Session 2 Flashcards

Question

Q. Physiological curvatures • Exaggeration of ? during pregnancy

Answer 1

A. lumbar lordosis

Answer 2

A. 1. (L2/3), L3/4 or L4/5 (after the conus medullaris so only mobile spinal nerve roots not cord; least chance of neurological damage) 2. (Skin), subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural fat and veins, dura mater, arachnoid mater, (subarachnoid space)

Answer 3

1. Yes, rest, exercise/ innocuous activity, overweight, unhealthy lifestyle, deconditioned core muscles 2. Intermittent 3. Mental health: Benefits, Accident, Fear/Beliefs, Job, Relationship Disc degeneration and ‘marginal osteophytosis’ • Nucleus pulposus can dehydrate with age • Height of IV disc decreases • Load stresses on the IV disc alter → reactive ‘marginal osteophytosis’ adjacent to affected endplates (spondylosis deformans, senile ankylosis) • As disc space decreases in height, increased stress is also placed on the facet joints → osteoarthritis (innervated by meningeal branch of spinal nerve → pain) • Decreased size of intervertebral foramen and compression of spinal (segmental) nerves

Answer 4

Q. Describe the pathophysiology and clinical features of prolapsed intervertebral discs LO A. • **Disc Degeneration:** chemical changes associated with aging cause discs to dehydrate & BULGE • **Prolapse**: protrusion of the nucleus pulposus with slight impingement into the spinal canal (contained) • **Extrusion**: nucleus pulposus breaks through annulus fibrosus, but remains within the disc space. • **Sequestration**: nucleus pulposus breaks through annulus fibrosus and separates from the main body of the disc in the spinal canal. DICK PICS EVERY SATURDAY

Answer 5

1. L4/5 or L5/S1, posterolaterally 2. • Paracentral – 96% * Far Lateral – 2% * Canal Filling – CES – 2%

Answer 6

A. Paracentral -\> L4 Far lateral disc -\> L3

Answer 7

A. Chronic back pain ???

Answer 8

1. Sciatica is compression of the nerve roots which contribute to the sciatic nerve 2. Spinal disc herniation pressing on the lumbar or sacral nerves. Other causes spondylolisthesis (vertebra slips forward over another one), spinal stenosis (narrowing of the spinal canal in the lower back), piriformis syndrome, pelvic tumours, and compression by a baby's head during pregnancy.

Answer 9

1. • L4 • L5 • S1 • S2 • S3 2. C4 T4 above and below the nipples

Answer 10

1. A. Dermatomes 2. Anterior thigh, Anterior knee **medial shin** Lateral Thigh, **lateral calf,** dorsum of foot Posterior Thigh, Posterior Calf, **Heel, Sole of Foot**

Answer 11

1. Lower back pain, Buttock pain, Leg pain, Numbness, Tingling, Calf muscle weakness, Foot and toe muscle weakness 2. 30 to 50, 3 months

Answer 12

1. Canal filling disc compressing the Lumbar and Sacral Nerve roots 2. • A. A herniation (bulging) of a spinal disk in the lumbar area that presses on the nerves - the most common cause • Narrowing of the spinal canal (stenosis) • A spinal lesion or tumour • A spinal infection, inflammation, haemorrhage or fracture • A complication from a severe lumbar spine injury such as a car crash, fall or other traumatic injury such as a stabbing • A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation)

Answer 13

1. 30 - 50 yr olds 2. No 2% of all prolapsed invertebral discs 3. • Bilateral Sciatica * Perianal Numbness * Painless Retention of Urine * Urinary/ Faecal Incontinence 4. • Intermittent Self Catherisation • DRE • Sexual Dysfunction

Answer 14

A. spinal canal narrows and compresses the spinal cord and nerves at the level of the lumbar vertebrae

Answer 15

1. Narrowing of the vertebral foramen in the lumbar region 2. Aging. It can also sometimes be caused by spinal disc herniation, osteoporosis, a tumor, or trauma. In the cervical (neck) and lumbar (low back) region it can be a congenital condition to varying degrees. 3. The elderly 4. Claudication (pain and/or cramping in the lower leg due to inadequate blood flow to the muscles. The pain usually causes the person to limp) (Pain in legs when walks • Neurogenic • Vascular)

Answer 16

1. Venous engorgement 2. A. 70, 15, 15

Answer 17

A. Spondylolisthesis (A slip forwards of the vertebra above on the vertebra below)

Answer 18

A. Types of Spondylolisthesis • Dysplastic – abnormality in the shape of the facet joints • Isthmic – Defect in the pars interarticularis -\> a fracture of the isthmus causes one vertebral body to slip forward on top of the vertebral body below it • Degenerative – age – arthritis weakens ligaments and joints • Iatrogenic – laminectomy procedures that result in pars fractures • Pathological – bone or connective tissue disorders or infection, neoplasm,

Answer 19

1. Back Pain and L5 Sciatica as arch not intact no central canal stenosis, 2. Common symptom of lumbar spinal stenosis 3. discomfort, pain, numbness and weakness in the calves, buttocks, and/or thigh

