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Neurology > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is the function of the back

A

Maintaining posture

Movement of the limbs and trunk

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2
Q

What is indicated by the dimples on the lower back

A

Positions of the posterior superior iliac spine

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3
Q

What is the first palpable vertebral process - usually

A

C7

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4
Q

What are the extrinsic back muscles

A 
Those with an attachment out with the back itself 
Trapezius 
Rhomboids
Levator scapulae 
Latissimus dorsi
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5
Q

What innervates the extrinsic back muscles

A

Anterior rami of the spinal nerves

Exception is the trapezius (CNIX)

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6
Q

What are the intrinsic back muscles

A

Those whose attachments are entirely within the back

Erector spinae and transversospinalis

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7
Q

What are the functions of the intrinsic back muscles

A

Maintain posture and move the spine

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8
Q

Which of the intrinsic back muscles is superficial

A

Erector spinae

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9
Q

What are the attachments of the erector spinae muscles

A

Inferiorly attach to the sacrum and iliac crest via a common tendon
Superiorly attach via individual muscle fibres to either a rib, a transverse process or a spinous process

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10
Q

Are the erector spinae muscles horizontal or vertical

A

Vertical

3 sets that lie lateral to the spine itself

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11
Q

What are the attachments of the transversospinalis

A

Found between the transverse and spinous processes

Individual fibres attach to a vertebrae and either; the skull, a rib, another vertebrae or the sacrum

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12
Q

What is the nerve supply of the intrinsic back muscles

A

They have segmental nerve supplies - match the myotome distribution

Posterior rami from the cervical, thoracic and lumbar branches

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13
Q

What are the main causes of back pain

A

Majority is mechanical (e.g. muscle strain)
1% is from the cord itself
2% is visceral - GI, pelvic, renal or AAA

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14
Q

What movements occur if the erector spinae contacts

A

If bilaterally = extension

If unilaterally = lateral flexion

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15
Q

Which type of spinal curve is primary

A

Kyphosis - cervical and sacral still present in adults

Lordosis is secondary - develops as we do

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16
Q

What is the function of the transverse processes

A

ligament, muscle and rib articulations

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17
Q

What is the function of the articular processes

A

Form the facet joints and allow for mobility with adjacent vertebrae

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18
Q

What is found in the intervertebral foramen

A

spinal nerves

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19
Q

Describe the structure of the intervertebral discs

A

outer fibrous ring – annulus fibrosus
for strong bond
inner soft pulp – nucleus pulposus
for flexibility and protection

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20
Q

Which vertebral levels have no discs

A

None between C1 and 2 or the fused sacrum and coccyx

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21
Q

Describe the ligamentum flavum

A

Short ligaments

Connect adjacent laminae posterior to the cord

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22
Q

Describe the posterior longitudinal ligament

A

Narrow and weak ligament
Prevents over flexion of the spine
Less support for disc - more likely to prolapse posteriorly

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23
Q

Describe the anterior longitudinal ligament

A

Broad and strong
gives strong support to the disc
Prevents over flexion of the spine

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24
Q

Describe the supraspinous ligaments

A

Connect the tips of spinous processes

Strong and fibrous

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25
Q

Describe the interspinous ligament

A

Connect superior and inferior surfaces of adjacent spinous processes
weak, membranous

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26
Q

What are the common features of the cervical vertebrae

A

transverse foramen
bifid spinous process
triangular shaped vertebral foramen

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27
Q

Which vertebrae has an odontoid process

A

C2 - Axis

This projects superiorly

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28
Q

What forms the atlanto-occipital joints

A

The occipital condyles and the superior articular facets of the atlas
They are synovial

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29
Q

What movements occur at the atlanto-occipital joints

A

Flexion and extension of the neck

Small amounts of lateral flexion and rotation

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30
Q

What forms the atlanto-axial joints

A

3 synovial articulations
2 between the inferior articular facets of the atlas and superior articular facets of axis
1 between the anterior arch of the atlas and odontoid process of the axis

