Spine

Question 1

Name threre contraindications for performing a lumbar punctrure

Answer 1

General
-Raised ICP
-Bleeding diathesis/anticoagulants
-Thrombocytopaenia

Local
-Infection
-Kyphosis/scoliosis

Question 1

Name three indications for performing a lumbar puncture

Answer 1

SAH, Meningitis, MS diagnsois

Question 2

Name three complications of a lumbar puncture

Answer 2

General
-Headache–> stretch of bridging veins
-Coning

Specific
-Bleeding
-Haematoma
-CSF leak
-Infection

Question 3

What is the origin of the sympathetic nervous system?

Answer 3

Thoracolumbar (T1-L2)

Question 4

WHat is the origin of the parasymptathetic nervous system?

Answer 4

Craniosacral
–>(3, 7, 9, 10)
–>S2-S4

Question 5

What is the nerve supply to the heart?

Answer 5

Vagus parasympathetic

Sympathetic T1-T4: affected in spinal cord injury >T6

Question 6

What is the nerve supply to the foregut?

Answer 6

-Vagus parasympathetic
-Greater sphlanchnic sympathetic

Question 7

What is the nerve supply to the midgut

Answer 7

Vagus, lesser sphlanchnic

Question 8

What is the nerve supply to the hindgut?

Answer 8

Parasympathetic –> inferior hypogastric plexus
Sympathetic –> least sphlanchnic

Question 9

WHat do the hypogastric plexus and nerves innervate?

Answer 9

-Colon
-Sigmoid
-Rectum
-Bladder
-Sphincters

Question 10

What nerves contribute to the micturition process?

Answer 10

Voiding–> parasympathetic (contraction detrusor, relaxation of internal sphincter)
Sympathetic–> retention (relaxation detrusor, contraction internal sphincter)

Question 11

Name the ascending tracts in the spinal cord

Answer 11

-Lateral and anterior: spinothalamic
-POsterior: dorsal column

Question 12

Name descending tracts in spinal cord

Answer 12

-Corticospinal tracts (anterolateral)
-Corticobulbar tracts (face)

Question 13

What functions are carried out by the spinothalamic tracts?

Answer 13

-Lateral: pain and temperature
-Anterior: crude touch, pressure

Question 14

What functions are carried out by the corticospinal tracts?

Answer 14

MOtor to limbs

Question 15

What functions are carried out by the corticobulbar tracts?

Answer 15

-Motor to face _ tongue + mastication

Question 16

At what levels do the spinal cord tracts decussate?

Answer 16

-Spinothalamic: at entry point/1-2 levels above
-Dorsal columns: medulla
-Corticospinal: pyramid at junction of medulla and spinal cord

Question 17

Name three features of neurogenic shock

Answer 17

-Bradycardia
-Hypotension
-Flaccid paralysis
-Flushed warm skin

Question 18

What are the salient differences between cauda equina syndrome and conus medullaris syndrome?

Answer 18

Cauda: LMN, conus: UMN

UMN:
-Rigidity
-Spasticity
-Hyperreflexia
-Babinski upgoing

LMN:
-Fasciculation
-Hyperreflexia
-Weakness

Question 19

What is anterior cord syndrome? what would be the functional deficit? What would cause it?

Answer 19

Only dorsal column spared
-Motor paralysis
-Loss of pain and temperature

Causes:
-Disc, neoplasia, vascular lesion (aortic dissection/aneurysm)

Question 20

What is posterior cord syndrome? What would be the functional deficit?

Answer 20

Dorsal column affected
–> no proprioception/fine touch/vibration sense
–> Pain/temperature/crude touch/motor spared

Causes: Trauma, disc, 12 deficiency, MS

Question 21

What is central cord syndrome? what would be the functional defficit?

Answer 21

Cause:
–> trauma to neck most common)
–> tumour
–> syringomyelia (cyst in cord)

-Motor more commonly affected (more midline)
–> upper limbs more commonly affected (more midline)

Question 22

What is brown sequard?

Answer 22

Hemisection of spinal cord
–> trauma
–> tumour
–> MS
–> TB

All ipsilateral deficit exctept: spinothalamic
–> contralateral loss of pain and temp