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1
Q

describe pathway of cutaneous afferents from the face? [1]

A
  • Cutaneous afferents from the face travel in cranial nerves and enter the trigeminal nucleus
  • Post-synaptic fibres from the trigeminal nucleus decussate and run alongside the medial lemniscal fibres from the body.
  • the face afferents end in the VPM thalamus (ventro-postero-medial nucleus),
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2
Q

afferents from the face end come up through the medial lemniscus and terminate in which part of the thalamus? [1]

afferents from the body come up through the medial lemniscus and terminate in which part of the thalamus? [1]

A

afferents from the face end come up through the medial lemniscus and terminate in which part of the thalamus? [1]
VPM- ventro-postero-medial

afferents from the body come up through the medial lemniscus and terminate in which part of the thalamus? [1]
ventero-postero-lateral: VPL

(together they form complete somatosensory thalamus)

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3
Q

which of the following will show localised pain?

corticospinal tract
anterior spinothalamic tract
posterior spinothalamic tract
lateral reticulospinal tract
medial reticulospinal tract

A

which of the following will show localised pain?

corticospinal tract
anterior spinothalamic tract
posterior spinothalamic tract
lateral reticulospinal tract
medial reticulospinal tract

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4
Q

*** what are the VPM and VPL? [2] ***

A

VPL = Ventral Posterolateral Nucleus. primary thalamic relays for somatic sensation; that is, nociceptive and tactile/proprioceptive information from the body

VPM = ventral posteromedial nucleus. primary thalamic relays for somatic sensation; that is, nociceptive and tactile/proprioceptive information from the head

both nuclei in the thalamus !!

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5
Q

what is romberg’s test? what are you testing? how do you perform? what is a postive sign? [1]

A

Romberg’s test:

  • tests proprioception
  • standing patient and close eyes. instability & loss of balance is a positive sign
  • called sensory ataxia (due to dorsal column damage)
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6
Q

why does inflammation produce long lasting pain?

A

tissue damage releases pro-inflam chemicals into extracellular space

these chemicals (e.g. bradykinin, K+) activate nociceptor & cause it to stay open for long depolariastion

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7
Q

a painful stimulus activates which receptors? [3]

A

a painful stimulus activates which receptors? [3]
touch receptor
wide dynamic range receptor
nociceptors

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8
Q
A
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9
Q

which of the lateral spinothalamic tracts causes perception of pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

A

which of the lateral spinothalamic tracts causes perception of pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

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10
Q

explain path of lateralspinothalamic tract
- which three nuclei does it terminate at? [3]

A

lateral spinothalamic tract:

decussates at site of entry and goes up

  • axons reach midbrain, they branch to different nuclei
    i) periaqueductal grey (PAG) - arousal
    ii) mediodorsal nucleus
    iii) ventromedial thalamic group
    ii & iii = where concious perpection of pain is registered !

BUT NOT TO VPL / VPM (i.e. not somatosensory

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11
Q

which of the lateral spinothalamic tracts causes arousal & attention to pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

A

which of the lateral spinothalamic tracts causes arousal & attention to pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

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12
Q
A
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13
Q

:)

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

A

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

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14
Q

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

A

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

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15
Q

where do you find the insula? [1]

between which lobes? [2]

A

where do you find the insula? [1]
lateral fissure

between which lobes? [2]
frontal and temporal

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16
Q

** what changes would be felt bc of this lesion (brown-sequard)? **

A
  1. loss of pain and temperature on right side of body below lesion (spinothalamic decussates at level of spinal cord entry)
  2. loss of motor movement on same side as lesion (corticospinal goes down ipsilateral side)
  3. loss of proprioception and vibration sense on the same side from damage (DCML has already decussated)
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17
Q

What are the two layers of the dura mater? [2]

A
  • *periosteal layer** (which lines the inner surface of the bones) [1]
  • *meningeal** layer which forms dural folds. [1]
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18
Q
A
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19
Q

posterior spinocerebellar tract pathway?

A

enters via dorsal root into dorsal horn: synapses with secondary neuron here and goes into posterior spinocerebella tract and goes up to cerebellum on SAME side (ipsilateral)

no decussation !!

