Quiz 4 Flashcards
(79 cards)
0
Q
Phrenic Nerve: roots, supplies
A
- Roots: C3, C4, C5
- Supplies: diaphragm
1
Q
Cervical Plexus: roots, supplies
A
- Roots: C1-C4, minor contributions from C5
- Supplies: skin and muscles of head, neck, superior shoulders, and chest
2
Q
Cervical Plexus Nerves: Superficial (sensory-4) and Deep (motor-3)
A
Superficial:
- lesser occipital
- great auricular
- transverse cervical
- supraclavicular
Deep:
- ansa cervicalis (superior and inferior root)
- phrenic
- segmental branches
3
Q
Brachial Plexus: roots, position, supplies, prefixed brachial plexus, postfixed brachial plexus
A
- Roots: C5-T1
- Position: above 1st rib, posterior to clavicle, enters axilla
- Supplies: shoulders and upper limb
- Prefixed: with C4
- Postfixed: with T2
4
Q
Parts of Brachial Plexus
A
- roots: anterior rami of spinal nerves
- trunks: superior, middle, inferior = uniting of several spinal nerves
- divisions: anterior, posterior = posterior to clavicles
- cords: lateral, medial, posterior
- branches: named nerve branches from cords
5
Q
Brachial Plexus Nerves (16)
A
axillary median radial ulnar musculocutaneous long thoracic thoracodorsal dorsal scapular nerve to subclavius suprascapular upper subscapular lower supscapular lateral pectoral medial pectoral medial cutaneous nerve to arm medial cutaneous nerve to forearm
6
Q
Lumbar Plexus: roots, supplies, location
A
- Roots: L1-L4
- Supplies: anterolateral abdominal wall, external genitals, part of lower limbs
- Location: between superficial and deep heads of psoas major, anterior to quadratus lumborum
7
Q
Lumbar Plexus Nerves (6)
A
iliohypogastric ilioinguinal genitofemoral lateral cutaneous nerve of thigh femoral obturator
8
Q
Sacral Plexus: roots, location, supplies
A
- Roots: L4-L5 and S1-S4
- Location: anterior to sacrum
- Supplies: buttocks, perineum, lower limbs
9
Q
Sacral Plexus Nerves (10) and Ant/Post
A
superior gluteal- Post inferior gluteal- Post nerve to piriformis- Post nerve to quadratus femoris- Ant inferior gemellus- Ant nerve to obturator internus and superior gemellus- Ant perforating cutaneous nerve- Post? posterior cutaneous nerve of thigh- Post? sciatic nerve- both pudendal nerve- Ant
10
Q
Sciatic Nerve: consist of what nerves, nerve roots
A
- Consists of: tibial (–> medial and lateral plantar) and common fibular nerve (–> superficial and deep fibular)
- Roots: L4-S3 NOT S4
11
Q
Coccygeal Plexus: roots, supplies, nerves
A
- Roots: S4-S5
- Supplies: area of skin in coccygeal
- Nerves: coccygeal nerve, anococcygeal nerve
12
Q
Nerve Roots of Musculocutaneous Nerve
A
C5, C6, C7
13
Q
Nerve Roots of Axillary Nerve
A
C5, C6
14
Q
Nerve Roots of Median Nerve
A
C6-T1
15
Q
Nerve Roots of Radial Nerve
A
C5-T1
16
Q
Nerve Roots to Ulnar Nerve
A
C8, T1
17
Q
Cervical Enlargement and Lumbosacral Enlargement Nerve Roots
A
Cervical: C3-T1
Lumbosacral: L1-S2
18
Q
Where do spine roots exit in lumbar/sacral region vs. cervical region?
