as it branches from the abdominal aorta
56
What is the route taken by presynaptic sympathetic axons to reach the adrenal medulla?
Pass through aorticorenal ganglion | Synapse DIRECTLY onto adrenaline/ NA secreting cells of the adrenal medulla
57
How do presynaptic axons of parasympathetic outflow leave the CNS? What is this known as?
Via CN III, VII, IX, X and sacral spinal nerves | Craniosacral outflow
58
What do presynaptic parasympathetic axons travel on to reach the eye?
Ciliary ganglion
59
What do presynaptic parasympathetic axons travel on to reach the lacrimal and salivary glands?
Parasympathetic ganglia in the head
60
What do presynaptic parasympathetic axons travel on to reach the organs of the head, neck, chest and abdomen as far as the midgut?
Vagus nerve
61
What do presynaptic parasympathetic axons travel on to reach the hindgut, pelvis and perineum?
Sacral spinal nerves
62
What is a classical clinical example of impaired sympathetic innervation to head and neck?
Horner's syndrome
63
What are the symptoms of Horner's syndrome?
Miosis Ptosis Reduced sweating (anhydrosis) Increased warmth and redness
64
What are the causes of compression of the cervical parts of the sympathetic trunk in Horner's syndrome?
``` Root of neck trauma Carotid dissection Internal jugular vein engorgement Deep cervical node metastases Pancoast tumour (lung apex) ```
65
What vertebrae can be palpated first on the back?
T1 spinous process
66
What do skin dimples on the lower back represent?
PSIS
67
What are the three parts of the trapezius, relative to their position on the back?
Descending (superior) Transverse (middle) Ascending (inferior)
68
Which rotator cuff muscle can be palpated on the back?
Teres major
69
Which muscle may be affected in lower back pain?
Erector spinae
70
What are the extrinsic back muscles (top - bottom), and what do they attach to?
``` Levator scapulae Rhomboid major and minor Trapezius Latissimus dorsi PECTORAL GIRDLE ```
71
What is the function of the extrinsic back muscles?
Move upper limb
72
What is the function of the intrinsic back muscles?
Maintain posture and extend the spine (ES) or rotate the spine (TVSPS)
73
What is the main superficial intrinsic back muscle? Where does it attach inferiorly?
Erector spinae | Common tendon to sacrum and iliac crest
74
What are the divisions of the erector spinae, and thus where do they attach superiorly?
Rib (Costalis) Transverse process of vertebra (Longus) Spinous process of vertebra (Spinous)
75
What is the main deep intrinsic back muscle? Where is it located?
Transversospinalis | Within grooves between transverse and spinous processes
76
Where do the muscle fibres of transversospinalis attach between?
Vertebra and skull Vertebra and rib One vertebra and another Sacrum and vertebra
77
What is the nerve supply to the back muscles?
Segmental (as per dermatome/ myotome) | Via posterior ramii branches (cervical , thoracic, lumbar)
78
What muscles lie laterally to the vertebral column?
MUSCLES OF POSTERIOR ABDO WALL Psoas major Quadratus lomborum
79
What muscles lie posterally to the vertebral column?
INTRINSIC BACK MUSCLES Transversospinalis Erector spinae
80
What muscles lie laterally to the posterior abdominal wall muscles?
``` MUSCLE OF UL Latissimus dorsi MUSCLES OF ANTEROLATERAL ABDO WALL Transverse abdominus Internal oblique External oblique ```
81
If the erector spinae muscle contracts bilaterally the spine will undergo...
Extension
82
If the erector spinae muscle contracts unilaterally the spine will undergo ...
Lateral flexion
83
What muscles control flexion of the spine?
Rectus abdominus | Psoas major
84
How many vertebrae are there in the adult vertebral column?
33
85
How are the vertebrae divided?
``` 7 cervical (C1 - C8) 12 thoracic (T1 - T12) 5 lumbar (L1 - L5) 5 sacral (1 sacrum) 4 coccygeal (1 coccyx) ```
86
What are the 3 functions of the vertebrae?
Support head and trunk when upright Protect spinal cord and nerves Allow movement of head on neck and trunk
87
What are the main curvatures of the spine and are they primary or secondary?
