Neurology Anatomy Flashcards Preview

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Flashcards in Neurology Anatomy Deck (118):
1

Which muscles make up the Extrinsic back muscles?

Trapezius
Levator scapulae
Rhomboids (major + minor)
Latissimus Dorsi

2

What is the functions of the extrinsic back muscles?

- Attach back to pectoral girdle (have attachment point somewhere outwith back)

- Move upper limb

3

Main innervation of the extrinsic back muscles?

Anterior rami of cervical spinal nerves
(Exception = trapezius --> spinal accessory)

4

What are the 2 main groups of Intrinsic back muscles?

Erector spinae (superficial)

Transversospinalis (deep)

5

What is the function of the intrinsic back muscles?

Maintain back posture
Move spine

6

Where is the erector spinae muscles located?

3 vertical groups located lateral to the spine

7

What are the common inferior and superior attachments of the erector spinae muscles?

Inferior - sacrum, iliac crest

Superior - rib, transverse process of vertebra, spinous process of vertebra

8

Where is the Transversospinalis intrinsic back muscle located?

Within the grooves between the transverse & spinous processes

9

What is the nerve supply of the intrinsic back muscles?

Segmental nerve supply (as per myotome/dermatome)

Posterior rami branches (cervical, thoracic, lumbar)

10

What are the three main muscles of the anterolateral abdominal wall (superficial to deep)?

External oblique
Internal oblique
Transverse abdominis

11

What are the main movements of the spine by erector spinae and transversospinalis?

Maintain posture + support

Extension of spine (erector spinae contracts bilaterally)
Unilateral contraction = lateral flexion

12

What are the sections of the vertebral column?

Cervical C1-C7
Thoracic T1-T12
Lumbar L1-L5
Sacrum (5 sacral)
Coccyx (4 coxxygeal)

33 vertebrae in total

13

How does the size of vertebrae change as you travel down the spine?

Become larger as they become more weight bearing

Sacrum + Coccyx become smaller again once weight transferred to hip bones

14

What is the functions of the vertebral column?

Support head + trunk when upright
Protect spinal cord (+ nerves)
Allow movement

15

Explain the development of the curvatures of the vertebral column

As a fetus the spine is a continuous curve which slowly starts to develop separate curvatures as the child begins to walk and weight bear

Adults have 2 primary lordosis curvatures (cervical, sacral) and 2 secondary kyphosis (thoracic, lumbar)

16

What does the vertebral arch consist of?

Pedicle x2
Lamina x2

17

What is the function of the inferior and superior articular process of a vertebra?

Mobility with adjacent vertebrae via synovial facet joint

18

Where in the spine are spinal nerves found?

Intervertebral Foramen

19

What pathology can common affect the facet joint between articular processes?

Arthritis

20

What is an Intervertebral disc?

Sits between the bodies of adjacent vertebrae
Strong attachment

21

Between which vertebrae are there no intervertebral discs?

C1-C2
Sacrum
Coccyx

22

What is the formation of the intervertebral disc?

Outer fibrous ring - Annulus Fibrosus (strong)

Inner soft pulp - Nucleus Pulposus (flexibility + protection)

23

How much of the length of the spine is made up by intervertebral discs?

20-25%

24

What are the three main ligaments found within the spinal cavity?

Ligamentum flavum

Posterior longitudinal ligament

Anterior longitudinal ligament

25

What is the function of the anterior longitudinal ligament?

Stronger support for disc
Prevents over-extension of spine
Broad + strong

26

What is the function of the Posterior Longitudinal ligament?

Prevents over-flexion of spine

27

True or False:
Posterior longitudinal ligament provides MORE support for the disc than the anterior longitudinal ligament

FALSE

Posterior longitudinal ligament is narrow + weak

28

What is the function of the ligamentum flavum?

Connects adjacent laminae posterior to the spinal cord

29

Where does the supraspinous ligaments connect?

Connects tips of spinous process
Strong, fibrous

30

Where does the Interspinous ligament connect?

Connect superior and inferior surfaces of adjacent spinous processes
Weak, membranous sheet-like

31

Which vertebrae does not have a body or spinous process?

C1 - Atlas

Has posterior arch and anterior arch instead

32

Which vertebrae has an odontoid process?

C2 - Axis
Projects superiorly from body and articulates with C1

33

What is the main movement of the Atlanto-axial joints?

Rotation

34

What are the four stages of cervical vertebrae dislocation?

1 - flexion sprain
2 - anterior subluxation, 25% translation
3 - 50% translation
4 - complete dislocation (facet jumped over to other side + locked in place)

35

At what levels does the spinal cord begin and end?

Begins at foramen magnum - C1 segment

Ends around vertebral level L1/L2 (conus medullaris)

36

What is a Laminectomy?

Used to access spinal canal, posterior exposure of the spinal cord and/or spinal roots
Relieve pressure on spinal cord or nerve roots

37

What symptoms will patients complain of with somatic general sensory pathology?

Pain (neuralgia), pins & needles (paraesthesia), numbness, sensitivity, thermal (hot or cold), loss of coordination/balance/clumsiness

38

What symptoms will patients complain of with somatic motor pathology?