A
Lumbar/sacral- nerve roots exit below corresponding vertebral body
Cervical- nerve roots exit above corresponding vertebral body except C8 because there is no C8 vertebral body
19
Q
Spinal Cord Membranes; Epideral Fat; Ligamentum Flavum
A
Membranes: pia (deep), arachnoid, dura (superficial)
Epideral fat: between dura and periosteum that contains venous drainage
Ligamentum Flavum: most prominent in cervical and lumbar regions, connect lamina of adjacent verts
20
Q
Lateral displacement of disc: where do compressions occur and what nerve is affected
A
- Lateral compressions occur in cervical region, but not in lower parts become spinal nerves exit below
- Compression is on spinal nerve root below disc (ex: C3-C4 disc compresses C4)
21
Q
Lumbar/Sacral Region: Far lateral herniation, posterolateral herniation, central disc herniation –> what spinal nerve roots affected
A
- Far lateral herniation: spinal nerve root above
- Posterolateral herniation: spinal nerve root below
- Central herniation: more than one nerve affected or spinal cord compression
22
Q
Neuropathy-definition, types, sx
A
- Definition- nerve disorder/damage
- Types- mononeuropthy (single nerve involved), mononeuropathy multiplex (2+ nerves involved in different locations), polyneuropathy (many nerves involved)
- Sx- numbness, tingling, burning, sharp pain, weakness
23
Q
Diabetic Neuropathy Types- distal symmetric sensorimotor polyneuropathy, autonomic neuropathy, focal and multifocal mononeuropathies, diabetic lumbosacral radiculoplexus neuropathy, radiculopathy
A
- distal symmetric sensorimotor polyneuropathy- most common, stocking glove distribution of distally to proximal
- autonomic neuropathy- orthostatic hypotension, constipation
- focal and multifocal mononeuropathies- entrapment neuropathies
- diabetic lumbosacral radiculplexus neuropathy- pain in high/thigh/buttocks, weakness or large leg muscles
- radiculopathy- pain in area of one or more spinal nerves
24
Mechanical Neuropathies: compression/entrapment, laceration, traction, neurapraxia, Wallerian degeneration
1. compression/entrapment- ulnar, median, perineal, tibial
2. laceration- cut
3. traction
4. neurapraxia- temporary disturbance of nerve conduction
5. Wallerian degeneration- degeneration of axons and myelin distal to side of injury
25
Complex Regional Pain Syndrome- define, sx, types
- chronic pain syndrome affecting one of the limbs usually after an injury or trauma
- malfunction of PNS and CNS
- sx- localized pain, edema, sweating, changes in skin blood supply
- type 1: reflex sympathetic dystrophy (most common) with nonspecific nerve damage after injury
- type 2: causalgia with specific nerve injury
26
Guillain-Barre: what happens/cause, sx
- acute inflammatory dymyelinating polyneuropathy where myelin attacks nerves
- after viral illness
- sx: weakness distal to proximal, areflexia, numbness and tingling in extremities, can get ANS involvement
27
Myasthenia Gravis: cause, sx
- Cause: antibodies against ACh receptors on skeletal muscle
- Sx: weakness worsens with use, symmetric muscle weakness proximal to distal, blurred vision, trouble swallowing or speaking, fatigue
28
Eaton Lambert Myasthenic Syndrome- cause, sx
- Cause: antibodies against presynaptic Ca+ channels which decreases release of ACh
- Sx: weakness lessens with repetition, symmetric muscle weakness proximal to distal, decreased reflexes
29
Myopathies: dermatomyositis & polymyositis
1. Dermatomyositis
- lymphocytic mediated muscle cell damage and small vessel damage
- proximal muscle weakness, characteristic violet colored skin rash at joints
2. Polymyositis
- same cause as dermatomyositis
- proximal muscle weakness
30
Duchenne muscular dystrophy
- X linked recessive defect in dystrophin gene
| - Sx: proximal muscle weakness that progresses to distal
31
Radiculopathy
- nerve root damage that leads to sensory and.or motor dysfunction
- burning or tingling pain within dermatome, can have decreased reflexes and muscle strength within the nerve root path
- Dx: straight leg raise, crossed straight leg raise, valsalva maneuver, neck flexion, spine percussion
