Anatomy 3 Flashcards
sensory branches of V1 vs V2 vs V3
supraorbital, supra/infratrochlear, external nasal, lacrimal vs infraorbital, zygomaticotemporal, zygomaticofacial vs auriculotemporal, buccal, inf alveolar, lingual, mental
5 layers of scalp
skin: highly vasc, thin, w/ hair follicles & sebaceous glands
connective tissue: thick subq tissue, highly vasc, sensory innervation
aponeurosis: intermediate tendon of occipitofrontalis
loose areolar tissue: sponge-like layer giving scalp mobility, blood/pus can give infxn here
pericranium: dense connective tissue, periosteum of neurocranium
ophthalmic vs maxillary vs mandibular branches of trigeminal n innervate?
scalp, forehead, up eyelid, sclera, bridge of nose vs low eyelid, cheek, up lip, maxillary teeth vs low lip, chin, ant 2/3 tongue, mandibular teeth
describe LN drainage for face & scalp
Occipital, mastoid, parotid, submandibular/mental LN –> superficial cervical LN –> deep cervical LN (jugulodigastric/omohyoid LN) –> jugular lymphatic trunk –> thoracic duct for L side –> venous angle (where IJV meets braciocephalic v)
motor branch/sve of CN 7 exit thru? and becomes what n? innervating what? cont thru what other structure?
stylomastoid foramen. post auricular n. auricular muscles & occipital belly of occipitofrontalis. parotid gland in parotid plexus
CN 7 enters face as 1 of 5 branches:
temporal, zygomatic, buccal, marginal mandibular, cervical
largest salivary gland = parotid gland. this does what?
deliver saliva to oral cavity via parotid duct
facial expression/mimetic muscles: insertion vs action vs innervation vs embryo origin vs lesion. does U/LMN dmg cause asymm?
skin/subq tissue vs emote vs CN 7 vs 2nd pharyngeal arch vs ipsi paralysis. yes: spares forehead, affects forehead –> Bell’s
muscles of scalp & ears: occipitofrontalis vs auricular muscles
both innervated by post auricular n from CN7. digastric muscle w/ front & occ bellies connected by epineurial aponeurosis; wrinkles forehead & scalp vs ant/post/sup, vestigial, inserts into pinna
muscles of orbital margin, eyebrows, nose: corrugator supercilli vs procerus vs nasalis vs orbicularis oculi (palpebral, orbital)
wrinkle eyebrows in concern vs furrow top nose & medial eyebrows in disdain vs flair nostrils vs gentle closure, tight closure
muscles of mouth/lips: orbicularis oris vs elevators of up lip vs depressors of low lip vs risorious vs modiolus. know pics for ea Lec 32, slides 17-18
sphincter muscle around lips –> purse, ctrl entry/exit of opening vs zygomaticus major/minor, levator labii superioris, levator anguli oris vs depressor labii inferioris, depressor anguli oris, mentalis vs smirk vs convergence of all facial muscles –> dimples
buccinator. where does parotid duct go?
cheek muscle, NOT mastication. pierces thru buccinator to deliver saliva thru oral cavity
platysma
broad thin sheet muscle in subq of anterolat neck –> form neck ridges for stress or grimace. also blends w/ other muscles for facial expression around mouth/chin
chorda tympani n pre vs post ganglionic parasympathetics. joins with?
petrotympanic fissure in mid ear –> skull base –> sup salivatory nucleus –> GVE CN7 vs submandibular ganglion –> lingual branch V3 –> submandibular & sublingual salivary glands –> taste ant 2/3. lingual n –> sensory of ant 2/3 to V3
greater petrosal n pre vs postganglionic parasympathetics
in pterygoid canal to pterygopalatine fossa vs pterygopalatine ganglion –> zygomatic branches V2 & lacrimal branch V1 to lacrimal gland, palatine branches of V2 to mucus glands
what happens if lesion in internal acoustic meatus vs stylomastoid foramen vs chorda tympani n vs greater petrosal n
unilat face paralysis, loss taste ant 2/3, partial dry mouth, dry eye & nose vs unilat face weakness, asym smile, deficit in forehead wrinkling & blinking (Bell’s) vs loss taste ant 2/3, partial dry mouth vs dry eye & nose
TMJ. articular surfaces? fxn?
