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2nd year > anatomy - movement and control > Flashcards

anatomy - movement and control Flashcards

1
Q

upper motor neurone lesion

A

hypertonicity - spasticity after a couple of days
spasticity
paralysis of movement rather than individual muscles
hopping rabbit posture
moderate muscle wasting
babinski sign
hyperreflexia

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2
Q

lower motor neurone lesion

A

paralysis of individual muscles
hypotonicity - flaccidity
muscle wasting
tendon reflexes are absent

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3
Q

what supplies the internal capsule?

A

middle cerebral artery

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4
Q

function of basal ganglia

A

initiation and termination of movement
initiation and termination of some cognitive functions - attention, memory, planning, emotions and cognition via projections to cortical and limbic systems

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5
Q

damage of basal ganglia

A

leads to spontaneous and inappropriate movement

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6
Q

what is the anatomy of the basal ganglia?

A

collection of nuclear masses in forebrain
caudate nucleus
putamen
globus pallidus
amygdala - part of limbic system
2 midbrain structures = substantia nigra and subthalamus

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7
Q

caudate nucleus

A

most superior part of basal ganglia
above and lateral to thalamus
medial to internal capsule

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8
Q

putamen and globus pallidus

A

together = lentiform nucleus

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9
Q

putamen and caudate nucleus

A

functionally related

form corpus striatum

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10
Q

what makes up the limbic system?

A 
hippocampus
amygdala
thalamus
hypothalamus
their connections
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11
Q

what is the role of the limbic system?

A 
initiation and termination
neuroendocrine
motivation 
mood 
attention 
planning 
focus 
concentration 
emotional function
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12
Q

what is the amygdala?

A

part of limbic system

where movement and cognitive/ emotional abilities are linked

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13
Q

substantia nigra

A

dopaminergic neurones to basal ganglia
pigmented dopaminergic neurones projecting to corpus striatum of basal ganglia
largest nuclei in midbrain
black due to melanin

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14
Q

what is ballismus?

A

severe chorea with thrashing motions

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15
Q

what is athetosis?

A

involuntary writhing movements of limbs and neck - twisting anf turning

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16
Q

pneumonic for cerebellar problems

A

DANISH

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17
Q

DANISH

A 
Dysdiadokokinesis
Ataxia
Nystagmus
Intention tremor
Speech disturbance
Hypotonia
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18
Q

non- corticospinal motor pathways

A

originate from subcortical groups of motor neurons/ nuclei
control posture and balance
control coarse movements of proximal muscles
coordinate head, neck and eye movements in response to visual stimuli/ targets
project back to cortical motor regions and circuits in the spine

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19
Q

what is the trunk?

A

body minus head and limbs

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20
Q

what is the torso?

A

the trunk

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21
Q

what is the back?

A

spine

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22
Q

what is the spine

A

starts at inferior border of skull and ends at tip of coccyx

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23
Q

what is the role of the spine?

A
  • protects spinal cord and spinal nerves
  • carries the superior portion of body
  • allows resistance to gravity
  • absorbs shocks through curves and intervertebral discs
  • allows limited movement of trunk and neck
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24
Q

vertebra of the spine?

A

33 vertebrae

24 separate bones

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25
Q

what are the regions of the spine?

A 
cervical 
thoracic
lumbar
sacral
coccygeal
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26
Q

sacral spine

A

5 vertebrae fused together

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27
Q

coccygeal spine

A

4 vertebrae all fused together - represented with Co not C

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28
Q

shape of cervical spine

A

lordosis

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29
Q

shape of thoracic spine

A

kyphosis

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30
Q

shape of lumbar spine

A

lordosis

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31
Q

formation of cervical lordosis

A

3 months when baby lifts head

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32
Q

lumbar lordosis formation

A

10 months - 1 year when baby begins to walk

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33
Q

exaggerated lumbar lordosis

A

common in pregnant women

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34
Q

exaggerated thoracic kyphosis

A

common in elderly

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35
Q

what are the different types of spina bifida?