``` Cervical lordosis (2) Lumbar lordosis (2) Thoracic kyphosis (1) Sacral kyphosis (1) ```
88
What curvature pathology is caused by excessive anterior weight e.g. in pregnancy or obesity?
Excessive lumbar lordosis
89
What curvature pathology is caused by old age typically?
Excessive thoracic kyphosis
90
List the parts of a vertebra
Spinous process x 1 Transverse process x 2 Inferior and superior articular processes x 4 Vertebral foramen Vertebral body Vertebral arch (made up of 2 x pedicle (superior) and 2 x lamina)
91
What type of joint is the articulation between articular processes and adjacent vertebrae?
Synovial facet joint
92
Which structure contains and protects the spinal cord and nerves?
Intervertebral foramen
93
What joints are affected in arthritis of the spine?
Facet joint
94
Where are IV discs found? What are they at risk of?
Between adjacent vertebral bodies | Disc herniation
95
Where is there an abscence of IV discs?
Between C1 and C2
96
Describe the structure of an IV disc
Outer fibrous ring - annulus fibrosis | Inner soft pulp - nucleus pulposis
97
Which short ligament connects the adjacent lamina posteriorly to the spinal cord?
Ligamentum flavum
98
What is the function of the posterior longitudinal ligament?
Narrow and weak | Prevents overflexion
99
What is the function of the anterior longitudinal ligament?
Broad and strong | Prevents overextension
100
What is the function of the supraspinous ligaments?
Strong, fibrous | Connects tips of spinous processes
101
What is the function of the interspinous ligaments?
Weak, membranous | Connect superior and inferior parts of adjacent spinous processes
102
List the ligaments of the vertebral column
``` Ligamentum flavum Posterior longitudinal ligament Anterior longitudinal ligament Supraspinous ligaments Interspinous ligaments ```
103
Which vertebra are classed as atypical and why?
C1: ATLAS - no body or spinous process - A + P arch instead C2: AXIS - odontoid process, which projects superiorly from body C7: VERTEBRA PROMINENS - 1st palpable spinous process
104
Which ligament connects C1 and C2 vertebra?
Transverse ligament
105
Where does the atlanto-occipital joint connect?
Between occipital condyles of C1 and superior articular facets of atlas
106
What type of joint is the atlanto-occipital joint? What is it's function?
Synovial joint Flexion and extension of neck (yes, no) Some lateral flexion and rotation
107
Where does the atlanto-axial joint connect?
3 articulations 2 x inferior articular facets of atlas and superior articular facets of axis 1 x anterior arch of atlas and odontoid process of axis
108
What is the main role of the atlanto-axial joint?
Rotation
109
What are the names given to the area at the top and bottom of the sacral canal?
Sacral promontory | Sacral hiatus
110
What are commonly classed as the 'wings' of the sacrum?
Left and right ala
111
What exists within the sacral canal?
Cauda equina | Meninges
112
Which part of the sacrum is palpable?
Sacral hiatus
113
Which part of the sacrum is caudal anaesthesia inserted into to anaesthetise sacral spinal roots?
Sacral hiatus
114
Where does the spinal cord start and end?
``` Foramen magnum (C1) Vertebral level L1/L2 (Co1 segment) ```
115
What is the cauda equina?
All spinal nerve routes from L2 to Co that have descended to numbered vertebra where the spinal nerve is in IV foramen
116
What is the spinal cord surrounded by?
``` 3 layers of meninges (dura, arachnoid matter, pia) Epidural fat (and venous plexuses) ```
117
What is a laminectomy?
Removal of 1 or more spinous processes and adjacent lamina to relieve pressure on the spinal cord/ nerve roots
118
What type of receptors exist in all body wall structures for somatic general senosry spinal nerves. List some examples
Sensation specific receptors | Pain, touch, temperature, proprioception, vibration
119
What type of fibres do somatic motor axons on spinal nerves synapse onto on the body wall?
Skeletal muscle
120
What type of fibres do sympathetic axons on spinal nerves synapse onto?
Smooth muscle
121
What fibres does the spinal cord segmental synapse between for spinal reflexes?