Answer 20

1. Vertebral body has cartilaginous joints, joints are covered with hyaline cartilage and between them fibrocartilage discs. Joint strengthened by anterior and posterior longitudinal ligaments. Facet (synovial joint) strengthened by interspinous, ligamentum flavum and supraspinous 2. • Large size, cylindrical vertebral body, triangular foramen * Lack facets for articulation with ribs * Thin, long transverse processes * except for L5 which are massive for the attachment of iliolumbar ligaments to connect the transverse processes to the pelvic bones

Answer 21

1. tectorial membrane

Answer 22

A. vertebra C7 to the sacrum

Answer 23

A. - extradural space - S2, filum terminale - posterior surface of the coccyx

Answer 24

A. **Kyphosis**: Excessive thoracic curvature, causing a hunchback deformity. * *Lordosis**: Excessive lumbar curvature, causing a swayback deformity. * *Scoliosis**: A lateral curvature of the spine, usually of unknown cause. * *Cervical Spondylosis**: A decrease in the size of the intervertebral foramina, usually due to degeneration of the joints of the spine. The smaller size of the intervertebral foramina puts pressure on the exiting nerves, causing pain.

Answer 25

A. A birth defect where there is incomplete closing of the backbone and membranes around the spinal cord

Answer 26

A. There are two types: spina bifida occulta and spina bifida cystica. Spina bifida cystica : meningocele and myelomeningocele.

Answer 27

A. **Outer vertebrae is not completely closed**, spinal cord does not protrude, skin at the lesion may be normal, hairy/ dimple in the skin, or a birthmark

Answer 28

A. Meninges to herniate between the vertebrae. nervous system remains undamaged. Causes of meningocele include teratoma and other tumors of the sacrococcyx and of the presacral space, and Currarino syndrome.

Answer 29

A. unfused portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord also protrude through the opening, forming a sac enclosing the spinal elements, such as meninges, cerebrospinal fluid, and parts of the spinal cord and nerve roots.

Answer 30

A. Spondylolisthesis: slipped vertebral bone Spondylolysis: stress fracture in The pars interarticularis of the vertebral arch.

Answer 31

1. Common symptom of lumbar spinal stenosis which results from compression of the spinal nerves 2. The pathophysiology is thought to be ischemia of the lumbosacral nerve roots secondary to compression from surrounding structures, hypertrophied facets, ligamentum flavum, bone spurs, scar tissue, and bulging or herniated discs.

Answer 32

1. Stability – ligaments (flavum, supraspinatous, interspinatous, posterior longitudinal ligament in flexion) (anterior longitudinal ligament in extension) Joints – facet and cartilaginous intervertebral joints Attachments of the ribs by Demi facets? intervertebral discs permit flexibility of the spine 4) vertebral body - weight bearing and size increases as you go down the spine - promotes stability 2. Cervical: Thoracic: Lumbar:

Answer 33

A. Dehydration of the intervertebral discs leads to loss of height and Age-related postural hyperkyphosis is an exaggerated anterior curvature of the thoracic spine, sometimes referred to as Dowager’s hump or gibbous deformity. This condition impairs mobility,2,31 and increases the risk of falls33 and fractures.26 The natural history of hyperkyphosis is not firmly established. Hyperkyphosis may develop from either muscle weakness and degenerative disc disease, leading to vertebral fractures and worsening hyperkyphosis, or from initial vertebral fractures that precipitate its development.

Answer 34

A. • Smallest of the discrete vertebrae • Bifid Spinous Process (except C7) • Transverse foramen in transverse process (Foramen transversarium): – Conduit for vertebral artery and vein (except C7) – C7 foramen transmits the accessory? vertebral vein • Large triangular vertebral (neural) foramen • Body is small and broad from side to side • Superior articular facet faces upward and backward while inferior articular facet faces downward and forward.

Answer 35

A. - Occiput of skull superiorly – atlanto- occipital joint – 50% of Total flexion and extension e.g. “nodding” - Axis (C2) inferiorly – atlanto-axial joint → 50% Total rotation e.g. shaking the head • No vertebral body (Body is fused with axis to form dens or odontoid process) • No spinous process • Widest cervical vertebra • Vertebral arches are thick and strong to form a powerful lateral mass

Answer 36

1. – The Odontoid Process or Dens – Rugged lateral mass – Large spinous process 2. The transverse ligament which is located on atlas. The transverse ligament along with dens prevents horizontal movement of axis

Answer 37

A. • Longest spinous process • Spinous process is not bifid • The transverse process is large, but the foramen transversarium is small and only transmits the accessory vertebral veins.