hinge synovial joint for elev/dep, gliding, sm rotational movements; separated by articular disc, reinforced by lat/sphenomandibular/stylomandibular ligs. mandibular fossa, ant/articular tubercle, head of mandible. mandib head & articular disc moves ant to go below ant tubercle
mastication muscles: insertion vs action vs innervation vs embryo origin vs lesion. does U/LMN dmg cause asymm?
mandible vs move/manipulate mandible for mastication vs CN V3 vs 1st pharyngeal arch vs ipsi paralysis of muscles; open jaw to lesion. not UMN b/c bil input but LMN does
mastication muscles: temporalis vs masseter vs med pterygoid vs lat pterygoid location & fxn. Lec 33, slide 11
in temporal fossa to zygomatic arch to coronoid process; elev/retract vs from zygomatic arch to angle of mandible; elev/protrude vs in infratemporal fossa to angle mandible; elev/protrude vs in infratemporal fossa to condylar process to articular disc; dep/protrude
what happens if lesion to lingual n near foramen ovale vs infratemporal fossa?
ipsi sensory loss ant 2/3 tongue vs ipsi sensory loss ant 2/3 tongue & denervation submandibular/lingual salivary glands
describe inf alveolar n block. complications?
anesthetic to mandibular foramen –> numb ipsi mandibular teeth, low lip, chin. injecting into parotid gland or med pterygoid
pre & postganglionic parasympathetics of CN3 vs CN9 vs C10
Edin-West nucleus –> ciliary ganglion to ciliary branch V1 –> ciliary muscle for accommodation, sphincter pupillae for pupil constrict vs inf salivatory nucleus –> otic ganglion –> auriculotemporal branch V3 –> parotid gland vs dorsal motor nucleus –> postganglionic neurons –> thoracoabd viscera like heart, lungs, GI tract to 2/3 transverse colon for peristalsis
what lobes contact what surface of cranial fossa?
orbital frontal lobe w/ ant cranial fossa; inf temp lobe w/ mid cranial fossa; brainstem & cerebellum w/ post cranial fossa
midbrain communicates w/ prosencephalon thru what? mass effect vs herniation effect
tent notch. any distortion in brain surface d/t mass lesion vs severe mass effect –> push intracranial structures from 1 cmpt to another
subfalcine vs central vs transtentorial vs tonsillar hern
unilat mass effect –> hern cingulate gyrus –> impinge ACA vs central/downward brainstem displacement –> inc traction on CN6 –> lat rectus palsy, esotropia vs med temp lobe/uncus thru tent notch –> triad: blown pupil, hemiplegia, coma vs cerebellar tonsils hern + Chiari –> compressed medulla –> resp/bp prob
uncal hern can compress what? Kernohan’s phenomenon
compress ipsi crux cerebri –> ipsi CN3 + contralat corticospinal. compress contralat midbrain’s crux cerebri against tent notch –> ipsi CN3 & corticospinal
limbic lobe. insula vs operculum vs circular sulcus
fxnal lobe for limbic system –> mem, emot, olf integration. open lat sulcus –> 2 long gyri, 3 short gyri vs lobe overlying insula; frontal, parietal, temporal opercula vs curved sulcus surrounding insula for visceral afferent integration, part of primary gustatory cortex
extreme capsule vs claustrum vs external capsule vs lentiform nucleus vs internal capsule
white matter for speech vs thin nucleus b/w extreme & external capsule vs cholinergic route from deep grey nuclei to cortex vs putamen + GP vs corticofugal/petal fibers go up to cortex
know Lec 21, slides 19-27; orbital gyri; med/lat olf striae