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31
Q

What is the main movement atlanto-axial joints

A

Rotation

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32
Q

Are cervical vertebrae more likely to dislocate or fracture

A

Dislocate

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33
Q

How do you administer caudal anaesthesia

A

Enter at L3/4
Inject the anaesthetic into the sacral hiatus
This will numb the sacral spinal nerve roots of the cauda equina
More commonly used in children

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34
Q

At what level is an epidural administered

A

L3/4

Below the end of the spinal cord so you do not hit it

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35
Q

Where does the spinal cord begin and end

A

Begins at the foramen magnum (continuation of medulla oblongata)
Ends around L1/L2 vertebral level

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36
Q

What is the cauda equina

A

The nerve roots from L2-to CO form this as they descend to the correct vertebral level to exit the spine
Below the end of the cord itself

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37
Q

What is a laminectomy

A

Removal of one or more spinous processes and the adjacent lamina

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38
Q

When is a laminectomy needed

A

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

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39
Q

What sensory symptoms may occur if the spinal nerves are damaged

A

Pain, pins and needles, numbness, hypersensitivity, loss of coordination and temperature changes

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40
Q

What motor symptoms may occur if the spinal nerves are damaged

A

Muscle stiffness, tightness or spasm
Floppiness or loss of tone
Weakness - reduced power
Loss of coordination or balance

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41
Q

What general somatic sensory functions does a spinal nerve supply its segment with

A

Receptors for touch, temperature, proprioception, vibration and pain
these are located in the body wall

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42
Q

What general somatic motor functions does a spinal nerve supply its segment with

A

Supply the skeletal muscles with motor fibres
Found in the body wall
used for locomotion

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43
Q

What sympathetic motor functions does a spinal nerve supply its segment with

A

Autonomic control of the smooth muscle in associated blood vessels and hair follicles

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44
Q

What are the spinal reflexes

A

circuits of sensory afferents and motor efferent nerve fibres
Have a protective function

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45
Q

List the dermatomes found in the hand

A

C6 = thumb
C7 = middle finger
C8- little finger

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46
Q

List the dermatomes found in the arms and forearms

A 
C5 = regimental badge patch 
C6 = lateral forearm and thumb
T1 = medial forearm to elbow
T2 = medial arm, base of axilla and sternal angle
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47
Q

What are the dermatomal landmarks on the trunk

A 
T4 = nipple 
T10 = umbilicus 
T12 = pubic symphysis
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48
Q

List the dermatomes found in the head and neck

A

C2 - back of scalp and Adam’s apple

C3 - back and side of neck and jugular notch

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49
Q

Where is the C4 dermatome

A

Clavicle and shoulder tip - acromion is the landmark

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50
Q

List the dermatomes found in the lower limb

A 
L1 – Groin 
L2 – Anterior/inside thigh
L3 – Anterior knee
L4 – Inner calf to medial malleolus
L5 – Outer calf and dorsum of foot 
S1 – Heel or pinky toe 
S2 – Posterior knee/thigh
S3 – Buttock
S4 – Perineum
S5 – Perianal skin
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51
Q

Which nerve sections form plexuses

A

The anterior rami

T2-T12 don’t contribute

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52
Q

Which named nerves give cutaneous supply to the trunk

A

Intercostal nerves from T2-11 anterior rami supply upper anterolateral trunk

Subcostal nerve from T12 supplies the lower region

Lower anterolateral trunk wall is supplied by iliohypogastric & ilioinguinal nerves

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53
Q

What is the difference between a spinal nerve and a named nerve

A

Spinal nerves contain axons from only 1 spinal level

Named nerves contain axons from 1 or more levels

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54
Q

Which spinal nerve roots form the femoral nerve

A

L2,3,4

Therefore it supplies these 3 dermatomes

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55
Q

List the named cutaneous nerves of the neck

A 
Lesser occipital (C2) - behind ear 
Greater auricular (C2,3) - angle of mandible and external ear 
Transverse cervical (C2,3) - anterior neck 
Supraclavicular (C3,4) = clavicle and shoulder tip
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56
Q

What is the nerve point of the neck

A

Point at which the sensory nerves from the cervical plexus converge
At the midpoint of the posterior border of the SCM