Answer 38

Q. • Thickening of the Supraspinous Ligament • Attached to: – External occipital protruberance – Spinous processes of all cervical vertebrae – Spinous process of C7 • Function: - Maintains secondary curvature of cervical spine - Helps the cervical spine support the head - Major site of attachment of neck and trunk muscles (e.g. Trapezius, Rhomboids)

Answer 39

A. • **Demi-facets** (T2-T8); whole facets T1, T9-10 (we T11, T12?) • **Costal facets** on transverse processes for articulation with tubercle of rib (except T11 & T12) • Vertebral foramen is small & circular **Articular processes face posterolaterally (superior) and anteromedially (inferior) – permits rotation, limits flexion**

Answer 40

A. _Anterior Cord_ – Sensory and Motor Light Touch, Pinprick and Pain _Posterior Cord_ (Dorsal Columns)– Vibration and Proprioception More _central_ tracts move the arms and more _lateral_ tracts move the legs

Answer 41

A. Last functioning level Remember level of the nipples is the junction between C4 and T4

Answer 42

A. more horizontally, above, C7/T1

Answer 43

A. Inferior surface of mandible in line with C1 Know which is C7 as it does not connect with the head of the ribs

Answer 44

Cervical spondylosis

Answer 45

A. (Age related neck pain due to) Degenerative osteoarthritis of intervertebral joints in cervical spine Disc loses water, losses pressure then losses height, pressure change across the disc then get these osteophytes can happen at the front and back (circumferentially) of the neck sindesmophytes), as there is a reduction in height the facet joints then become arthritic Develop on the side nerve root problems Posteriorly cord root problems • Pressure on nerve roots leads to radiculopathy: – Dermatomal sensory symptoms: paraesthesia, pain – Myotomal motor weakness • Pressure on the cord leads to myelopathy (less common): – Global weakness – Gait dysfunction – Loss of balance – Loss of bladder and bowel control

Answer 46

A. Hangman’s fracture – Hyperextension of head on neck – Axis fractures through the pars interarticularis – Unstable fracture – Forward displacement of C1 & body of C2 on C3

Answer 47

A. Peg fracture (PEGS get hit on the back by the wind) Transverse fracture through the dens – Blow to back of head e.g. falling against a wall when balance is compromised – ‘Open mouth’ AP X-ray = ‘peg view’ or MRI cervical spine

Answer 48

A. Fractures of the atlas: Jefferson’s fracture : burst fracture • Describe: Fracture of anterior & posterior arches of atlas • Mechanism: Axial load e.g. diving into shallow water, impact against the roof of a vehicle, falls from playground equipment • Typically causes pain but no neurological signs • May damage arteries at base of skull with secondary neurological sequelae e.g. ataxia (disorders that affect co-ordination, balance and speech), Horner’s syndrome

Answer 49

A. A low energy RTA that results in neck pain/dizziness/headache but no identifiable structural injury High mobility low stability

Answer 50

A. C6 Pain: Biceps into thumb and index finger Motor weakness: Biceps and wrist extension Sensory: Numbness/ P&Ns Thumb and Index finger

Answer 51

A. Compression of the spinal cord

Answer 52

A. Compression of the spinal cord

Answer 53

A. Osteoarthritis of the cervical spine Osteophytes Thickening Ligamentum Flavum Signal Change in the Spinal Cord

Answer 54

A. Osteoarthritis of the cervical spine Osteophytes Thickening Ligamentum Flavum Signal Change in the Spinal Cord

Answer 55

A. Pain: Neck Pain Motor weakness: Shoulder Abduction Sensory: Numbness/ P&Ns from shoulder down and feet

Answer 56

A. Pain: Neck Pain (arthritis) Motor weakness: Elbow Flexion, Wrist Movements and finger movements Sensory: Numbness/ P&Ns from elbows down and feet

Answer 57

A. Fracture of the vertebra giving bony fragments in the canal or tumour developing in the canal compressing the spinal cord

Answer 58

A. Pain: Thoracic Pain Motor weakness: Weakness of all muscles in the legs Sensory: Numbness/ P&Ns from umbilicus down Loss of Sphincter Control

Answer 59

A. Pain: Neck Pain Motor weakness: Shoulder Abduction Sensory: Numbness/ P&Ns from shoulder down and feet

Answer 60

A. Pain: Neck Pain (arthritis) Motor weakness: Elbow Flexion, Wrist Movements and finger movements Sensory: Numbness/ P&Ns from elbows down and feet

Answer 61

A. Fracture of the vertebra giving bony fragments in the canal or tumour developing in the canal compressing the spinal cord

Answer 62

A. Pain: Thoracic Pain Motor weakness: Weakness of all muscles in the legs Sensory: Numbness/ P&Ns from umbilicus down Loss of Sphincter Control

Answer 63

A. Pain: High Thoracic Pain Motor weakness: Weakness of all muscles in the legs and INTERCOSTALS Sensory: Numbness/ P&Ns just below the nipples Loss of Sphincter Control

Answer 64

A. Vertebral foramen Less likely to impinge on the spinal cord

Answer 65

A. Hangman’s fracture

Answer 66

A. Vertebral artery and vein accept C7 were only the accessory vertebral vein passes through

Answer 67

1. C1/C2; C1 has no vertebral body 2. To accommodate the thicker cervical spinal cord 3. smaller

Answer 68

1. Atlanto-occipital joint, atlanto-axial joint, axis, transverse ligament 2. articular surfaces of the cervical vertebrae are more horizontally orientated than in other vertebrae, thus force to dislocate is less fracture 3. The vertebral foramen is large