know those structures; H shaped; terminates into temp lobe/limbic structures, contralat olf bulb via ant commissures & temp lobe /limbic structures
temp lobe = involved w/ 4 fxns. par lobe = involved w/ 2 fxns. occ lobe has 2 cortices:
primary auditory cortex, Wernicke’s, higher order processing visual info, complex aspects of learning & mem. processing somatosensory info, spatial orient & direct attn. primary visual cortex, visual assoc cortex
neurons of neocortex have what 6 layers? layer 4/internal granule layer vs layer 5/internal pyramidal layer deal w/? homotypical vs heterotypical gran vs heterotypical agran
molecular, external gran, external pyramid, internal gran, internal pyramid, multiform. primary input vs primary output. all layers equal thick vs 4>5 (more favorable) vs 4<5
association fibers. sup longitudinal fasciculus vs arcuate fasciculus vs uncinate fasciculus vs cingulum
runs from gyrus to gyrus, lobe to lobe in same hemi. connects front, par, occ lobes vs connects front, temp lobes vs connects orbital front, ant temp lobes for limbic fxn vs connects cingulate gyrus, parahippocampal gyrus
commissural connections. CC vs ant commissure vs post commissure
connections b/w hemis or contralat parts. largest; forceps minor b/w front lobe via genu & rostrum, forceps major b/w occ lobes vs b/w amydala, decussating olf med striae vs pupillary light reflex
Motor system: primary vs premotor vs supplementary motor cortex
UMN cell bodies vs organize/plan posture, BG input vs plan
frontal lobe has more fxnal regions: Broca’s area vs FEF vs micturition inhibitory area vs prefrontal cortex vs limbic cortex
in unilat inf prefrontal gyrus, motor speech, BAA 44/45 vs in post mid frontal gyrus, contralat conjugate gaze, CN3/5/6 vs urin incont vs restraint, initiative, order vs cingulate gyrus, orbitofrontal cortex, limbic lobe
par lobe has more fxnal regions: Wern’s area vs primary somatosensory cortex vs parietal assoc cortex; what happens if dmged?
speech & lang comprehension, supramarginal (BA 40), angular (BA 39) gyri, BA 22; temp & par lobes vs assigned receptive fields, specialized sensory; postcentral gyrus (BA 3/1/2) vs spatial analysis esp non dom; if dmged –> hemi-neglect syndrome –> don’t recog contralat of world
temp lobe has more fxnal regions: sup/mid/inf temporal gyri vs transverse temp gyri vs occipitotemp/fusiform gyrus vs parahippocampal gyrus
unilat auditory assoc cortex for auditory processing vs primary auditory cortex (BA 41) vs face, color, number recog vs part of limbic lobe
occ lobe has more fxnal regions: cuneus & lingual gyri vs occipital gyri w/ BA
primary visual cortex, BA 17 visual assoc cortex, BA 18/19
occ lobe has 2 pathways: ventral vs dorsal
to occipitotemp assoc cortex –> answers “what” –> face, color, letter recog vs to parietoocc cortex –> answers “where” –> analyze motion & spatial relationship b/w objects
disconnection syndrome. lesion to dom occ cortex thru ipsi CC leads to?
infarcts to language centers or CC –> transcortical apraxia (L PCA prob?). alexia w/o agraphia
neurons of corticospinal vs corticobulbar tract
muscles of face, ph/larynx, tongue have U/LMN vs UMN of CN 5, 7, 9/10/11, 12
sublenticular vs retrolenticulara limb of internal capsule
connects MGB w/ primary auditory complex via auditory radiation vs connects LGB w/ primary visual cortex via optic radiation
aa supplying internal capsule? what happens if there are lesions?