Muscle stiffness/tightness/spasm, muscle floppiness or looseness, muscular weakness, loss of coordination/balance/clumsiness

39

What are the main dermatomes of the upper limb?

C5, C6, C7, C8, T1, T2

40

True or False:
C1 does not have a dermatome

TRUE

C1 only has motor function/myotome

41

What are the main dermatomes of the lower limb?

L1 - S5

42

What is the arrangement of dermatomes of the lower limb?

Goes down the front (L1 - L5)
Up the back (S1 - S3)
Then circles around the groin (S3, 4, 5)

43

True or False:
The dorsal roots (posterior) carry sensory information only

TRUE

Ventral roots carry motor information

44

What are the end named nerves of the Brachial Plexus?

Musculocutaneous
Axillary
Median
Radian
Ulnar

45

From which cervical nerves does the brachial plexus arise from?

C5 - T1

46

What is the sensory nerve supply of the anterolateral neck skin and posterior scalp & neck?

Anterolateral neck = Cervical plexus (C1-4)
Posteriorly - posterior rami of C2-C8

47

What is the mneumonic for the named nerves of the cervical plexus supplying the anterolateral neck skin?

Little Goats Treat Softly

L - Lesser occipital nerve
G - Greater auricular nerve
T - Transverse cervical nerve
S - Supraclavicular nerve

48

What nerve supplies the 'anatomical snuffbox'?

Cutaneous branches of Radial nerve

49

Where is somatosensory information processed in the cerebral cortex?

Postcentral gyrus

50

What does the C1-C4 motor axons of the cervical plexus supply?

Neck postural & strap muscles
Diaphragm

51

What does the C5 - T1 motor axons of the brachial plexus supply?

Muscles of upper limb
Extrinsic back muscles (move upper limb or scapula)

52

What do the T2-L3 motor axons supply?

Postural back muscles (via posterior rami)
Intercostal muscles (via anterior rami)
Anterolateral abdominal wall muscles

53

What do the L1-S4 motor axons supply?

Muscles of lower limb
Perineal skeletal muscles

54

Which spinal nerves make up the Femoral nerve?

L2-L4

55

What movement would you ask a patient to do to test C5 myotome?

Shoulder abduction (Deltoid)

56

What movement would you ask a patient to do to test C6 myotome?

Elbow flexion (biceps brachii)

57

What movement would you ask a patient to do to test C7 myotome?

Elbow extension (triceps brachii)

58

What movement would you ask a patient to do to test C8 myotome?

Finger flexion (flexor digitorum superficialis)

59

What movement would you ask a patient to do to test T1 myotome?

Finger abduction (dorsal interossei)

60

What movement would you ask a patient to do to test L3 myotome?

Knee extension (quadriceps femoris)

61

What movement would you ask a patient to do to test L4 myotome?

Ankle dorsiflexion (tibialis anterior)

62

What movement would you ask a patient to do to test L5 myotome?

Great toe extension (extensor hallucis longus)

63

What movement would you ask a patient to do to test S1 myotome?

Ankle plantarflexion (gastrocnemius)

64

What movement would you ask a patient to do to test S2 myotome?

Knee flexion (biceps femoris)

65

Where is the primary somatomotor cortex of the cerebellar cortex?

Precentral gyrus

66

Give an example of a monosynaptic stretch reflex arc?

Patellar reflex

67

Give a basic runthrough of how the patellar reflex works

1- patellar tendon tapped
2- stretches quadriceps fibres
3- Muscle spindles initiate APs in anterior rami axons of femoral nerve
4- sensory APs conducted to dorsal horn of L3
5- Axons pass into anterior horn to synapse on LMNs that supply quadriceps
6- APs conducted via LMN axons in femoral nerve to reach quadriceps NMJ
7- Muscle contracts to extend knee joint

68

Why are space occupying lesions in the skull dangerous?

Not a lot of 'spare room' in skull
Only capable of slow rate expansion
Increased ICP from SOL cacn result in herniation

69

What are the layers of the scalp?

SCALP
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Pericranium

70

True or False:
When a fracture of the skull reaches a suture line it tends to cross it

FALSE
When a fracture line reaches a suture is DOES NOT tend to cross suture line
Minimises propagation of fracture

71

What are the two most relevant suture lines of the neurocranium?

Sagittal suture
Coronal suture

72

What are sutures?

Fibrous joints
Help prevent skull fractures from spreading

73

Which bones make up the Pterion?

Frontal
Parietal
Temporal
Sphenoid

74

Which artery courses over the deep aspect of the pterion?

Middle Meningeal artery

75

Why is the pterion a relevant anatomical location?

Thinnest part of the skull
AND major artery runs directly underneath

76

What is Meningitis?

Bacterial or viral infection of the meninges

77

What are meninges?

Protective coverings for the brain + spinal cord

78

What are the 3 layers of the meninges? (outer to inner)

DURA - tough/fibrous, encloses dural venous sinus

ARACHNOID - reabsorb CSF (arachnoid granulation)
- Subarachnoid Space

PIA MATER - adherent to brain

79

What is the Tentorium Cerebelli?