Answer 69

A. C2, C6 and C7 Quadriplegia (paralysis of all four limbs) and cessation of respiratory movements

Answer 70

A. Hyperextension injuries of the neck (e.g. associated with a rear-end vehicle collision) more commonly affect the upper cervical spine. Such injuries can result in vertebral fracture and disc prolapse, cervical spinous process or odontoid process fracture . Tearing of the anterior longitudinal ligament or kinking of the posterior longitudinal ligament (in the degenerative spine) can also occur. Car seat head rests act to minimise the range of hyperextension that can occur

Answer 71

A. Hyperflexion injuries of the cervical region e.g. during a head-on collision tend to involve the lower part of the cervical spine. Such injuries can lead to a number of complications such as crush fractures of the vertebral body or rupture of the supraspinous ligament making the bony spine unstable. Rupture of the lower cervical intervertebral discs (e.g. C5/C6 and C6/C7) can also occur, which may cause compression of spinal nerve roots C6 and C7.

Answer 72

1. full in-line spinal immobilised 2. Canadian C spine rules 3. Radiological examination e.g. plain radiography (3 views) and/or a CT

Answer 73

A.1. The facet/zygapophyseal joint can be affected by osteoarthritis affecting the nearby intervertebral foramina 2. Degeneration of the intervertebral discs = pain along the distribution of the dermatome relating to the spinal nerve +/- muscle weakness in the muscles derived from the associ ated myotome.

Answer 74

A. internal and external tables of compact bone, separated by diploë

Answer 75

A. Tri-laminar arrangement confers protective strength without adding significant weight

Answer 76

Sutures these are fibrous joints (saggital, coronal and lambdoid), serrated preventing slippage and movement

Answer 77

A. puberty

Answer 78

A. A small cluster of mesenchymal stem cells (MSCs) form a tight cluster of cells (a nidus). The MSCs become osteoprogenitor cells (each developing more Golgi apparatus and rough endoplasmic reticulum). The osteoprogenitor cells become osteoblasts and lay down an extracellular matrix containing Type I collagen (osteoid). The osteoid mineralises to form rudimentary bone tissue spicules, which are surrounded by osteoblasts, and contain osteocytes. The spicules join to form trabeculae, which merge to form woven bone, which is finally replaced by the lamellae of mature compact bone.

Answer 79

A. Fetal skulls have fontanelles

Answer 80

A. Large areas of unossified membranous gaps between flat bones of calvaria

Answer 81

1. Allow for alteration of the skull size and shape during childbirth • Permit growth of infant brain A. • Anterior ~18 months- 2 years • Posterior ~1-3 months • craniosyntosis (rare condition) baby develops or is born with an abnormally shaped skull. It happens when one or more of the infant's cranial sutures fuses too early

Answer 82

A. Clinically Useful when Examining Newborns and Infants • Slightly convex shape in a healthy baby • Inspection and gentle palpation of anterior fontanelle can be used to assess intracranial pressure and state of hydration

Answer 83

A. - calvaria are smooth and unilaminar; no diploë is present. - The frontal and parietal eminences are especially prominent - The cranium of a newborn infant is disproportionately large compared to other parts of the skeleton; - Infant: the facial skeleton forms 1/8 of the cranium / adult: the facial skeleton forms 1/3of the cranium - frontal suture - intermaxillary suture and mandibular symphysis - no mastoid and styloid processes

Answer 84

A.- Yes – Thickness of cranial bones varies, resistance to fracture therefore varies - Main concern is risk of intracranial injury (i.e. injury to brain, blood vessels, cranial nerves) • CT scanning should be performed in all patients with known or suspected skull fractures to identify any intracranial injuries

Answer 85

A. – Linear: pass full thickness of skull, fairly straight, involve no bone displacement – Depressed: fragment is displaced inwards towards the brain (hard blow, thin area

Answer 86

A. basilar skull fractures

Answer 87

A. Stain on CSF on the pillow (breakage in the meninges) , Battle's sign -- bruising of the mastoid process of the temporal bone, Raccoon eyes -- bruising around the eyes, i.e. "black eyes"

Answer 88

A. - Thinnest area of skull: relatively easy to fracture - Blows to the side of the head - Middle meningeal artery (anterior branch) - Intracranial haemorrhage (extradural)

Answer 89

A. Fractures: - nasal - zygomatic bone & arch - mandible Injury: supra ciliary

Answer 90

A. – Dura: tough fibrous membrane (Potential space) – Arachnoid: soft translucent membrane (Potential space) – Pia: microscopically thin, delicate closely adherent to surface of brain (cannot peal pia)

Answer 91

A. Subarachnoid

Answer 92

1. This fluid-filled space helps maintain the balance of extracellular fluid in the brain. CSF is a clear liquid similar to blood in constitution; it provides nutrients but has less protein and a different ion concentration. 2. choroid plexuses of the four ventricles of the brain.