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57
Q

List the named cutaneous nerves of the upper limb

A 
Supraclavicular 
Axillary 
Musculocutaneous nerve - cutaneous branch 
Radial nerve 
Ulnar nerve 
Median
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58
Q

Which spinal levels form the axillary nerve

A

C5 and C6

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59
Q

Which spinal levels form the radial nerve

A

C5,6,7,8 and T1

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60
Q

Which spinal levels form the ulnar nerve

A

C7,8 and T1

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61
Q

Which spinal levels form the median nerve

A

C5,6,7,8 and T1

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62
Q

Describe the sensory pathway

A

Stimulation in a specific area causes an AP to be generated by receptors in that area
Passes into the associated nerve plexus
Continues to the anterior rami and then the associated spinal nerve
Then AP travels along the posterior root and then rootlets
Finally enters the posterior horn of the spinal cord

63
Q

What muscles are supplied by the motor axons of the cervical plexus

A

Postural neck muscles and the strap muscles

Diaphragm

64
Q

What muscles are supplied by the motor axons of the brachial plexus

A

Muscles of the upper limb

Some of the extrinsic back muscles (those that move limb and scapula)

65
Q

What muscles are supplied by the T2-L3 motor axons

A 
Postural back muscles (via posterior rami)
Intercostal muscles (via anterior rami)
Anterolateral abdominal wall muscles
66
Q

What muscles are supplied by the motor axons of the lumbosacral plexus

A

Muscles of the lower limb

Perineal skeletal muscles

67
Q

How do you test the C5 myotome

A

Shoulder abduction - test the deltoid action

68
Q

How do you test the C6 myotome

A

Elbow flexion

Testing biceps brachii

69
Q

How do you test the C7 myotome

A

Elbow extension

Testing triceps brachii

70
Q

How do you test the C8 myotome

A

Finger flexion

Testing FDS

71
Q

How do you test the T1 myotome

A

Finger abduction

Testing the dorsal interossei

72
Q

How do you test the L3 myotome

A

Knee extension

Testing quadriceps femoris

73
Q

How do you test the L4 myotome

A

Ankle dorsiflexion

Testing tibialis anterior

74
Q

How do you test the L5 myotome

A

Great toe extension
Testing EHL
Have to do this although it contributes to ankle dorsiflexion and plantaflexion as L4 and S1 respectively compensate

75
Q

How do you test the S1 myotome

A

Ankle plantarflexion

Testing the gastrocnemius

76
Q

How do you test the S2 myotome

A

Knee flexion

Testing biceps femoris

77
Q

Describe the motor pathway

A

AP’s generated by intention in the primary somatomotor cortex
AP conducted via the UMN in the corticospinal tract
Continue along axons to anterior horn of relevant spinal level
They synapse with the LMN at that level and stimulate a further AP
Continues along spinal nerve and then either the A or P rami
May pass through a nerve plexus
Reach the NMJ and supply the muscle

78
Q

What is a reflex

A

An involuntary response to a stimulus

79
Q

List the main spinal reflexes and the level they test

A 
Biceps - C5,6 
Triceps - C7 
Brachioradialis - C6
Knee Jerk - L3 
Ankle jerk - S1
80
Q

How can the olfactory nerves be damaged

A

Base of skull fracture
Will lead to anosmia
CSF can start dripping through the nose - clear fluid

81
Q

Can olfactory nerves be repaired

A

YES
some of the only nerves that can
Possible to regain your sense of smell

82
Q

Describe the path of the olfactory nerve

A

Lays within olfactory mucosa in the nasal cavity
Pass through the cribiform plate of the ethmoid bone
Synapses in the olfactory bulb
Passes back in the olfactory tract to the cortical areas

83
Q

Describe the path of the optic nerve

A

Neurons from the retina travel posteriorly in the optic nerve
Passes through the optic canal in the middle cranial fossa
Meet at the optic chiasm to cross and become the optic tracts
Connect with CNS at the diencephalon

84
Q

What passes through the optic canal

A

Optic nerve

Ophthalmic artery

85
Q

How do you test the olfactory nerve

A

Not routinely done
Can ask if they’ve noticed a change
Or ask to smell a familiar smell (coffee, orange etc) while holding one nostril shut