Sheet of Dura mater that tents over the cerebellum

Has central gap to permit brainstem to pass through

80

Where does the tentorium cerebelli attach?

Ridges of petrous temporal bones

81

What is the Diaphragm sellae?

Tough sheet of dura mater forming roof (diaphragm) over Pituitary Fossa

82

What is the sensory innervation of the dura mater?

CN V (trigeminal)

83

What is the Falx Cerebri?

Separates right + left hemispheres
Midline structure made of dura mater

84

Where does the Falx Cerebri attach?

- Crista galli of ethmoid bone anteriorly
- Internal aspect of sagittal suture
- Internal occipital protuberance posteriorly

85

Where does the Cerebral veins drain to?

Drain venous blood from brain into the
Dural Venous Sinuses

86

Where is the Confluence of sinuses in the brain located?

In the midline of internal occipital protruberance

87

What is the Danger Triangle?

Area over the face with connections between superficial veins of face + cavernous sinus
Any infection in superficial veins could potentially travel back in to cranium

DON'T POP SPOTS

88

What is the origin of the Right Vertebral Artery?

Branch of right subclavian artery off brachiocephalic trunk

89

What is the course of the Right Vertebral artery into the cranial cavity?

- Branches off R subclavian artery
- Passes through transverse foraminae in cervical vertebrae
- Passes through foramen magnum to enter cavity

90

What does the Right External Carotid artery supply?

Remains external to cranial cavity to supply neck, face & scalp

91

What are the two main branches of the Common Carotid artery?

External Carotid artery

Internal carotid artery (becomes internal to cranial cavity via carotid canal)

92

What is the main artery of the brain formed by the right and left Vertebral Artery?

Basilar artery

93

What does the right anterior cerebral artery supply?

Supplies MEDIAL aspect of right cerebral hemisphere

94

What does the left Middle cerebral artery supply?

Supplies LATERAL aspect of left cerebral hemisphere

95

What is the name of the circulatory anastamosis that supplies blood to the brain and surrounding structures?

Circle of Willis

96

Where is the Circle of Willis?

Inferior to midbrain
Closely related to pituitary stalk + optic chiasm
Within subarachnoid space

97

What gives arteries some protection from compression?

They are ALL bathed in CSF

98

What is the subarachnoid space?

Space between arachnoid mater and pia mater (meninges)
Completely surround brain + spinal cord to provide some cushioning + protection

99

What is contained within the subarachnoid space?

Cerebrospinal fluid (CSF)

100

Where is CSF produced and reabsorbed?

Produced inside choroid plexus of ventricles

Reabsorbed into dural venous sinuses via arachnoid granulations

101

How much CSF is produced every day?

400-500 mls/day

102

Where can the subarachnoid space be accessed for CSF sample?

Accessed via Lumbar puncture at L3/4 or L4/5

103

Where does the subarachnoid space end in the spinal cord?

Level of S2 part of sacrum

104

What is the path of travel within the ventricles of the brain?

Lateral ventricle (R + L)
> 3rd Ventricle
> Cerebral Aqueduct
> 4th Ventricle
> Central canal of spinal cord (or subarachnoid space)

105

Where is the 3rd ventricle located?

In midline within the diencephalon

106

Where is the 4th ventricle located?

Between the cerebellum and pons

107

What is the Cerebral aqueduct?

Connects 3rd and 4th ventricles in the midline

108

What is the circulation of CSF from the choroid plexus to the dural venous sinus?

1. Secreted by choroid plexus
2. R + L lateral ventricle
3. (via foraminae of Monro) to 3rd ventricle
4. (via cerebral aqueduct) to 4th ventricle
5. Mainly into subarachnoid space (some into central canal)
6. Reabsorbed from subarachnoid space via arachnoid granulations
7. Dural venous sinuses

109

What is Hydrocephalus?

Excessive production, obstruction to flow or inadequate reabsorption leads to increased CSF volume

110

How is hydrocephalus treated?

Ventricular peritoneal shunt (shunt catheter beneath skin from the lateral ventricle to the peritoneal cavity which reabsorbs CSF)

111

What is an Extradural haemorrhage and what is a common cause?

Between bone & dura

Ruptured middle meningeal artery (pterion fracture)

112

What is a Subdural haemorrhage and what is a common cause?

Separates dura from arachnoid

Torn cerebral veins
Common in falls in elderly

113

What is a Subarachoid haemorrhage and what is a common cause?

Bleeding into the CSF of subarachnoid space

Ruptured Circle of Willis (berry) aneurysm
Congenital aneurysm

114

What might a ipsilateral fixed dilated pupil (blown pupil) indicated?

Compression of oculomotor nerve by uncal herniation

115

What are the 4 different types of Supratentorial herniation?

Cingulate (subfalacine)
Central
Uncal (or transtentorial)
Transcalvarial

116

What is a clear sign of a uncal herniation?

Blown pupil
(compression of oculomotor nerve from temporal lobe going down past tentorium cerebelli)

117

What is seen with tonsillar herniation?

Cerebellar tonsils herniate INTO foramen magnum

118

How long do shunts to treat hydrocephalus last?

10 years