Answer 93

1. – Periosteal = endosteum lining inner bones of skull – Meningeal = layer adjacent to arachnoid 2. – Dural folds – Dural venous sinuses (spaces which become venous channels)

Answer 94

1. external periosteal layer, periosteum, internal meningeal, spinal dura, 2. outer layer is not continuous with the dura mater of the spinal cord, which consists of only a meningeal layer

Answer 95

A. • Falx cerebri (cerebral falx) • Tentorium cerebelli (cerebellar tentorium) • Falx cerebelli (cerebellar falx) • Diaphragma sellae (sellar diaphragm)

Answer 96

1. Stabilise the Brain and act as Rigid Dividers 2. the right and the left cerebral hemispheres 3. frontal crest of the frontal bone and crista galli of the ethmoid bone anteriorly Internal occipital protuberance posteriorly Ends by becoming continuous with the tentorium cerebelli

Answer 97

A. occipital lobes & cerebellum The tentorium cerebelli attaches rostrally to the clinoid processes of the sphenoid, rostrolaterally to the petrous part of the temporal bone, and posterolaterally to the internal surface of the occipital bone and part of the parietal bone.

Answer 98

A. - supratentorial and infratentorial compartments. The supratentorial compartment is divided into right and left halves by the falx cerebri, tentorial notch, through which the brainstem (midbrain, pons, and medulla oblongata) extends from the posterior into the middle cranial fossa.

Answer 99

1. endothelium-lined spaces between the periosteal and the meningeal layers of the dura. They form where the dural septa attach along the free edge of the falx cerebri and in relation to formations of the cranial floor 2. Large veins from the surface of the brain empty into these sinuses and most of the blood from the brain ultimately drains through them into the IJVs.

Answer 100

A.- The superior sagittal sinus - It begins at the crista galli and ends near the internal occipital protuberance at the confluence of sinuses, a meeting place of the superior sagittal, straight, occipital, and transverse sinuses. - The superior sagittal sinus receives the superior cerebral veins and communicates on each side through slit-like openings with the lateral venous lacunae, lateral expansions of the superior sagittal sinus.

Answer 101

A. Arachnoid granulations are tufted prolongations of the arachnoid that protrude through the meningeal layer of the dura mater into the dural venous sinuses. Transport of CSF from the subarachnoid space to the venous system.

Answer 102

A. The inferior sagittal sinus is much smaller than the superior sagittal sinus. It runs in the inferior concave free border of the falx cerebri and ends in the straight sinus. The straight sinus is formed by the union of the inferior sagittal sinus with the great cerebral vein. It runs inferoposteriorly along the line of attachment of the falx cerebri to the tentorium cerebelli, where it joins the confluence of sinuses.

Answer 103

A. transverse sinuses, left sinus

Answer 104

A. -Emissary veins -Valveless and blood may flow in both directions, but is usually away from the brain

Answer 105

A. It passes through the foramen cecum of the cranium, connecting the superior sagittal sinus with veins of the frontal sinus and nasal cavities. A parietal emissary vein, which may be paired bilaterally, passes through the parietal foramen in the calvaria, connecting the superior sagittal sinus with the veins external to it, particularly those in the scalp

Answer 106

A. Connects each sigmoid sinus with the occipital/posterior auricular vein. A posterior condylar emissary vein may also be present, passing through the condylar canal, connecting the sigmoid sinus with the suboccipital venous plexus.

Answer 107

A. - Middle meningeal artery - Maxillary artery - middle cranial fossa through the foramen spinosum - runs laterally in the fossa, and turns superoanteriorly on the greater wing of the sphenoid, where it divides into anterior and posterior branches. The anterior branch of the middle meningeal artery runs superiorly to the pterion and then curves posteriorly to ascend toward the vertex of the cranium. The posterior branch of the middle meningeal artery runs posterosuperiorly and ramifies (breaks up into distributing branches) over the posterior aspect of the cranium. Small areas of dura are supplied by other arteries: meningeal branches of the ophthalmic arteries, branches of the occipital arteries, & small branches of the vertebral arteries.

Answer 108

A. foramen spinosum or foramen ovale

Answer 109

A. Arachnoid trabeculae passing between the arachnoid and the pia The trabeculae are composed of flattened, irregularly shaped fibroblasts that bridge the sub- arachnoid space. The arachnoid and pia are in continuity immediately proximal to the exit of each cranial nerve from the dura mater. The arachnoid mater contains fibroblasts, collagen fibers, and some elastic fibers. Although thin, the arachnoid is thick enough to be manipulated with forceps. The avascular arachnoid, although closely applied to the meningeal layer of the dura, is not attached to the dura; it is held against the inner surface of the dura by the pressure of the CSF.