86
Q

How do you test the optic nerve

A 
Acuity (Snellen charts)
Colour (Ishihara plates – colour blindness)
Fields (Four quadrants)
Reflexes (Pupillary light reflexes)
Fundoscopy
87
Q

What are the functions of the oculomotor nerve

A

Eye movement - motor

Pupil construction - parasympathetic

88
Q

Where do the parasympathetic fibres of the oculomotor nerve synapse

A

Ciliary ganglion

They then join the ciliary nerves

89
Q

Describe the path of the oculomotor nerve

A

Leaves from the midbrain
Travels towards the orbit in the lateral wall of the cavernous sinus
Passes through the superior orbital fissure - through the common tendinous ring
Enters the orbit and supplies all muscles except 2

90
Q

How do you test the oculomotor nerve

A

Part of the H test for eye movement

To test parasympathetics check for pupillary constriction

91
Q

Describe the path of the trochlear nerve

A

Leaves from the midbrain
Travels towards the orbit in the lateral wall of the cavernous sinus
Passes through the superior orbital fissure - over common tendinous ring
Enters the orbit and supplies the superior rectus

92
Q

Describe the path of the abducent nerve

A

Leaves brain at the pontomedullary junction
Travels towards the orbit within the cavernous sinus
Pass through the superior orbital fissure
Supplies the lateral rectus

93
Q

What is the function of the trochlear nerve

A

Eye movement - motor

94
Q

What is the function of the abducent nerve

A

Eye movement - motor

95
Q

How do you test the trochlear and abducent nerves

A

Part of the H test for eye movement

96
Q

What is the function of the vestibulocochlear nerve

A

Axons are in the vestibular and cochlear apparatus
Passes through the internal acoustic meatus in the posterior fossa
Travels posteriomedially to the pontomedullary junction

97
Q

How do you test the vestibulocochlear nerve

A

Rinne and Weber tests

98
Q

What passes through the IAM

A

Vestibulocochlear nerve and the labyrinthine artery

99
Q

What is the function of the spinal accessory nerve

A

Motor supply to the SCM and the trapezius

100
Q

Describe the path of the spinal accessory nerve

A

Arises from the cervical spinal cord (C1-4)
Ascends through foramen magnum then travels towards jugular foramen in posterior cranial fossa
Passes through jugular foramen
Axons supply SCM on deep surface, then continue across the posterior triangle to supply trapezius and SCM

101
Q

How do you test the spinal accessory nerve

A

Ask patient to shrug shoulders
Ask them to turn head to flex neck and turn towards the opposite side

Look for symmetry and strength

102
Q

What is the function of the hypoglossal nerve

A

Motor supply to the muscles of the tongue

103
Q

Describe the path of the hypoglossal nerve

A

Leaves CNS at medulla oblongata (many rootlets)
Moves anteriorly then passes through the hypoglossal canal
Descends lateral to carotid sheath.
At the level of the hyoid turns anteriorly towards lateral aspect of tongue.
Supplies most muscles of the tongue.

104
Q

How do you test the hypoglossal nerve

A

Ask patient to stick tongue straight out
If both CNXII’s are functioning normally the tongue tip remains in the midline on protrusion
If there is unilateral CN XII pathology the tongue tip will point towards the side of the injured nerve

105
Q

What are the divisions of the trigeminal nerve

A

CNV1 - ophthalmic - sensory
CNV2 - maxillary - sensory
CNV3 - mandibular - sensory and motor

106
Q

Describe the path of the trigeminal nerve

A

Leaves brain at the pons
Travels inferior to the edge of the tentorium cerebelli between the posterior and middle cranial fossae
CNV1 passes through superior orbital fissue
CNV2 passes through foramen rotundum
CNV3 passes through the foramen ovale

107
Q

What does CNV1 supply

A

Sensory to the upper eyelid, cornea, conjunctiva and root/bridge/tip of nose
Bone and soft tissue of orbit, anterior nasal cavity, paranasal sinuses and the anterior + posterior cranial fossae