Somatic sensory and somatic motor axons
122
Describe the types of general sensory somatic symptoms that the body wall percieves
``` Pain (neuralgia) Pins and needles (paraesthesia) Numbness (anaesthesia) Sensitivity (hyperanaesthesia) Hot or cold Loss of coordination/ balance/ clumsiness (ataxia) ```
123
Describe the types of somatic motor symptoms that the body wall percieves
Muscle stiffness, tightness or spasm (cramp) Muscle flappiness or looseness (hypotonia) Muscular weakness (reduced power) Loss of coordination/ balance/ clumsiness (ataxia)
124
What are the neural components of the body wall?
Somatic general sensory fibres Somatic motor fibres Sympathetic fibres (motor to organs) Spinal reflexes
125
What is used to test sensory function of spinal nerves?
Dermatomes
126
What is used to test motor function of spinal nerves?
Myotomes
127
In what situation, would we test both motor and sensory function of spinal nerves?
Spinal reflexes
128
What area of the brain is common for CVA?
Internal capsule
129
Identify the dermatomal locations of the cervical roots in the upper limb
C1: SN has no sensory axons C2: Back of scalp and Adams apple (area that looks like a helmet with a strap tied below the chin) C4: Clavicle and shoulder tip (neck lace) C3: Back of neck and jugular notch (area between C2 and 4) C5: 'Badge patch' (anterior chest and continues to wrist) WE DIVE TO T1 (most of arm) C6: Thumb (+ index finger, if you join together they make 6) and lateral posterior arm C7: Index and middle finger (continuation) and middle posterior forearm C8: Ring and little finger (continuation) and medial posterior forearm
130
Identify the dermatomal locations of the thoracic roots in the upper limb and trunk
``` Entire area makes the letter T T1: Medial forearm (limbs are topmost ) T2: Medial arm and sternal angle T4: Male nipple ('boob') T10: Umbilicus (bell butTEN) T12: Pubic symphysis ```
131
Identify the dermatomal locations of the lumbar roots in the pelvis and lower limb
Supplies legs and loin L1: Groin 'hands in pockets' (1nguinaL area) L2: Anterior thigh L3: Anterior thigh L4: KNEE (to medial malleolus) (down on L4s) and great toe (great 'fire' of London) L5: Dorsum of foot (middle part of sole is triangle like an inverted V (roman for 5)
132
Identify the dermatomal locations of the sacral roots in the lower limb
Concentric fashion (out to in) S1: Heel (POSTERIOR LEG) S2: Posterior knee (lateral leg and foot inc. little toe) (FREE INC, GENITAL AREA) (BULLSEYE OF ANUS) S3: Buttock (FREE INC. GENITAL AREA) S4: Perineum S5: Perianal skin (anus)
133
What is the sensory area supplied by the posterior ramii, allowing us to test these ramii?
Supply a strip of skin centrally down back and posterior neck (C2 - C8 spinal nerves)
134
How would we test the sensory component of the anterior ramii?
Forms plexuses - cervical, brachial, lumbar, sacral which can be tested
135
Which spinal cord levels do not contribute to anterior ramii?
T2 - T12
136
Which nerves are formed from the bifurcation of L1?
Ilioinguinal and iliohypogastric
137
Which nerves are formed from the anterior ramii of T2 - T11?
Intercostal nerves
138
Which nerve is formed from the anterior ramii of T12?
Subcostal nerve
139
What is the difference between a spinal nerve and a named nerve?
Spinal nerves are axons originating from one spinal cord level e.g. L5 spinal nerve, whereas named nerve are axons originating from 1 or more spinal cord levels supplying an area e.g. musculocutaneous nerve (C5, 6, 7)
140
Identify the plexus and list the nerve roots giving rise to the named nerve cutaneous innervation of the neck
CERVICAL PLEXUS | Anterior ramii of C1, 2, 3, 4
141
Identify the specific sensory nerves and roots which form the named nerve cutaneous innervation of the neck
CERVICAL PLEXUS LITTLE GOATS TRED SOFTLY: Starting from - 11 o'clock: Lesser occipital nerve (C2) - posterior to external ear 1 o'clock: Great auricular nerve (C2, 3) - angle of mandible and external ear 3 o'clock: Trasverse cervical nerve (C2, 3) - anterior neck 6 o'clock: Supraclavicular (C3, 4) - clavicle, shoulder pain
142
What is the nerve point?