lenticulostriate aa & ant choroid a. pure motor or sensory stroke
overview of motor system: BG vs cerebellum vs thal
acts on thal for voluntary movement vs acts on thal to compare planned movement w/ actual movement vs transmit signals from BG & cerebellum abt movement
cerebral cortex lat vs med motor systems: lat corticospinal; rubrospinal vs ant corticospinal; vestibulospinal; reticulospinal; tectospinal
voluntary movement; discrete fxns vs bil axial & girdle muscles; H/N positioning & bal; posture; head/eye orient to sound
nucleus ambiguus. lesion?
in ventrolat medulla; column of LMN providing motor innervation to CN 9-11 –> innervates muscles of ph/larynx & palate. sagging palate arch, uvula away from lesion, hoarse/breathy, dysarthria/phagia
CN11 has 2 parts: cranial vs cervical. lesion?
part of nucleus ambiguus vs ventral horn column C1-C5 innervating trap & SCM. shoulder droop
what does CN12 do? lesion?
GSE for animating tongue. tongue protrudes, dev toward lesion, atrophy
somatic vs auto nervous system
motor innervation to voluntary muscles, well-localized somatosensory from skin, muscle, joints vs motor innervation to involuntary muscles, poorly localized somatosensory & subcons reflex from viscera
structure of somatic vs auto efferents
cell body in CNS –> LMN –> target voluntary vs cell body in CNS –> preganglionic neuron –> postganglionic neuron –> target involuntary
craniosacral/parasympathetic vs thoracolumbar/sympathetic division of ANS. sxs for ea? which embyo structure do they come from?
GVE of CN 3/7/9/10, S2-4 (splanchnic n), rest & digest; anabolic. broncho/pupil constrict, vasodil, dec bp/HR, ctx blad/relaxes urin sphincter vs T1-L2/3, f/light; catabolic. broncho/pupil dil, vasoconstrict, inc bp/HR, relaxes blad/ctx urin sphincter. wk5: basal plate from neural tube & neural crest
structure of parasympathetic vs sympathetic efferents
hypothal –> dorsal longitudinal fasciculus –> parasympathetic nucleus –> long preganglionic neuron –> short postganglionic neuron –> target involuntary vs hypothal –> hypothalamospinal pathway –> sympathetic nucleus –> short preganglionic neuron –> long postganglionic neuron –> target involuntary
describe S2-4 parasympathetics
preganglionic intermediate grey matter –> pelvic splanchnic nn in pelvic plexus –> postganglionic neurons –> terminal end GI tract for peristalsis distal 1/3 transverse colon to anus; sm muscle in external genital for erection; sm muscle in blad for urination
T1-L2/3, parietal distribution of sympathetic nervous system
T1-L2/3 intermediolat cell column grey matter –> ventral horn –> ventrl root –> spinal n –> ventral rami –> presynaptic white rami communicans –> sympathetic trunk/chain –> synapse in paravertebral ganglion, ascend, descend –> postsynaptic gray rami communicans –> ventral rami –> motor innervation to glands, blood vessels, arrector pilli
visceral distribution for sympathetic nervous system (heart/lung, abd/pel)
T1/2-T5 intermediolat column grey matter –> sympathetic trunk –> cerv/up thoracic paravertebral ganglia –> cardiopulm splanchnic n for heart & lungs. T6-T10 or T12-L2 –> sympathetic trunk –> abd/pelvic splanchnic n –> prevertebral/pre-aortic ganglia celiac ganglion or inf mesenteric ganglion –> periarterial plexus –> abd/pel
sympathetic pathway for head. lesion in this pathway?