A

spina bifida occulta
closed spinal dysraphism
meningocele
myelomeningocele

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36
Q

spina bifida occulta

A

closed asymptomatic neural tube defect in which some of the vertebrae are not completely closed

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37
Q

closed spinal dysraphism

A

deficiency of at least 2 vertebral arches

can be covered with a lipoma

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38
Q

meningocele

A

protrusion of meninges filled with CSF through defect in skull or spine

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39
Q

myelomeningocele

A

open spinal cord

with a meningeal cyst

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40
Q

innervation of anterior 2/3 of tongue

A

hypoglossal = motor
facial = special sensory (taste)
trigeminal mandibular branch via lingual nerve = general sensory
vagus nerve = motor to palatoglossus

41
Q

innervation of posterior 1/3 tongue

A

glossopharyngeal nerve = general and special sensory

42
Q

intrinsic muscles tongue

A

superior longitudinal
inferior longitudinal
transverse
vertical

43
Q

extrinsic muscles of tongue

A

hypoglossus
styloglossus
genioglossus
palatoglossus

44
Q

embryological origin of the tongue

A

pharyngeal arches

each one has its own cranial nerve supply

45
Q

locked jaw

A

dislocation of temporomandibular joint/ TMJ

  • head of mandible moves past articular tubercle
  • caused by opening mouth too wide
  • physical relocation required
46
Q

what are the phases of swallowing?

A

voluntary oral phase
involuntary pharyngeal phase
involuntary oesophageal phase

47
Q

voluntary oral phase

A

controlled by cerebral cortex via cranial nerves

48
Q

involuntary pharyngeal phase

A

rapid
controlled by sensory receptors and swallowing centre in medulla
triggers reflex arc
respiration is momentarily stopped

49
Q

involuntary oesophageal phase

A

peristaltic movement
involves vagus and accessory nerves
sympathetic fibres

50
Q

what cranial nerves are involved in swallowing?

A 
trigeminal
facial 
glossopharyngeal 
vagus 
controlled by cerebral cortex and brainstem
51
Q

other controls of swallowing

A

common integration area
brainstem
cranial nerve nuclei

52
Q

common integration area

A

integrates sensory information about food, size, temperature and texture from mouth, pharynx and larynx
makes decision whether to swallow and sends orders to reflex muscles of mastication which close the larynx and epiglottis

53
Q

deglutition reflex arc

A
  1. sensory receptors in oropharynx send signal to deglutition centre in brainstem
  2. initiates motor activity mediated by cranial nerves
  3. effects muscle contraction to:
    - elevate soft palate to close the nasopharynx
    - move the epiglottis and elevate it to close off the larynx
    - initiates peristalsis of pharynx and oesophagus
  4. respiration is temporarily stopped during the pharyngeal phase
54
Q

what is the role of the gag reflex?

A

protection of GI tract

55
Q

gag reflex

A
  1. glossopharyngeal nerve – tactile sensation from posterior 2/3 tongue
  2. brainstem – sensory nucleus of trigeminal nerve
  3. brainstem – nucleus ambiguous of vagus and hypoglossal nuclei
  4. vagus and glossopharyngeal nerves – efferent pathway to muscles
  5. innervation of muscles of soft palate, pharynx, upper part of oesophagus and stylopharyngeus (innervated by glossopharyngeal nerve)
56
Q

prevalence of back pain

A

10%

57
Q

lifetime prevalence of back pain

A

80%

58
Q

disease burden of back pain

A

psychological problems
lots of people off work
leading cause of disability globally

