APPLIED ANATOMY | Part III Flashcards
The noci-ceptive pathway is:
A. An afferent three-neuron and dual-ascending system with descending modulation from cortex thalamus and brainstem
B. The first-order neurons have their origins in the periphery as A delta (Aδ) and
polymodal C fibers
C. Aδ fibers transmit “first pain”
D. Polymodal C fibers transmit “second pain”
E. All of the above are accurate
The nociceptive pathway is an afferent three-neuron, dual-ascending (i.e., anterolateral and dorsal column medial leminiscal pathways) system, with descending modulation from the cortex, thalamus, and brainstem.
A delta = ‘FIRST SHARP PAIN”
C polymodal fibers = “SECOND, DIFFUSE PAIN”
Cortical regions that are responsible for language:
A. Right hemisphere
B. Left hemisphere
A. Right hemisphere
Cortical regions that are responsible for language are located in the left hemisphere in almost all right-handed people as well as in the majority of left-handed people.
In the brain, there are two primary regions responsible for LANGUAGE. Wernicke area is responsible for language acquisition. This is located where:
A. posterior superior temporal cortex
B. premotor frontal cortex
C. anterior superior temporal cortex
A. posterior superior temporal cortex
The two primary regions responsible for language are:
Broca area - located in the premotor frontal cortex and responsible for language formation.
Wernicke - located in the posterior superior temporal cortex and responsible for language acquisition.
A 50 year old adult is scheduled for an emergency CT scan due to ‘EXPRESSIVE APHASIA’ from what seem to be a stroke. Dr. Rataban was called in for sedation.
Expressive aphasia is a lesion in:
A. Broca’s area
B. Wernicke area
B. Wernicke area
Lesions in Broca area lead to expressive aphasia whereas those in Wernicke area cause receptive aphasia.
Broca’s is Expressive while Wernicke is Receptive.
Mr. X is a known case of parkinson’s disease. He came in to the ER for an elective cataract surgery. Parkinsons is considered to be a disease that primarily affects EXTRAPYRAMIDAL structures. Extrapyramidal system consists of a group of the following brain structures EXCEPT:
A. caudate nucleus
B. globus pallidus
C. putamen
D. substantia nigra
E. amygdala
E. Amygdala
The extrapyramidal system consists of a group of brain structures that
modify motor function but are not components of the corticospinal tract and
primary motor cortex. These structures include the basal ganglia (comprised
of the caudate nucleus, globus pallidus, putamen, substantia nigra, and red
nucleus), cerebellum, and components of the auditory and vestibular pathways.
Dysfunction of structures in the extrapyramidal system results in
difficulty with motor control without frank weakness, which includes Parkinson disease, essential tremor, and ataxia.
TRUE or FALSE
The brain receives approximately 70% of its blood supply from two internal carotid arteries anteriorly
The brain receives approximately 70% of its blood supply from two internal carotid arteries anteriorly and 30% from two vertebral arteries posteriorly forming the basilar artery.
70% - Internal carotid areteries
30% - Vertebral arteries
The common carotid artery, originating from the aortic arch, divides at the level
of the ____ into the internal and external carotid arteries.
A. thyroid cartilage
B. cricoid cartilage
C. 1sr tracheal ring
D. superior part of the hyoid bone
The common carotid artery, originating from the aortic arch, divides at the level
of the thyroid cartilage into the internal and external carotid arteries
The bilateral vertebral arteries originate from ____________ and converge to form the basilar artery at the pontomedullary junction.
A. subclavian arteries
B. innominate arteries
C. ascending aorta
SUBCLAVIAN ARTERIES
The bilateral vertebral arteries originate from the subclavian arteries and
converge to form the basilar artery at the pontomedullary junction.
TRUE or FALSE
less than 50% of people demonstrate a “complete” circle of Willis.
TRUE
Identify which area is a SUB-FALCINE localized herniation:
A. 1
B. 2
C. 3
D. 4
A. 1
What is the falx-cerebri composed of?
A. Dura mater
B. Pia mater
A. Dura mater
Where is excess CSF reabsorbed?
A. arachnoid granulations on the top of the brain (SUPERIOR sagittal sinuses)
B. arachnoid granulations on the top of the brain (LATERAL sagittal sinuses)
C. arachnoid granulations on the top of the brain (INFERIOR sagittal sinuses)
A. arachnoid granulations on the top of the brain (SUPERIOR sagittal sinuses)
Which is ACCURATELY described in terms of the normal physiologic FLOW of the CSF?
A. Lateral ventricles > Cerebral aqueduct of sylvius > 4th ventricle > Foramen of Luschka > Foramen of Magendie > Cerebral cisterns
B. Lateral ventricles > Cerebral aqueduct of sylvius > Foramen of Luschka > Foramen of Magendie > 4th ventricle > Cerebral cisterns
C. Lateral ventricles > Foramen of Luschka > Foramen of Magendie > Cerebral aqueduct of sylvius> 4th ventricle > Cerebral cisterns
A. Lateral ventricles > Cerebral aqueduct of sylvius > 4th ventricle > Foramen of Luschka > Foramen of Magendie > Cerebral cisterns
CSF Flow:
Lateral ventricles -> through the foramina of Monro to the third ventricle -> cerebral aqueduct (of sylvius) -> fourth ventricle -> exits inside of brain through two lateral foramina of Luschka and one medial foramen of Magendie -> cerebral cistern (above and at the foramen magnum). Then CSF flows down the spinal cord and back up and over the brain to the arachnoid granulations -> Returned to the superior sagittal sinus and returned to the venous system
READ
The venous system of the brain consists of both deep and superficial veins that ultimately drain into the dural venous sinuses.