T1-T3 intermediolat column grey matter –> sympathetic trunk –> sup cervical ganglion (C1-C4) –> periarterial plexus on E/ICA –> dilator pupillae, sup tarsal muscle for up eyelid, facial sweat glands. ipsi Horner (miosis, ptosis, anhidrosis)
visceral afferents give what kind of sensory info? how does referred pain occur?
hunger/full, nausea; pain from ischemia, stretch, spasm. visceral aff converge on somatic aff –> lower excitation threshold for somatic aff –> dermatome pain
spinal lvls of sup vs middle vs inf cervical ganglion vs stellate ganglion
C1-4 vs C5-6 vs C7-8 vs C7-T1
what’s prevertebral plexus? what’s sympathetic trunk/chain?
in front of aorta, includes prevertebral/pre-aortic ganglia, adjacent to celiac/sup mesenteric/inf mesenteric/aorticorenal ganglia. from neck to pel, lat border of vert bodies from sympathetic neural crest, connected to ventral rami via grey/white communicans
alpha 1 vs alpha 2 vs beta 1 vs beta 2 receptors
Gq, IP3 –> excite/ctx –> vasc sm muscle, GI/blad sphincters, radial eye muscle vs inhib adenylate cyclase –> dec cAMP –> inhib/dil presynaptic nerve terminals, PLT, fat cells, GI wall vs activate adenylate cyclase –> inc cAMP –> excite SA/AV node, ventricular heart muscle –> inc HR/ctx/conduction vel vs activate adenylate cyclase –> inc cAMP –> relax/dil vasc sm muscle, bronchioles, GI/blad
how does too much vs too little acetylcholine play a role in PNS?
diarrhea, diaphoresis, urination, salivation, lacrimation, miosis, bronchospasm, bradycardia vs urin retention, dry mouth/eyes, mydriasis, anhidrosis, halluc, agitation, tachycardia
visceral aff of internal organs have receptors to detect what?
noci w/ sympathetic fibers; mechanical & chemical stimuli to pC/O2, pH, glu, temp w/ parasympathetic fibers (mostly CN10)
ENS ctrl: myenteric vs submucosal/meissner plexus
b/w external longitudinal & deep circular sm muscle layers; ctrls motility vs b/w circular muscle & most internal layer muscularis mucosae; ctrls ion & fluid transport
role of hypothal in ANS
integrate higher cortical & limbic systems w/ autonomic ctrl –> feed, thermoreg, circadian rhythms, water bal, emotion, sex rive, reprod, motivation
hierarchal reflex loop in ANS
ENS = indep –> autonomic ganglia ctrl ANS + ENS –> spinal cord ctrl autonomic ganglia –> brainstem receiving visceral aff input to ctrl viscera –> forebrain CNS receiving input from brainstem to ctrl ANS
know which eye muscles move eye in 9 directions
Slides 4-5, 12
CN3 comes out of?; lesion? CN4 comes out of?; lesion? CN6 comes out of?; lesion?
midbrain w/ sup colliculus; exotropia, mydriasis, ptosis. midbrain w/ inf colliculus/fasc in dorsal brainstem, LMN decussating to contralat SR; hypertropia, excyclotropia, head tilt away from affected eye –> fail H test. caudal pons near 4th v/pontomedullary jxn; esotropia, diplopia worsens when abducting affected eye
supranuclear ctrlled eye movements: vergence vs conjugate
shifting eyes b/w near/far objects –> con/divergence vs shifting eyes in same direction –> horiz/vertical, saccades via contralat frontal eye fields & smooth pursuit via post temp lobe
horizontal vs vertical gaze center; lesion?. know the lesions to ea area
paramedian pontine reticular formation –> LMN in ipsi CN6 –> decussate in medial longitudinal fasciculus –> contralat CN3 vs rostral interstitial nucleus of MLF & Cajal in midbrain; in dorsal midbrain d/t tumor in pineal gland, hydroceph, progressive supranuclear palsy –> Parinaud syndrome: bil paralysis of upward gaze –> setting sun sign. Lec 28, slides 26-27, 30
VZV & HSV lie dormant in where?