Answer 110

A. - even thinner membrane - **vascularized** - **shiny** appearance - follows contours of brain

Answer 111

A. • The dura–cranial interface (extradural or epidural “space”) is not a natural space between the cranium and the external periosteal layer of the dura because the dura is attached to the bones. It becomes a space only pathologically—for example, when blood from torn meningeal vessels pushes the periosteum away from the cranium. The potential or pathological cranial epidural space is not continuous with the spinal epidural space (a natural space occupied by epidural fat and a venous plexus) because the former is external to the periosteumlining the cranium and the latter is internal to the periosteum covering the vertebrae. • The dura–arachnoid junction or interface (“subdural space”) is likewise not a natural space between the dura and the arachnoid. A space may develop in the dural border cell layer as the result of trauma, such as after a blow to the head. • The subarachnoid space, between the arachnoid and the pia, is a real space that contains CSF, trabecular cells, arteries, and veins.

Answer 112

A. Cephalohaematoma (A) (Sub-periosteal) or Subgaleal (B) (Sub-aponeurotic)

Answer 113

A. Bleed between the periosteum and the bone cannot pass between the suture lines Cannot pass to the intracranium wouldn’t

Answer 114

A. Extradural Haemorrhage Arterial Bleed Bleeding between the bone and outermost layer of dura Periosteal dura Split away layer of periosteal dura Blood cannot travel beyond suture lines as periosteum is continuous with the sutures Arteria; bleed middle meningeal artery

Answer 115

A. Bridge between the arachnoid layer and the dura layer If there is a bleed it is a venous blood In elderly people simple stumble can rattle the brain and shear veins and cause sub Dural heamarrhadge banana shape What will limit the blood the falx cerebri as fold in the midline is stopping its spread can spread down one half

Answer 116

A. -Subarachnoid Haemorrhage -Arterial bleed • Secondary to trauma or spontaneous rupture of blood vessel e.g. aneurysm – Usually a branch of ‘Circle of Willis’ (the arterial circuit responsible for supplying brain structures) • Blood leaks into subarachnoid space, mixing with CSF – Sudden, often fatal • CT imaging of head – 93% picked up if within 24 hours; 100% if within 6 hours – Lumbar puncture-if CT inconclusive: sample CSF to identify presence of blood (haemoglobin degradation products)

Answer 117

A. Bleeding can also occur within the brain tissue itself (e.g. contusions (region of injured tissue or skin in which blood capillaries have been ruptured; a bruise) tearing of white matter) – Intracerebral haemorrhage 2. Liquefactive

Answer 118

A. Addition of ‘volume’ to an already fixed space (the skull) leads to rise in pressure and damage to brain tissue, brainstem and other important structures e.g. cranial nerves

Answer 119

A.compression and displacement of brain against rigid dural folds and/or through foramen magnum = **_Herniation -\> neurological signs squish nervous tissue_** **__**

Answer 120

A. -Separation of meningeal from periosteal layer of dura - brain (in cerebral veins) - internal jugular vein (jugular foramen)

Answer 121

A. -Separation of meningeal from periosteal layer of dura - brain (in cerebral veins) - internal jugular vein (jugular foramen)

Answer 122

A. Tempooromandibular

Answer 123

A. A- frontal sinus B- zygoma C- zygomatic arch D- mandible E-coranoid F- angle of mandible G- Dens H- foramen magnum? I- maxillary sinus J-

Answer 124

1. Skeleton of the head 2. Neurocranium (n for neck higher up) & viscerocranium (v for vagina which is lower down)

Answer 125

1. Bony brain case + cranial meninges 2. Eight bones: 4 singular bones centered on the midline (frontal, ethmoidal, sphenoidal, & occipital) 2 x bilateral pairs (temporal & parietal)

Answer 126

1. calvaria, cranial base 2. primarily flat bones (frontal, parietal, and occipital) formed by intramembranous ossification of head mesenchyme from the neural crest. Primarily irregular bones with substantial flat portions (sphenoidal & temporal) formed by endochondral ossification of cartilage (chondrocranium) or from more than one type of ossification.

Answer 127

A. fibrous interlocking sutures; however, during childhood, some bones (sphenoid and occipital) are united by hyaline cartilage (synchondroses)

Answer 128

A. 3 singular bones centered on or lying in the midline (mandible, ethmoid, and vomer) & 6 bones occurring as bilateral pairs (maxillae; inferior nasal conchae; and zygomatic, palatine, nasal, and lacrimal bones).

Answer 129

A. temporomandibular joints

Answer 130

A. Several bones of the cranium (frontal, temporal, sphenoid, and ethmoid bones) are pneumatized bones, which contain air spaces (air cells or large sinuses), presumably to decrease their weight. The total volume of the air spaces in these bones increases with age.