Point at which sensory nerves of cervical plexus converge
143
Which sensory nerve is involved in referral of pain from the diaphragm?
Supraclavicular nerve (C3, 4)
144
Which nerve roots are important in referred pain from the myocardium?
T1, T2
145
What supplies the anatomical snuffbox?
Cutaneous branches of the radial nerve
146
Identify the specific sensory nerves and roots that form the named nerve cutaneous innervation of the upper limb
BRACHIAL PLEXUS Shoulder - middle finger (lateral) and back up (medial) Supraclavicular (C3,4) - Shoulder Axillary nerve (C5, 6) - Badge patch area Radial nerve (C5, 6, 7, 8, T1) - Lateral arm (and most of posterior) Cutaneous branch of musculocutaneous (C5, 6, 7) - Lateral half of anterior forearm (and a bit posterior) Radial nerve (Lateral hand - snuffbox) Median nerve (C5, 6, 7, 8, T1) - Lateral 3 1/2 digits (and posterior fingertips of these fingers) Ulnar nerve (C7, C8, T1) - Medial 1 1/2 fingers (and these fingers posteriorly) Median antebrachial cutaneous nerve
147
Identify the sensory nerves of the lumbosacral plexus that form the named nerve cutaneous innervation of the ANTERIOR lower limb
``` 1ST LAYER: lateral to medial Subcostal nerve (T12) - corner Genitofemoral nerve (L1, L2) - 1 or 2 balls Ilioinguinal nerve (L1) - 1lioinguinaL ``` 2ND LAYER: lateral to medial Lateral cutaneous nerve of the thigh (L3, L4) Femoral nerve (L2, L3, L4) - FRONT Obturator nerve (L2, L3, L4) - OPEN YOUR LEGS 3RD LAYER: lateral to medial Common fibular nerve (L2, L3) - TELLING A FIB - HIDING SOMETHING Saphenous nerve (L3, L4) - from femoral - SECRET 4TH LAYER: lateral to medial Sural nerve (S1, S2) - 'sweet' little toe Superficial fibular nerve (L4, L5, S1) - shoe (most of foot) Deep fibular nerve (L5) - 'fin' - toe web
148
Identify the sensory nerves of the lumbosacral plexus that form the named nerve cutaneous innervation of the POSTERIOR lower limb
1ST LAYER: lateral to medial Iliohypogastric nerve (L1) - '1Lio' Posterior ramii (cluneal nerves) (S1, S2, S3) - 'No clue = hiding at back) Ilioinguinal nerve 2ND LAYER: lateral to medial Lateral cutaneous nerve of thigh Posterior cutaneous nerve of thigh (S1, S2, S3) Obturator and femoral nerves 3RD LAYER: lateral to medial Common fibular nerve Sural nerve (from tibial and common fibular: S1, S2 - SECRET (in middle) Saphenous nerve 4TH LAYER: lateral to medial Tibial nerve (L4, L5, S1, S2, S3) Calcaneal nerve (HEEL) Medial and lateral plantar nerves (SOLE)
149
Describe the route of a somato-sensory action potential from the skin to the somatosensory cortex
Stimulated nerve AP generated by receptors in L2 dermatome AP enters lumbar plexus and reaches L2 anterior ramii AP continues to L2 spinal nerve, then posterior root and rootlets AP reaches posterior horn of spinal cord
150
Identify the myotomes supplied by the cervical plexus
C1 - C4 motor axons - neck and strap muscles, diaphragm
151
Identify the myotomes supplied by the brachial plexus
C5 - T1 motor axons - muscles of upper limb, extrinsic back muscles (control upper limb and scapula)
152
Identify the myotomes supplied by the lumbosacral plexus
L1 - S4 motor axons - muscles of lower limb, perineal skeletal muscle
153
Identify the myotomes supplied by T12 - L3 motor axons
``` Postural back muscles (posterior ramii) Intercostal muscles (anterior ramii) AL abdominal wall muscles (via thoracoabdominal, subcostal, iliohypogastric, ilioinguinal) ```
154
How do you clinically test the C5 motor axons, supplying a myotome? What muscle are you testing?