108
Q

What does CNV2 supply

A

Sensory to the skin of the lower eyelid, maxilla, ala of nose, upper lip
Lower posterior nasal cavity
Maxilla & maxillary sinus
Floor of the nasal cavity/palate
Maxillary teeth & associated soft tissues

109
Q

What does CNV3 supply with sensory

A

Skin over the mandible and temporomandibular joint
Middle cranial fossa
Mandible
Anterior 2/3rds of the tongue - not taste
Floor of the mouth
Buccal mucosa
Mandibular teeth

110
Q

Which muscles are given their motor supply by CNV3

A

3 closing jaw muscles - masseter, temporalis and medial pterygoid
Jaw opening muscle - lateral pterygoid
Tensor veli palatini and tensor tymapni

111
Q

How do you test the trigeminal nerve

A

Get patient to close eyes and gently brush skin with cotton wool - each area
Compare sides

Palpate the strength of jaw contraction and get them to open jaw against resistance

112
Q

Which nerves are responsible for the corneal reflex

A

afferent is trigeminal, efferent is the facial nerve

113
Q

Describe the path of the facial nerve

A

Leaves brain at pontomedullary junction
Passes into the internal acoustic meatus and then out of the stylomastoid foramen (through the middle ear)
Most somatic motor axons pass into the parotid gland then into 6 branches that supply the muscles of facial expression

114
Q

At which point does the facial nerve give off the chorda tympani

A

When it passes through the middle ear

The chorda tympani will then travel through the posterior wall of the tympanic cavity

115
Q

What is the function of the chorda tympani

A

It conveys parasympathetic fibres to the sublingual and submandibular glands and taste to the anterior 2/3 of tongue

116
Q

Describe the difference in symptoms of facial nerve damage depending on the location

A

If the facial nerve is damaged below the tympanic cavity it is just facial muscles affected – Bell’s Palsy
If the cavity is affected you also lose taste and get dry mouth
If above the ear the stapedius is affected and noises become much louder

117
Q

How do you test the facial nerve

A

Test the muscles of facial expression

raise eyebrows, close eyes tight, smile, puff out cheeks and hold air

118
Q

Describe the path of the glossopharyngeal nerve

A

Leaves brain at the medulla
Travels in the posterior fossa then passes through the jugular foramen
Descends towards the pharynx and mouth

119
Q

What is the function of the glossopharyngeal nerve

A

Special sensory - taste o posterior 1/3
Sensory - pharynx, tonsils, eustachian tube and middle ear
Motor - stylopharygeus
Visceral afferent - carotid sinus baroreceptors and carotid body chemoreceptors
Parasympathetic - secretion from parotids

120
Q

What are the functions of the vagus nerve

A

Sensory
Motor
Visceral afferent
Parasympathetic

121
Q

Describe the path of the vagus nerve

A

Leaves brain at medulla
Passes directly towards the jugular foramen in the posterior fossa then passes through
In the neck it runs within the carotid sheath
In chest they run posterior to lung root before passing through the diaphragm

122
Q

Describe the positions of the recurrent laryngeal nerves

A

Left recurrent laryngeal nerve curves under arch of the aorta
Right recurrent laryngeal curves under the right subclavian artery

123
Q

How do you test the vagus nerve

A

Ask them to say ahhhhh - uvula should lift straight up
Ask them to swallow a small amount of water - watch movement and for spluttering
Listen to their speech

124
Q

what are SOL’s

A

Space occupying lesions

Abnormal tissue taking up space in the skull

125
Q

What is the Munro-Kellie hypothesis

A

Within the skull there is blood, CSF and brain tissue

If one factor increases, the other 2 must decrease to maintain ICP

126
Q

What are the layers of the scalp

A 
Skin 
Connective tissue - tough 
Aponeurosis 
Loose connective tissue 
Pericranium
127
Q

Why does the scalp bleed so much

A

Big network of blood vessels in the connective tissue layer
Additionally the CT layer is tough so practically holds the artery open instead of it helping in constrict