32
Most common disc herniation
C6, C7, L5, S1
33
Cauda Equina Syndrome
- damage to multiple nerve roots below L1
| - Sx: low back pain, bladder and rectal dysfunction, saddle anesthesia
34
A Delta vs C fiber Nociceptors
* A Delta - small, lightly myelinated axons with a conduction velocity of 5 to 30m/s
* C fibers - small, unmyelinated axons with a conduction velocity of 0.5 to 2m/s
* free nerve endings
35
Categories of Pain Perception: First pain vs. Second pain
1. First Pain- sharp pain sensation carried by A Delta fibers
2. Second Pain- diffuse longer lasting pain sensation carried by C fibers that can be polymodal (triggered by all modalities of nociceptive stimuli) or heterogenous (preferentially respond to one type of nociceptive stimuli)
36
Specialized Pathways of A Delta Fibers: Type 1 vs. Type 2
1. Type 1- respond to intense mechanical and chemical stimulation, high heat thresholds
2. Type 2- respond to lower heat thresholds, higher mechanical stimuli threshold
37
Heat: threshold, receptor, endovanilloids
* Threshold- 110 degrees F or 43 degrees C
* Receptor- TRPV1 or vanilloid sensitive to heat and capsaicin and when activated opens pore that leads to influx of Na and Ca/K
* Endovanilloids- made by cells that trigger response to injury similar to capsaicin
38
Capsaicin- stimulate what fibers, used for 2 things
- stimulate C fibers
- used to desensitize pain fibers/prevent neuromodulators from being released
- used as an analgesic and anti-inflammatory cream
39
Mechanical nociceptive receptors, Chemical nociceptive receptors, skeleton and cardiac muscle nociceptive receptors
Mechanical- TRPV2 and TRPA1 & ASIC
Chemical- TRPA1
Skeleton/Cardiac- ASIC3
40
Rex Lamina for C fibers, A Delta fibers, and Nonnociceptors
- C fibers: 1 & 2 to spinal cord interneurons
- A Delta fibers: 1 & 5 to brainstem and thalamic targets
- Nonnociceptors: 5
* some neurons in 5 are multimodal and respond to both pain and nonpain = wide dynamic range neurons
41
A Unilateral Spinal Cord Lesion: results in
- ipsilateral loss of touch, pressure, vibration, and proprioception from DC/Medial lemniscal pathway
- contralateral loss of pain and temperature sensation from anterolateral pathway
42
Visceral Pain: pathways
1. transmitted via dorsal horn neurons that also deal with cutaneous pain --> referred pain
2. travels via the DC/Medial leminiscal pathway
- neurons in VPL, nucleus gracilis, & central canal respond to noxious visceral stimuli & responses are reduced with lesion to DC and not to anterolateral
- drugs that block pain transmission into intermediate gray area block response of neurons in nuc gracilis to painful visceral stimuli but not to nonpainful cutaneous stimuli
43
Pain Matrix & 2 Methods of Pain Processing
* Sensory discriminative = location, intensity, quality; VPL to somatosensory cortex
* Affective motivational = fear, anxiety, autonomic activation; thalamic nuclei to cingulate cortex & insular cortex
1. somatosensory cortex --> sensory discriminative
2. insular cortex --> affective motivational
3. amygdala --> affective motivational
4. anterior cingulate cortex --> affective motivational
44
Trigeminothalamic Tract: conveys what, cranial nerves
- conveys: pain and temp from face
| - CN 7, 9, 10 into pons
45
Lamina 1- contains what
* network of sensory input that maintain physiological homeostasis/interoception
* Classes of neurons that are modality selective:
- sharp pain
- burning pain
- warmth/cold
- histamine
- slow mechanical stim/sensual touch
- sensors of metabolites released during muscle contraction
46
Hyperalgesia
- slightly painful stimuli perceived as more painful
| - Mediated at 2 levels: peripheral and central
47
Peripheral Sensitization - inflammatory soup
- interaction of nociceptors with substances released from damaged tissue called inflammatory soup
- substances arise from nociceptors and non-neuronal cells within or that migrate to the injurred site
- Products from nociceptors = substance P, ATP, calcitonin gene-related peptide
- Nonneuronal cells that contribute = mast cells, platelets, basophils, macrophages, etc.