``` Shoulder ABD (also elbow flexion) Deltoid ```
155
How do you clinically test the C6 motor axons, supplying a myotome? What muscle are you testing?
Wrist EXT | Biceps brachii
156
How do you clinically test the C7 motor axons, supplying a myotome? What muscle are you testing?
Elbow EXT | Triceps brachii
157
How do you clinically test the C8 motor axons, supplying a myotome? What muscle are you testing?
Finger FLEX | Flexor digitorium superficialis
158
How do you clinically test the T1 motor axons, supplying a myotome? What muscle are you testing?
Finger ABD | Dorsal interossei
159
How do you clinically test the L3 motor axons, supplying a myotome? What muscle are you testing?
Knee EXT | Quadriceps femoris
160
How do you clinically test the L4 motor axons, supplying a myotome? What muscle are you testing?
Ankle DF | Tibialis anterior
161
How do you clinically test the L5 motor axons, supplying a myotome? What muscle are you testing?
Great toe EXT | Extensor hallucis longis
162
How do you clinically test the S1 motor axons, supplying a myotome? What muscle are you testing?
Ankle PF | Gastrocneumius
163
How do you clinically test the S2 motor axons, supplying a myotome? What muscle are you testing?
Knee FLEX | Biceps femoris
164
Describe the route of a somato-motor action potential from the primary somatomotor cortex (UMN) to skeletal muscle.
Primary somatosensory cortex AP continues onto UMN axons of CST AP continues onto anterior horn of L3 spinal cord UMN synapse with L3 LMN AP continues to L3 spinal nerve AP continues onto L3 posterior or anterior ramus AP enters the lumbar plexus of named nerve and reaches NMJ of supplied nerve
165
What is a reflex? Describe the patellar reflex
Involuntary response to stimulus Patella senses stretch, activates APs in femoral nerves and sensory APs to dorsal horn of L3 axons Axons synapse on LMNs in femoral nerve Reach quadriceps NMJ and extension occurs
166
What is a monosynaptic reflex? What does it indicated?
Occurs each time a skeletal muscle is stretched | Normal muscle tone
167
Reflex muscle contractions are controlled by...
Descending pathways
168
What sign would suggest an UMN lesions versus a LMN lesion?
Spasticity | Flaccidity
169
Which axons are activated when testing the tendon jerk of biceps brachii?
C5, C6
170
Which axons are activated when testing the tendon jerk of brachioradialis?
C6
171
Which axons are activated when testing the tendon jerk of triceps brachii?
C7, C8
172
Which axons are activated when testing the knee jerk reflex?
L3, L4
173
Which axons are activated when testing the ankle jerk reflex?
S1, S2
174
Anterior roots contain only sensory/motor axons, whilst posterior roots contain only sensory/ motor axons?
Motor | Sensory
175
The space in the middle of the grey matter in the spinal cord is known as the?
Spinal canal
176
For CNI, give it's extracranial and intracranial course and connection with CNS (if applicable)
In olfactory mucosa in nasal cavity Synapse in olfactory bulb, and pass to olfactory tract NO CONNECTION
177
Outline how you would go about testing CNI
Smell while covering contralateral side
178
For CNII, give it's extracranial and intracranial course and connection with CNS (if applicable)
Neurones of retina travel posteriorly via optic nerve to the orbit Pass from the optic chiasm to the optic tract Diencephalon
179
Outline how you would go about testing CNII
``` Visual acuity (Snellen) Colour (Ishihara plates) Fields (4 quadrants) Reflexes (Pupillary light reflexes) Fundoscopy ```
180
For CNIII, give it's extracranial and intracranial course and connection with CNS (if applicable)
SOF into orbit and supply all extraocular muscles except 2, PSs synapse in ciliary ganglion Lateral wall of cavernous sinus (orbit) Mesencephalon (midbrain)
181
Outline how you would go about testing CNIII
Light reflexes via a torch (PS)
182
For CNIV, give it's extracranial and intracranial course and connection with CNS (if applicable)
SOF into orbit and supply SO muscle Lateral wall of cavernous sinus (orbit) Mesencephalon (midbrain)
183
Outline how you would go about testing CNIV
H test (in and down)