Answer 131

A. nasal and zygomatic bones,

Answer 132

Metopic suture, frontal bome

Answer 133

A. lacrimal, ethmoid, and sphenoids

Answer 134

A. Buccopharyngeal fascia

Answer 135

A. fossae, canal, foramina, fissures

Answer 136

A. intramembranous, endochondrial

Answer 137

A. supra-orbital foramen or notch, supra-orbital nerve and vessels, superciliary arch

Answer 138

A. alveolar processes, intermaxillary suture, medially, infra- orbital foramen, infra-orbital nerve and vessels,

Answer 139

A. alveolar process, body, ramus, mental foramina, mental nerves and vessels, mental protuberance, (also a MANDIBULAR FORAMEN LO)

Answer 140

A. temporal fossa, the external acoustic meatus opening, and the mastoid process of the temporal bone, Superiorly and posteriorly by the superior and inferior temporal lines, anteriorly by the frontal and zygomatic bones, and inferiorly by the zygomatic arch. The superior border of this arch corresponds to the inferior limit of the cerebral hemisphere of the brain.

Answer 141

A. Temporal process of the zygomatic bone and the zygomatic process of the temporal bone.

Answer 142

A. Frontal, parietal, sphenoid (greater wing), and temporal bones. Less commonly, the frontal and temporal bones articulate; sometimes all four bones meet at a point.

Answer 143

A. mastoid process, styloid process,

Answer 144

A. Coronal, sagittal and lambdoid. Coronal separates the temporal and parietal bones. Sagittal separates the parietal bones. Lambdoid separates the parietal & temporal bones from the occipital bone. Bregma is formed by the coronal and sagittal suture. Lambda is formed by the sagittal and lambdoid suture.

Answer 145

A. inferior portion of the neurocranium (floor of the cranial cavity) and viscerocranium minus the mandible

Answer 146

A. maxillae, maxillae anteriorly and the horizontal plates of the palatine bones posteriorly

Answer 147

A. greater wings, lesser wings, and pterygoid processes

Answer 148

1. lateral and medial pterygoid plates, extend inferiorly on each side of the sphenoid from the junction of the body and greater wings.

Answer 149

A. Spinal cord (becomes continuous with the medulla oblongata of the brain), the meninges (coverings) of the brain and spinal cord, the vertebral arteries, the anterior and posterior spinal arteries, and the spinal accessory nerve (CN XI)

Answer 150

A. By the occipital condyle

Answer 151

A. internal jugular vein (IJV) and several cranial nerves (CN IX–CN XI)

Answer 152

A. Spinal Part - arises from neurones of the upper spinal cord, specifically C1-C5/C6 spinal nerve roots. - enter the cranial cavity via the foramen magnum - traverses the posterior cranial fossa to reach the jugular foramen - It briefly meets the cranial portion of the accessory nerve, before exiting the skull (along with the glossopharyngeal and vagus nerves). - idescends along the internal carotid artery to reach the sternocleidomastoid muscle, which it innervates. It then moves across the posterior triangle of the neck to supply motor fibres to the trapezius.

Answer 153

A. Cranial Part - lateral aspect of the **medulla** oblongata - leaves via **jugular foramen**, where it briefly contacts the spinal part of the accessory nerve. - Immediately after leaving the skull, cranial part combines with the vagus nerve (CN X) at the inferior ganglion of vagus nerve (a ganglion is a collection of nerve cell bodies). The fibres from the cranial part are then distributed through the vagus nerve. For this reason, the cranial part of the accessory nerve is considered as part of the vagus nerve.

Answer 154

A. 1. shallowest 2. The frontal bone anteriorly, the ethmoid bone in the middle, and the body and lesser wings of the sphenoid posteriorly

Answer 155

A. orbital gyri (ridges)

Answer 156

A. foramen cecum of the frontal bone, which gives passage to vessels during feta development but is insignificant postnatally.

Answer 157

A. The crista galli On each side of this ridge is the sieve-like cribriform plate of the ethmoid. Its numerous tiny foramina transmit the olfactory nerves (CN I) from the olfactory areas of the nasal cavities to the olfactory bulbs of the brain, which lie on this plate.

Answer 158

A. sella turcica, posteroinferior

Answer 159

A. 1. The tuberculum sellae (horn of saddle): a variable slight to prominent median elevation forming the posterior boundary of the prechiasmatic sulcus and the anterior boundary of the hypophysial fossa. 2. The hypophysial fossa (pituitary fossa): a median depression (seat of saddle) in the body of the sphenoid that accommodates the pituitary gland (L. hypophysis). 3. The dorsum sellae (back of saddle): a square plate of bone projecting superiorly from the body of the sphenoid. It forms the posterior boundary of the sella turcica, and its prominent superolateral angles make up the posterior clinoid processes.

Answer 160

A. 1. **Superior orbital fissure:** Located between the greater and the lesser wings, it opens anteriorly into the orbit 2. **Foramen rotundum (round foramen):** Located posterior to the medial end of the superior orbital fissure, it runs a horizontal course to an opening on the anterior aspect of the root of the greater wing of the sphenoid into a bony formation between the sphenoid, the maxilla, & the palatine bones, the pterygopalatine fossa. 3. **Foramen ovale (oval foramen):** A large foramen posterolateral to the foramen rotundum, it opens inferiorly into the infratemporal fossa 4. **Foramen spinosum (spinous foramen):** Located posterolateral to the foramen ovale, it also opens into the infratemporal fossa in relationship to the spine of the sphenoid.