48
3 Purposes of Inflammatory Soup
1. protect injured area
2. promote healing
3. prevent infection
49
NSAIDs
- prostaglandins
- block effects of inflammatory soup
- provide analgesia and help control inflammatory disease
50
Central Sensitization; allodynia
- due to increases in excitability of neurons in dorsal horn after high levels of afferent nociceptive activity have occurred
- increase in excitability from nociceptors in dorsal horn spreads to other low threshold mechanoreceptors --> increased pain sensitivity
- allodynia: inducing pain by a normally nonpainful stimulus
51
Mechanisms that contribute to central sensitization (4)
1. Wind Up: summation of slow synaptic potentials lasts while stimulation occurs
2. Long term potentiation-like enhancement of postsynaptic potentials longer than period of stimulation
3. Reduction in GABAergic or glycinergic inhibition
4. Microglia and astrocytes release cytokine with injury
52
Neuropathic Pain
- chronic intense pain due to damage to afferent fibers in central pathways that are involved with pain
- occurs in shingles, diabetes, AIDS, stroke
- causes burning sensation with episodes of shooting pains
53
Physiologic Basis for Pain Modulation
1. There are descending pain modulation pathways that regulate transmission of pain info to higher centers
2. Local interactions b/w mechanoreceptive afferents and neural circuits within spinal cord can modulate transmission of pain to higher centers
3. Endogenous opioids can modify pain
54
Gate Theory of Pain
-transmission of nociceptive information through the spinal cord can be modified by simultaneous activation of low-threshold mechanoreceptors
55
Endogenous Opioids
- dramatic pain relieving effects
| - enkephalins, endorphins, dynorphins
56
Endocannabinoids
- act as NTs to decrease release of other NTs such as glutamate/GABA
- modulates the excitability of neurons
- suppress nociceptive neurons in dorsal horn of spinal cord without altering activity of non-nociceptive neurons
- if cannabinoid receptors are blocked then analgesic effect of periaqueductal gray matter is blocked
- repeated noxious stimuli increases amount of endocannabinoids in periaqueductal gray matter
57
Lesser Occipital Nerve Root
C2, C3
58
Greater Auricular Nerve Root
C3
59
Transverse Cervical Nerve Root
C3
60
Supraclavicular Nerve Root
C3, C4
61
Ansa Cervicalis Nerve Root
C1, C2, C3?
62
Iliohypogastric Nerve Root & Ant/Post
L1
| Anterior
63
Ilioinguinal Nerve Root & Ant/Post
L1
| Anterior
64
Genitofemoral Nerve Root & Ant/Post
L1
| Anterior
65
Lateral Cutaneous Nerve of Thigh Nerve Root & Ant/Post
L2, L3
| Posterior
66
Femoral Nerve Root & Ant/Post
L2, L3, L4
| Posterior
67
Obturator Nerve Root & Ant/Post
L2, L3, L4
| Anterior
68
Primary Somatosensory Cortex Lesion- lesion location, symptoms
Lesion- contralateral
| Symptoms- discriminative touch/joint position loss, cortical sensory loss, UMN weakness, visual field deficits, aphasia
69
Thalamic Lesion- lesion location, symptoms
Lesion- contralateral
| Symptoms- all sensory modalities but more noticeable in face, hand, foot; hemiparesis or hemianopia
70
Lateral Pons or Lateral Medulla- lesion location, symptoms
Lesion- anterolateral pathways and spinal trigeminal nucleus on same side
Symptoms- contralateral loss of pain and temp in body, ipsilateral loss of pain and temp in face
71
Lumbar Nerve Roots- lesion location, symptoms
Lesion- ipsilateral lumbar nerve root
| Symptoms- sensory loss in nerve root distribution, LMN weakness
72
Medial Medulla- lesion location, symptoms
Lesion- medial lemniscus
| Symptoms- contralateral loss of vibration and joint position
73
Isolated Ulnar Nerve Lesion- lesion location, symptoms
Lesion- ulnar nerve
| Symptoms- hand numbness and motor deficits of hand
74
Transverse Cord Lesion- lesion location, symptoms
Lesion- sensory level bilateral
| Symptoms- sensory and motor pathways, level dependent weakness and reflex loss
75
Brown Sequard Syndrome- lesion location, symptoms
Lesion- hemicord (lateral corticospinal tract, posterior columns, anterolateral system)
Symptoms- ipsilateral loss of vibration and joint position, contralateral loss of pain and temp sensation, ipsilateral UMN weakness
76
Central Cord Syndrome- lesion location, symptoms- small lesion vs. large lesion
Small Lesion- spinothalamic fibers crossing ventral commissure
Large Lesion- spinothalamic fibers, anterior horn, corticospinal tracts, posterior columns
Symptoms- cervical cape like distribution, sacral sparing, vibration and position loss, UMN signs
77
Posterior Cord Syndrome- lesion location, symptoms
Lesion- posterior columns
Symptoms- loss of vibration and position sense below lesion, may encroach lateral corticospinal tracts and cause UMN weakness
78
Anterior Cord Syndrome- lesion location, symptoms
Lesion- anterolateral pathways, anterior horn cells
Symptoms- loss of pain and temp sense below lesion, LMN weakness, incontinence if lesion controlling sphincter tone, UMN signs if large lesion