DRG, cranial nerve ganglia
dorsal/post rhizotomy
tx pain at certain spinal lvls by severing dorsal rootlets prevent aff reaching spinal cord; now txs spasticity/UMN sxs & cerebral palsy
spinothalamic tract/anterolat system vs DCML
3-neuron pathway to reach primary sensory cortex. for pain/temp, vague touch vs for vib, 2pt discrim, conscious proprio, fine touch. know how to draw the tracts
cordotomy
open or percutaneous procedure to tx intractable pain by cut lat funiculus from denticulate lig –> destroy spinothal tract –> disrupt pain signals –> contralat analgesia
syringomelia
cavity w/ lower cervical central spinal cord –> impinge on decussating fibers from anterolat system –> cape/belt-like loss pain/temp –> muscle atrophy w/ LMN in ventral horn (hands); assoc w/ Chiari I
tabes dorsalis/progressive locomotor ataxia
caused by Treponema pallidum –> neurosyphilis –> dorsal columns degen –> sensory ataxia, dec reflexes, proprio loss, wide-based stance => Romberg sign
lat medullary/Wallenberg syndrome
disrupt PICA or VA
spinothal tract –> contralat body loss pain/temp
trigem nucleus/tract –> ipsi facial loss pain/temp
descending hypothal –> ipsi Horner
nucleus ambiguus –> dysarthria/phagia, hoarse, palate droop w/ contralat uvula dev
ICP, vestibular nuclei –> ipsi ataxia, nystagmus, vertigo, nausea
dorsal spinocerebellar tract
from dorsal root to denticulate lig, from Clarke’s column (T1-L2) to ICP for unconsc proprio. above T1: unconsc proprio go up to fasc cuneatus –> accessory cuneate nucleus –> ICP. below L2: unconsc proprio go up to fasc gracilis –> Clarke’s nuclei
Friedreich’s ataxia
auto rec GAA expansion –> degen dorsal spinocerebellar tract, loss neurons in Clarke’s column, dentate nucleus & SCP degen
LMN vs UMN sxs. spinal shock/post stroke sxs
dec strength; dec reflex, muscle tone; severe atrophy; fasciculations vs dec strength; inc reflex, tone; mild atrophy; clonus, Babinski. after stroke in cortex, internal capsule, spinal cord –> flaccid paralysis then hemiplegia => UMN injury
med medullary/Dejerine syndrome vs med pontine/Foville syndrome vs med midbrain/Weber syndrome
disrupt ASA (pyramid, med lemniscus, CN12) –> inf alternating hemiplegia vs disrupt paramedian branch of BA (corticospinal, med lemniscus, ipsi CN6) –> mid alternating hemiplegia vs disrupt paramedian branch of PCA P1 (contralat LE paralysis, ipsi CN3) –> sup alternating hemiplegia
complete cord hemisection/lesion vs cord hemisection/lesion. phrenic nucleus?
all sens & motor pathways interrupted; sensory lvl = dec sensation in all dermatomes below lesion; transverse myelitis. dmg both phrenic n outputs vs ipsi motor & DCML, contralat sens; Brown-Seq. cell column in ventral horn C3-C5/6 producing phrenic n to innervate hemidiaphragm; if dmg –> can’t ventilate
subacute combined degen from B12 defic. Lhermitte’s sign?
affects dorsal columns –> cerebral white matter –> dementia, bil loss DCML, bil motor, hyperreflexia, difficulty walking. from dorsal column dmg: simult flexion of neck & hips –> electric shock pain in extremities
poliomyelitis vs amyotrophic lat sclerosis/Lou Gehrig’s dz
d/t virus dmging ventral horn vs d/t dmging ventral horn, CN nuclei, lat corticospinal tracts –> U/LMN sxs, dysarthria/phagia, impaired resp
ant spinal cord syndrome & causes
affects ASA supplying ant 2/3 spinal cord. watershed zone infarcts d/t HTN, violent neck extension, thoracic surgeries
internuclear ophthalmoplegia
lesion to MLF –> can’t do contralat med rectus –> contralat effort nystagmus. early sign of MS