Answer 161

A. 1. the largest and deepest 2. cerebellum, pons, and medulla oblongata 3. occipital bone, but the dorsum sellae of the sphenoid marks its anterior boundary centrally and the petrous and mastoid parts of the temporal bones contribute its anterolateral “walls.” 4. clivus, in the centre of the anterior part of the fossa leading to the foramen magnum. Posterior to this large opening, the posterior cranial fossa is partly divided by the internal occipital crest into bilateral large concave impressions, the cerebellar fossae. The internal occipital crest ends in the internal occipital protuberance formed in relationship to the confluence of the sinuses, a merging of dural venous sinuses.

Answer 162

1. Arteriole 2. Pterion trauma and middle meningeal artery 3. periosteal layer of the dura mater and the bone 4. Convex lens 5. Periosteal layer is continuous with the sutures

Answer 163

1. Venous 2. Bridging veins 3. Fall of elderly person veins stretched more due to weak CT more likely to rupture 4. Banana shaped, spreads. Prevented by the falx cerebri. 5. cranial floor ( basilar skull fracture) 6. BATTLE’S SIGN – brusing over the mastoid process RACCOON EYES- - bring around both eyes HAEMOTYMPANUM – blood behind the eardrum CSF RHINORRHEA- CSF leak from nose CSF OTORRHEA – CSF leak from ear ROB the RACCOON 7. BATTLES SIGN - blood from skull fracture seeps into the soft tissue around the eyes, anterior fossa fractures then the periosteal dura ruptures continuous with bone, sinuses bleed into loose connective tissue CSF Rhinorrhea - ruptures arachnoid layer CSF otorrheao – how doe it end up in the ear??

Answer 164

A. Top: Cephalohaematoma (Sub-periosteal) limited by suture lines Bottom: Subgaleal (Sub-aponeurotic)

Answer 165

A. •Request an odontoid or peg view (open mouth view) •This view is taken in the anterior-posterior direction but with the patient opening their mouth •When cervical spine x-rays are requested three views are usually obtained: lateral, anterio-posterior (AP) and odontoid or peg view

Answer 166

A. A SPACE BETWEEN BONES OF THE SKULL WHERE OSSIFICATION IS NOT COMPLETE •The calvaria (of the neurocranium) is formed by the ossification of membranous forms of 7 bones: paired frontal, parietal and temporal bones and a single occipital bones. •Sutures, which are soft but tough membranous connections, lie in the junctions where there is incomplete fusion of the bones. •At certain points in the skull, these membranous areas between the bones are particularly large- these are called fontanelles. •The anterior fontanelle, which is the largest, is found at the junction between parietal and frontal bones, and the posterior fontanelle between the parietal and occipital bones. •There are actually 6 fontanelles in total in the newborn (but you do not need to know all of these)!

Answer 167

A. • Given the skull bones are not joined together firmly at birth the sutures & fontanelles allow the skull to change shape or mould thus assisting fetal delivery through the birth canal. • A degree of movement between the bones of the calvaria is also important after birth to allow growth of the brain and skull during early infant life. • The fontanelles fuse during early infancy and, as we get older (30- 40 years +), the sutures between the calvarial bones begin to ossify, obliterating from the internal surface outwards.

Answer 168

A. • The bones of the calvaria (e.g. frontal, squamous portion of temporal bone, parietal, occipital) grow via intramembranous ossification and eventually close the fontanelles. • The process of intramembranous ossification involves replacement of connective tissue (mesenchymal stem cells) with bone. • Cartilage is not present during this process. • The majority of bones in the rest of the body, including those forming the base of the skull (e.g. sphenoid, ethmoid) grow via endochondral ossification, where bone is replacing an existing cartilaginous model.

Answer 169

A. • A sunken fontanelle can give an indication of hydration status (i.e. dehydration). • A tense/bulging fontanelle can be seen if there is raised intra-cranial pressure; infections such as meningitis can also cause a bulging fontanelle. • The fontanelles can also provide a “window” for imaging the brain using ultrasound (very safe form of imaging but cannot penetrate bone). Ultrasound cannot be used for evaluating the brain in adults as the fontanelles are absent. • Note that fontanelles may appear to bulge slightly when a newborn/infant is crying or when lying flat and this is entirely normal. The ‘bulging’ returns to normal when the newborn/infant is calm and in a head-up position.

Answer 170

A. Fetal skull vs Adult Skull • Disproportionately large calvaria relative to the face in fetal skull; in adult skull facial skeleton forms 1/3 of cranium whereas infant skull it forms 1/8 • Small, underdeveloped maxilla, mandible and paranasal sinuses (air filled spaces within bones of skull; some of which are actually absent at birth) in fetal skull • Absence of erupted teeth in fetal skull • Small nasal cavities in fetal skull • Absence of mastoid and styloid process in fetal skull Think of JUGHEADS DAD FB as an alien baby!!

Session 2 Flashcards

(277 cards)