128
Q

List the bones of the skull

A 
Frontal 
Parietal - L&R 
Temporal - L&R 
Sphenoid 
Occipital

Joined at the sutures

129
Q

What is the pterion

A

Pterion is the meeting point of the frontal, parietal, temp and sphenoid and is usually the thinnest part of the skull

130
Q

What is the major risk of a fracture at the pterion

A

The middle mengingeal artery runs right underneath it

Fracture can rupture the artery and cause a brain haemorrhage

131
Q

What are the meninges

A

Layers of protective tissue around the brain and spinal cord
Dura mater - tough
Arachnoid mater- spidery and thin
Pia mater - very thin

132
Q

Where is the CSF found

A

Subarachnoid space

133
Q

What is meningitis

A

Infection of the meninges

Pain associated with meningitis is due to stretching of the dura

134
Q

Which nerve supplies the dura

A

Trigeminal

Only layer with sensory nerve supply

135
Q

What is the tentorium cerebelli

A

Sheet of dura mater “tenting” over the cerebellum
Attaches to the temporal bones
Central gap for pituitary stalk to pass through

136
Q

What is the falx cerebri

A

Midline structure of dura mater that separates the hemispheres

137
Q

What does the falx cerebri attach to

A

Crista galli of the ethmoid bone anteriorly
Internal aspect of the sagittal suture
Internal occipital protruberance posteriorly

138
Q

Describe the venous drainage of the brain

A

Cerebral veins drain blood from the brain itself which then passes it into the dural venous sinuses
These are found between the periosteal layer and meningeal layer

139
Q

Describe the arterial supply to the brain

A

Vertebral artery passes through transverse foramina from C6 upwards
They join to form the basilar artery
Internal carotid goes up into the cranial cavity and then joins the circle of willis with the basilar artery to become the main blood supply to the brain

140
Q

List the areas supplied by the cerebral arteries

A

Anterior - medial aspect of the hemisphere
Middle - lateral aspect of associated hemisphere
Posterior - posterior aspect

141
Q

How do you access the subarachnoid space

A

Can be accessed via lumbar puncture at L3/4 or L4/5 IV disc levels to obtain a sample of CSF

142
Q

Where does the subarachnoid space close

A

Around the level of S2

143
Q

Where is CSF produced

A

Choroid plexus in the lateral and 3rd ventricles

Modified pia mater

144
Q

What causes hydrocephalus

A

excessive production, obstruction to flow or inadequate reabsorption of CSF leads to an increased volume
Leads to an enlarged head in children

145
Q

How can you treat hydrocephalus

A

Ventricular peritoneal shunt

Shunt is put into the ventricles and fluid is redirected to the peritoneal cavity where CSF can be reabsorbed

146
Q

If a vessel is found in the subarachnoid space - what must it be

A

A branch from the circle of willis

147
Q

What is a extradural haemorrhage

A

Occurs between the bone and dura
Due to ruptured meningeal artery
Often the middle due to pterion injury

148
Q

What is a subdural haemorrhage

A

Occurs between the dura and arachnoid and separates them
Due to torn cerebral veins
Common after falls in the elderly

149
Q

What is a subarachnoid haemorrhage

A

Bleed into the CSF from the subarachnoid space
Due to ruptured aneurysm in the circle of willis - berry aneurysm
May be congenital

150
Q

What is transcalvarial herniation

A

Occurs after a blow to the head

Brain can herniate out gap in the bone

151
Q

What is cingulate herniation

A

Brain pushes across the falx cerebri

152
Q

What is uncal herniation

A

Part of the temporal lobe herniates down and under the tentorium cerebelli
This is very tough dura and so this can lacerate the temporal lobe

153
Q

Disc prolapse tends to affect the nerve root from the vertebral level above - true or false

A

False
It affects the lower nerve root
e.g. in a L4/5 prolapse it is L5 that is affected
This is because most discs prolapse backwards and the upper nerve hugs the pedicles and misses the disc, whereas it catches the lower nerve as it leave the cord

154
Q

If a patient presents with UMN signs, their issue has to be above L1/2 - true or false

A

True
This is because it has to be in the spinal cord and it ends at that level
If the issue is below L1/2 they will have LMN signs

Neurology (18 decks)

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