184
For CNVI, give it's extracranial and intracranial course and connection with CNS (if applicable)
SOF into orbit and supply LR muscle Cavernous sinus to orbit Pontomedullary junction
185
Outline how you would go about testing CNVI
H test (out)
186
For CNVIII, give it's extracranial and intracranial course and connection with CNS (if applicable)
Axons from cochlear and vestibular apparatus Posteromedially from IAM to PM junction Pontomedullary junction
187
Outline how you would go about testing CNVIII
Rinnie and Weber tests
188
For CNXI, give it's extracranial and intracranial course and connection with CNS (if applicable)
Axons supply SCMD, travel across posterior triangle to trapezius Foramen magnum to jugular foramen Cervical spinal cord
189
Outline how you would go about testing CNXI
``` Shrug shoulders (and resist) - TRAPEZIUS Turn head to flex neck (and resist) - SCMD ```
190
For CNXII, give it's extracranial and intracranial course and connection with CNS (if applicable)
Descends lateral to carotid sheath (at hyoid turns anteriorly to tongue) Pass anteriorly to hypoglossal canal Many rootlets lateral to pyramids of medulla
191
Outline how you would go about testing CNXII
Stick tongue out and move side-side | Tip of tongue will point towards side of pathology
192
For CNV, give it's extracranial and intracranial course and connection with CNS (if applicable)
Sensory passes superficial to deep structures of face posteriorly to foramen Motor from CNV3 travels from f. ovale to skeletal muscle Inferior to tentorium cerebelli Pons!
193
Give the superficial sensory divisions for the trigeminal supply to the face
CNVI: upper eyelid to tip of nose to forehead CNV2: Lower eyelid to upper lip and nostril CNV3: Lower lip and chin to TMJ/ mandible (except angle)
194
What gives sensory supply to the angle of mandible, and what are the roots of this nerve?
Great auricular nerve (C2, C3)
195
Give the deep sensory divisions for the trigeminal supply to the face
CNV1: orbit (not floor or lower eyelid), upper anterior nasal cavity, paranasal sinuses (not maxillary), anterior and posterior CF CNV2: lower posterior nasal cavity, maxillary sinus, maxilla, floor of nasal cavity/ palate, maxillary teeth, soft tissues CNV3: Middle CF, mandible A 2/3 of tongue, floor of mouth, buccal mucosa, mandibular teeth
196
Outline how you would go about testing the sensory divisons of CNV
Close eyes Cotton wool - 'Say when you feel me touching you' Compare sides
197
Which nerve is the 1st part of afferent limb of blink/ corneal reflex?
Long ciliary nerve
198
Outline how you would go about testing the motor division of CNX
Palpate strength of masseter (clench teeth) | Open jaw against resistance
199
For CNVII, give it's extracranial and intracranial course and connection with CNS (if applicable)
Somatic motor fibres to parotid gland and then facial expression muscles (1 out of 5) Directly to IAM Pontomedullary junction
200
The facial canal is located within what part of the temporal bone?
Petrous part
201
What is the function of chorda tympani, a branch of CNVII?
Taste to A 2/3 of tongue | PS to submandibular and sublingual glands (salvation)
202
What is the tiniest SkM in the body?
Stapedius
203
What is the role of the stapedius muscle, and what happens when you damage it?
Reduces stapes movement to dampen down excessive noise | Hyperacuisis
204
Outline how you would go about testing CNVII
Test the muscles of facial expression - raise eyebrows, close eyes tightly, smile, puff out cheeks and hold air
205
List the muscles of facial expression
Frontalis Orbicularis oculi Elevators of lips Orbicularis oris
206
For CNIX, give it's extracranial and intracranial course and connection with CNS (if applicable)
Descends in pharynx in mouth to stylopharyngeus, parotid gland, pharyngeal muscosa, carotid body and sinus, posterior 1/3 of tongue Directly to jugular foramen Medulla oblongata
207
Outline how you would go about testing CNIX
Elicit afferent limb of gag reflex
208
What is the only muscle supplied by CNIX
Stylopharyngeus
209
Which muscles are supplied with motor innervation from CNV?