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20
Q

describe pathway of anterior spinocerebellar tract xx enjoy

A

afferent nerve goes in via dorsal horn. synapse with secondary afferent here

a) MOST secondary fibres decussate and go up on the contralateral side
b) BUT, some fibres: stay on same side and go up ipsilateral side

aa) the controlateral ones: go to cerebellum, where they DECUSSATE AGAIN to get back to ipsilateral side
bb) ipsilateral side goes up and stays here

net effect is that both stay ipsilateral

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21
Q

describe pathway of anterior spinocerebellar tract xx enjoy

A

afferent nerve goes in via dorsal horn. synapse with secondary afferent here

a) MOST secondary fibres decussate and go up on the contralateral side
b) BUT, some fibres: stay on same side and go up ipsilateral side

aa) the controlateral ones: go to cerebellum, where they DECUSSATE AGAIN to get back to ipsilateral side
bb) ipsilateral side goes up and stays here

net effect is that both stay ipsilateral

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22
Q

which spinal tract carries the concious proprioception

Cortiocspinal
DCML
Spinothalamic
Spinocerebellar

A

which spinal tract carries the concious proprioception

Cortiocspinal
DCML
Spinothalamic
Spinocerebellar

23
Q

which arteries supply the areas where the nerve roots enter and exit the spine dorsally and ventrally, respectively? [1]

A

radicular arteries

24
Q

which part of spinal column does the artery of Adamkiewicz supply? [2]