59
Q

causes of back pain

A
  • scoliosis
  • herniated/ prolapsed disc
  • cancer
  • sciatica
  • trauma
  • pregnancy
  • mechanical – heavy lifting etc.
  • pathological fractures
  • ankylosing spondylitis
  • nerve compression
  • kyphosis
  • bad posture
  • HIV
  • depression
  • trauma
  • fragility fractures
  • stress fracture
  • infection – intervertebral disc
  • sclerosis
  • cauda equina syndrome – compression of cauda equina
  • arthritis
60
Q

red flags for back pain

A 
unexplained weight loss
urinary retention
young age
new pain
PMH of cancer
bladder symptoms 
lumps 
thrombocytopenia
neurological deficit
sexual dysfunction 
saddle anaesthesia 
fever
recent travel
fatigue
thoracic back pain
61
Q

cauda equina syndrome

A

compression of cauda equina
urinary retention
saddle anaesthesia

62
Q

causes of referred back pain

A 
kidney stones
pyelonephritis
MI
menstrual pain 
endometriosis
duodenal ulcers
pancreatitis 
abdominal aortic aneurysms
thoracic aortic aneurysms
63
Q

mechanical back pain

A

97% of back pain

64
Q

imaging for back pain

A

MRI is gold standard if concerned about cord progression or neurological symptoms
X-ray not normally needed in absence of red flag symptoms

65
Q

what age is back pain most concerning?

A

<20 year olds = very concerning

>55 year olds back pain = higher risk of serious causes such as AAA or cancer

66
Q

vertebral artery

A

runs through transverse foramen of cervical vertebrae
carries blood supply to posterior of brain - brainstem, cerebellum and posterior cerebral cortex
elderly can occlude this

67
Q

C1

A

no vertebral body

68
Q

C2

A

has dens/ peg

69
Q

C7

A

spinous process = prominent and palpable

70
Q

body of cervical vertebrae

A

small
wide
side to side

71
Q

spinous process of cervical vertebrae

A

short bifid

projects posteriorly

72
Q

vertebral foramen of cervical vertebrae

A

contains vertebral artery

triangular

73
Q

transverse process of cervical vertebrae

A

contain foramina

74
Q

movements of cervical vertebrae

A

flexion
extension
lateral flexion
rotation

75
Q

body of thoracic vertebrae

A

larger than cervical
heart-shaped
2 costal demifacets

76
Q

spinous process of thoracic vertebrae

A

long
sharp
projects inferiorly

77
Q

vertebral foramen of thoracic vertebrae

A

circular

78
Q

transverse process of thoracic vertebrae

A

facets for ribs - except T11 and 12

79
Q

Movements of thoracic vertebrae

A

rotation
limited lateral flexion due to ribs
flexion and extension prevented

80
Q

body of lumbar vertebrae

A

massive

kidney shaped

81
Q

spinous process of lumbar vertebrae

A

short
blunt
projects posteriorly

82
Q

vertebral foramen of lumbar vertebrae

A

triangular

83
Q

transverse process of lumbar vertebrae

A

thin and tapered

84
Q

movements of lumbar vertebrae

A

flexion
extension
some lateral flexion
rotation prevented

85
Q

intervertebral disc

A

between vertebra

degenerates over time causing height loss

86
Q

structure of intervertebral discs

A

centre = nucleus pulposus

outer layer = annulus fibrosis

87
Q

what happens in a herniated disc?

A

rupture of annulus fibrosis and nucleus pulposus seeps out

can cause compression of spinal nerve

88
Q

caudal epidural

A

given through sacral hiatus

89
Q

interlocking vertebrae

A

superior and inferior articular processes form the joint

intervertebral foramen between the 2 vertebrae

90
Q

intervertebral foramen

A

where spinal nerve leaves spinal cord

91
Q

arthritis

A

can cause compression of spinal nerve

92
Q

what are the ligaments of interlocking vertebrae

A 
supraspinous
interspinous
ligamentum flavum
anterior longitudinal
posterior longitudinal
93
Q

where does the spinal cord end?

A

L1

extends more inferiorly in babies and shorter people

94
Q

lesion of cauda equina

A

causes lower motor neuron lesion signs

95
Q

L4

A

vertebra is level with iliac crest

level for lumbar puncture as this is where the cauda equina is so won’t cause damage

96
Q

where does the subarachnoid space end?

A

S2

97
Q

test for scoliosis

A

bend over

one side will go lower than the other

98
Q

caudal epidural injections

A

used during birth process

2nd year (48 decks)

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