Tensor tympani Tensor veli palatini 1 pair of jaw closing muscles - lateral pterygoid 3 pairs of jaw opening muscles - masseter, temporalis, medial pterygoid
210
For CNX, give it's extracranial and intracranial course and connection with CNS (if applicable)
Structures between pallate and midgut Directly into jugular foramen Medulla oblongata
211
Why is pain often referred from pharynx to ear and vice versa?
Both supplied by glosopharyngeal nerve
212
What two vessels is the carotid sheath located between?
CCA and IJV
213
The left recurrent laryngeal nerve, branch of CNX, passes under...
Arch of aorta
214
The right recurrent laryngeal nerve, branch of CNX, passes under...
Right subclavian artery
215
Outline the route taken by both vagus nerves from the chest to abdomen
``` RIGHT: Lateral aspect of trachea LEFT: Lateral aspect of aortic arch Pass posterior to lung root on oesophagus Pass through diaphragm with oesophagus Pass onto surface of stomach Branches and travels to organs ```
216
List the branches of the vagus nerve in the abdomen
``` Celiac and superior mesenteric ganglia Foregut Renal Midgut (on mesenteries) Splenic Pancreatic ```
217
What vertebral level do the oesophagus and vagus nerve pass through the diaphragm?
T10
218
Where do the vagus nerves very last PS axons pass onto?
Splenic flexure of colon
219
Outline how you would go about testing CNX
MUSCLES OF PALATE (motor) - Say 'aaah' - uvula deviates to side that is functioning PHARYNGEAL MUSCLES - Swallow water and see if they splutter LARYNGEAL MUSCLES - Listen to speech and see if any hoarseness
220
What is a space-occupying lesion, and what are the two main types?
Abnormal tissue taking up space | Acute or subacute
221
What are the layers of the scalp?
``` SCALP Skin CT (artery-rich) Aponeurosis (tendon) Loose CT (thinnest) Pericranium (periostum - outer membrane of bone) ```
222
Why do scalp lacerations and incisions bleed excessively?
Scalp arteries form a rich anastomotic network just deep to skin
223
What two arteries do scalp arteries branch from?
Internal and external carotid
224
What is the thinnest part of the skull? What type of joint is it? What artery courses just deep to it?
Pterion Fibrous joint - suture (H shape) Middle meningeal artery
225
List the borders of each of the cranial fossa; anterior, middle and posterior?
Frontal bone - wings of sphenoid WIngs of sphenoid - petrous temporal bone Petrous temporal bone - occipital bone
226
What is the name for the protective coverings of the brain and spinal cord?
Meninges
227
List the 3 layers of membrane covering the brain and spinal cord, from superficial to deep
Dura matter 'hard matter' (ADHERENT TO SKULL) Arachnoid matter 'spidery mother' (Subarachnoid space) Pia matter 'faithful matter' (ADHERENT TO BRAIN)
228
What CN is the sensory supply to the dura?
CNV
229
Which layer of the meninges encloses the dural venous sinuses? What are the main three types?
Dura matter | DIaphragm sellae, tentorium cerebelli, falx cerebri
230
What is the diaphragm sellae? What does it sit upon?
Tough sheet of dura matter forming a roof over pituitary fossa (on sella turcica)
231
What is the tentorium cerebelli?
Tough sheet of dura matter tenting over cerebellum, which attaches to ridges of petrous temporal bone
232
What is the falx cerebri? What are the attachments to the deep aspect of skull?
Midline structure of dura matter that seperates the cerebral hemispheres Crista galli of ethmoid bone, internal sagittal suture, internal occipital protuberance
233
Where do the cerebral veins drain into?
Dural venous sinuses
234
List the main dural venous sinuses that drain blood from the brain
Sigmoid sinus 'S shape' Superior sagittal sinus Inferior sagittal sinus
235
Where does the sigmoid sinus drain and to what foramen?
IJV at jugular foramen
236
Where is the confluence of sinuses?
In midline at internal occipital protuberance
237
What is the danger triangle of the face?
Venous spread of infection from superficial to deep - ophthalmic vein has no valves and can leak backwards = CAVERNOUS SINUS THROMBOSIS
238
Outline the arterial supply to the brain
1. ICA (branch of CCA) 2. ECA (branch of CCA) 3. VA (branch of SCA)
239
What route does the vertebral artery take to reach the cranial cavity?