A

lower thoracic or upper lumbar vertebrae

25
vertebral artery is a branch of which artery? [1]
**subclavian**
26
what is the difference between radicular artereis and segmental medullary arteries?
Radicular arteries Supply the areas where the nerve roots enter and exit the spine dorsally and ventrally, respectively. These arise from anterior cervical arteries in the cervical region, from posterior intercostal arteries in the thoracic region, and from lumbar arteries in the lumbar region. They gain access to the cord via the intervertebral foramina, and important do not travel as far as the midline to anastomose with ASA or PSA. Segmental medullary arteries These are, to all intents and purposes, just like large radicular arteries. They arise similarly from the anterior cervical, intercostal and lumbar arteries, but the key difference is that they travel to the midline and anastomose with the ASA or PSA. The largest and most noteable segmental medullary artery is the great anterior segmental medullary artery of Adamkiewicz, which arises somewhere between T9 and T12, usually on the left, and anastomoses with the ASA to reinforce it as it supplies the lumbosacral spine.
27
28
Brown-Sequard Syndrome is damage to one side of spinal cord. what paraylsis / loss of senses occurs at: _ipsilaterally 1/2 levels below lesion ipsilaterally: 2 levels below lesion ipsilaterally 2 levels onwards below lesion on contralaterol sid_
_ipsilaterally:_ get **complete paralysis** below the level of the lesion: due to blocking of **corticospinal** _1/2 levels below lesion ipsilaterally:_ **complete anaethesia** for 1/2 levels due to block of ispilateral spinothalamic. _2 levels below lesion ipsilaterally:_ **loss of light touch, proprioception and vibration** (due DCML) _2 levels onwards below lesion on contralaterol side:_ **loss of** **pain, temp and crude touch 2 levels & below level of lesion -** due to the nerves in spinothalamic tract crossing over over couple below
29
what are the three main branches of facial nerve (VII), what type of innervation do they provide?
**greater pertrosal:** parasympathetic innervation to lacrimal gland (eye fluid & tears) * *chordae typmani:** - special sensory innervation to anterior 2/3rd of tongue; - parasympathetic innervation to sublingual and submandibular glands **motor root:** TZBMC (two zulus bit my cat); temporal, zygomatic, buccal, marginal mandibular, cervical: motor muscles of facial expression
30
what are the three main branches of facial nerve (VII), what type of innervation do they provide?
_greater pertrosal:_ **parasympathetic innervation to lacrimal gland (eye fluid & tears)** _chordae typmani:_ * *- special sensory innervation to anterior 2/3rd of tongue; - parasympathetic innervation to sublingual and submandibular glands** _motor root: TZBMC_ (two zulus bit my cat); temporal, zygomatic, buccal, marginal mandibular, cervical: **motor muscles of facial expression**
31
describe the difference in innervation from facial nerve between upper and lower muscles of face?
_muscles of upper part of face_ - frontalis: **bilateral innervation - gets innervation from both contralateral and ipsilateral motor cortex ! (**upper motor neurons from L & R of brain synapse the lower motor neuron, which innervates the frontalis) _muscles of lower part of face:_ **just contralteral innervation** one upper motor neuron from L or R, travel down and decussate and synapses with lower motor neuron
32
_what happens when have Bells palsy?_ - which part of facial nerve is affected? - what does this present as? _what happens when have stroke palsy?_ - which part of facial nerve is affected? - what does this present as?
_what happens when have Bells palsy?_ - which part of facial nerve is affected: **lower motor neuron** ​- what does this present as: **ipsilateral total paralysis** _what happens when have stroke palsy?_ - which part of facial nerve is affected: **upper motor neuron** - what does this present as: **contralateral lower muscles paralsis**
33
describe what innervation the vagus nerve innervation does for the following x - sensory - parasympathetic - motor [4]
- **sensory**: larynx (superior laryngeal and recurrent laryngeal nerve) - **parasympathetic**: goes up to midgut - **motor**: soft palate; pharynx; oesphagus; larynx (superior laryngeal and recurrent laryngeal nerve)
34
describe what innervation the vagus nerve innervation does for the following x - sensory - parasympathetic - motor [4]
describe what innervation the vagus innervation does for the following x - _sensory_: **larynx (**superior laryngeal and recurrent laryngeal nerve) - _parasympathetic:_ goes up to midgut - _motor_: **soft palate; pharynx; oesphagus; larynx (**superior laryngeal and recurrent laryngeal nerve)
35
36
37
midbrain: what is role of: - superior colliculi [1] - inferior colliculi [1] - cerebral peduncles [1]
midbrain: what is role of: - superior colliculi [1] * *eye movements and visual processing** - inferior colliculi [1] * *auditory processing** - cerebral peduncles [1] * *contains tracts descending from thalamus (CST & CBT)**
38
39
which level of the brainstaim did you find cerebral aquaduct? midbrain medulla thalamus pons corpus callosum
which level of the brainstaim did you find cerebral aquaduct? **midbrain** medulla thalamus pons corpus callosum
40
which CN spans all of the brainstem? [1]
facial nerve
41
where are the lesions? Lesion 1: Lesion 2:
where are the lesions? Lesion 1: **Right CN II** Lesion 2: **Right CN III if things are same = CN II lesion (afferent is ruined) if things are different = CN III lesions (efferent ruiend)**
42
which 3 reactions does the accomodation reflex test? [3]
constriction of pupils thickening of lens (cilliary muscle constriction) convergenece of eye balls ( CNIII: movement of eyeballs - medial rectus muscle !!)
43
Dolls eye reflex: Afferent CN? [1] Efferent CNs? [3] how do u test? what is a normal reflex and abnormal reflex?
Dolls eye reflex: Afferent CN? [1]: **CN VIII** Efferent CNs? [3] **CN III, CN IV, CN VI** - tested by turning head side to side - normal reflex: **head moves to right, eyes move left** - abnormal refelx: **head moves to right, eyes follow**
44
what structure connexts the cranial nerve nuclei controlling eye movement and the vestibular nuclei? [1]
**medial longitudinal fasiculus:** CN III, IV and VI
45
46
blink reflex: afferent and efferent CNs? gag reflex: afferent CN? efferent CN?
_Blink reflex:_ afferent CN: t**rigeminal - V1** (but also bright light (CN II & loud noise CN VIII)) efferent CN: **CN VII - acts on orbicularis occuli muscle to close** _gag reflex:_ afferent CN: **CN IX** efferent CN: **CN X**
47
which is main blood supply to pons? [1] - branches? [3]
which is main blood supply to pons? [1] **basilar artery** ​- branches? [3] **paramedian branches anterior iinferior cerebelllar artery superior cerebellar artery**
48
49
what is the blood supply to the medulla mainly from? [1] - what are the 5 branches? [5]
medulla blood supply = **verterbal arteries** - **anterior spinal artery - posterior spinal artery - posterior inferior cerebellar artery (PICA) - anterir inferior cerebellar artery (AICA) - basal artery**
50
51
which 2 arteries provide main blood supply to midbrain? [2]
which 2 arteries provide main blood supply to midbrain? [2] basilar artery * *- superior cerebellar artery - posterior cerebellar artery** choridal atery
52
Rule of 4: which 4 midline structures do you get? what are their deficits?
53
how do u check for raised intracranial pressure? [1]
**opthalmascope** - look for optic nerve where it enters retina (eyes are outgrwoth of brain). optic nerve gets squashed at high pressure - causes papilledema / optic discs bulge out
54
Rule of 4: which 4 lateral structures do you get? what are their deficits?

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