These sinuses are valveless endothelialized channels lying between the dura mater and skull periosteum. All of the sinuses eventually drain into the sigmoid sinus and thereafter into the internal jugular veins.
What area of the brain is supplied by the anterior cerebral artery?
A. Frontal and superior poles of the cerebrum
B. Temporal pole of the cerebrum
C. Occipital pole of cerebrum
Anterior cerebral -> The frontal and superior poles of the cerebrum
Middle cerebral -> Temporal pole of the cerebrum
Posterior cerebral -> Occipital pole of cerebrum
What area of the brain is supplied by the middle cerebral artery?
A. Frontal and superior poles of the cerebrum
B. Temporal pole of the cerebrum
C. Occipital pole of cerebrum
B. Temporal pole of the cerebrum
What area of the brain is supplied by the posterior cerebral artery?
A. Frontal and superior poles of the cerebrum
B. Temporal pole of the cerebrum
C. Occipital pole of cerebrum
C. Occipital pole of cerebrum
What area of the brain is supplied by the internal carotid artery?
Vertebral cerebral?
Basilar?
Posterior cerebral?
Posterior communicating?
- Internal carotid -> branches to the walls of cavernouse sinus, pituitary gland, and trigeminal ganglion; primary supply to brain
- Vertebral cerebral -> Cranial meninges and cerebellum
- Basilar -> Brainstem, cerebellum, and cerebrum
- Posterior cerebral -> Inf. aspect of cerebral hemisphere and occipital lobe
- Posterior communicating -> optic tract, cerebral peduncle, internal capsule, and thalamus
The cerebrospinal fluid (CSF) is produced mostly by the choroid plexus of the ____ and ___ ventricles
The cerebrospinal fluid (CSF) that is produced mostly by the choroid plexus of the lateral and third ventricles
The average volume of CSF in an adult is
approximately 150 mL.
CSF is created at a rate of 15 to 20 mL/h and moves from these ventricles via the aqueduct of Sylvius to the fourth ventricle.
Dorsal column is responsible for:
A. Proprioception and Light touch
B. Pain and Temperature
A. Proprioception and Light touch
The spinal cord itself is composed of central gray matter, the dorsal columns containing tracts responsible for proprioception and light touch, lateral spinothalamic tracts responsible for pain and temperature, and outer white matter containing the lateral corticospinal tracts
Lateral spinothalamic tract is responsible for:
A. Proprioception and Light touch
B. Pain and Temperature
B. Pain and Temperature
Which of the following spinal tract is responsible for vibration: fine touch?
A. Lateral corticospinal tract
B. Posterior column
C. Anterolateral spinal tract
B. Posterior column
Lateral corticospinal tract -Motor -pyramidal decussation (cervivomedullary juntion)
Anterolateral spinal tract - Sensory ( pain temperature crude touch) - anterior comissure
Posterior column or medial lemniscal - Sensory ( vibration proprioception fine touch) -internal arcuate fibers ( lower medulla)
This is the distal termination of the SPINAL CORD in adult?
A. L1
B. L3
A. L1
L1 - ADULT
L3 - NEONATES
The artery of Adamkiewicz corresponds to what vertebral level?
A. T11
B. T10
C. T9
D. T7
A. T11
This thin and transparent layer coats spinal cord. It is the innermost meningeal layer?
A. Pia
B. Dura
C. Arachnoid
PIA MATER
Meningeal layer from OUTER to INNER
- DAP
Dura > Arachnoid > Pia
when blood collects between dural mater and arachnoid mater?
A. Subdural Hematoma
B. Epidural Hematoma
A. Subdural Hematoma
TRUE or FALSE
The spinal cord receives its blood supply from one anterior spinal artery and two posterior spinal arteries
TRUE
One Anterior
Two Posterior
TRACE the blood supply of the spine from AORTA?
The * ANTERIOR spinal artery originates from six to eight major radicular arteries derived from the aorta, with the largest one being the artery of Adamkiewicz (usually
occurring at T11 or T12 and generally supplying T8 to the conus medullaris
terminus).
The POSTERIOR spinal arteries originate from the posterior cerebral circulation and supply the dorsal horns and white matter (posterior third of the spinal cord).
Which segmental arteries reach the spinal nerve roots ____
A. radicular arteries
B. anterior medullary arteries
C. posterior medullary arteries
radicular arteries
When performing a stellate ganglion block, it is best to avoid complications such as pneumothorax and vascular injury. At which of the following vertebral levels should local anesthetic be injected to minimize complications?
A) C5
B) C6
C) C7
D) T1
B) C6
Although the stellate ganglion lies on the anterior surface of the C7 transverse process, to best avoid complications such as vascular injury to the vertebral artery and pneumothorax, the block should be performed at the level of C6.
The stellate ganglion, also known as the inferior cervical ganglion or the cervicothoracic ganglion, is located anterior to the neck of the first rib, posterior to the common carotid artery, where it is formed by the fusion of the lower cervical and first thoracic
ganglia and extends to the inferior aspect of the transverse process of C7.
The ganglion is posterior and superior to the lung
apex. It is anterior and medial to the anterior scalene, phrenic nerve, brachial plexus and its branches, vertebral artery, and longus colli muscle.