Through transverse foraminae in cervical vertebrae | Through foramen magnum
240
Outline the branches of the Circle of Willis from bottom to top
Vertebral arteries (connected by anterior spinal) Basilar artery (anastomosis of two VAs) (Pontine arteries) Posterior cerebral arteries (division of basillar artery) ICAs (connected to PCAs by posterior communicating arteries) 1. Ophthalmic arteries 2. Branch of ICAs = Anterior cerebral arteries (connected by anterior communicating artery) MCAs (continuation of ICAs)
241
Which arteries supply the medial, lateral and posterior aspects of the cerebral hemispheres respectively?
ACAs MCAs PCAs
242
Where can the Circle of Willis be found?
Inferior to midbrain, close to the pituitary stalk and optic chiasm in subarachnoid space
243
What circulates within the subarachnoid space?
CSF
244
Where does the subarachnoid space terminate?
S2 part of the sacrum
245
Outline the route taken by CSF from production to reabsorption
1. Secreted by choroid plexus 2. From right and left lateral ventricles (via Foraminae of Munro - ONE FOR EACH) 3. Into midline 3rd ventricle (Cerebral aqueduct) 4. Into 4th ventricle 6. Into subarachnoid space of brain and cord (and some into central canal) 7. Reabsorbed into dural venous sinuses
246
Where are the lateral ventricles, 3rd ventricle and 4th ventricle located, respectivelly?
Cerebral hemispheres Diencephalon Between cerebellum and pons
247
What reabsorbs CSF back into the dural venous sinuses?
Arachnoid granulations
248
What is hydrocephalus? How is it managed?
Excess production, obstruction to flow or inadequate reabsorption leading to increased CSF volume Ventricular peritoneal shunt (connects ventricles to peritoneal cavity)
249
List the types of bleeding that can occur within the cranial cavity and what causes each of them
EXTRADURAL HAEMORRHAGE (between bone and dura) due to ruptured middle meningeal artery (damage to pterior) SUBDURAL HAEMORRHAGE (seperates dura from arachnoid) due to torn cerebral veins SUBARACHNOID HAEMORRHAGE (into CSF of subarachnoid space) due to ruptured CIrcle of WIllis 'Berry aneurysm'
250
What can happen if you sustain damage to the extradural venous plexuses?
Epidural haematoma compressing spinal cord or cauda equina
251
Where is the needle inserted in epidural anaesthesia? Why?
Subarachnoid space where it surrounds cauda equina (spinal nerves not as easily damaged as conus medullaris and vertebrae not fused) Typically L3/4
252
What are the four common types of supratentorial herniation?
Cingulate (under falx cerebri) Central (through tentorium cerebelli) Uncal (uncus = medial temporal lobe, inferior to tentorium cerebelli) Transcalvarial (fracture of cranial cavity)
253
What nerve can be compressed in uncal supratentorial herniation? What is the effect?
Oculomotor nerve | Fixed dilated pupil (ipsilateral)
254
What are the two common types of infratentorial herniation?
Upward (over tentorium cerebelli) | Downward/ tonsillar herniation (of cerebral tonsils into foramen magnum)
255
Where is the cerebral aqueduct located anatomically?
In the midbrain
256
Which cranial nerve is located in the anterior midline of the midbrain?
Oculomotor nerve
257
Which CN is the only nerve to exit the brainstem posteriorly?
Trochlear nerve - EXIT POSTERIOR MIDBRAIN AT JUNCTION WITH PONS
258
What is different about cervical spinal nerves compared to other spinal nerves?
Cervical spinal nerves exit above the vertebrae but all others exit below
259
If a patient has reduced sensation unilaterally on the face, including the forehead and lip, what does this suggest?
More likely involves peripheral facial nerve (Bell's palsy) than a centrallesion (forehead sparing)
260
How do you clinically test the L2 motor axons, supplying a myotome? What muscle are you testing?
Hip FLEX | Iliopsoas
261
What pathology is often associated with Horner's syndrome, due to the sympathetic nervous system travelling close to the site of damage?
Internal carotid dissection

Y3 Neurology Anatomy (12 decks)

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