Chapters 1-3 Flashcards
1
Q
T/F: CNS axons regenerate if cut
A
F
2
Q
T/F: PNS myelinated neurons can regenerate if cut
A
T (go down endoneurial sheath formed by Schwann scells)
3
Q
Rx for Guillain-Barré syndrome
A
Plasmaphoresis; gamma globulin
4
Q
Dorsal rami innervate ____ (3)
A
Skin of medial 2/3 of back from vertex of skull ; deep intrinsic muscles; facet joints between vertebrae
5
Q
Alternate name for the suboccipital nerve
A
Dorsal ramus of C1
6
Q
Alternate name for the dorsal ramus of C2
A
Greater occipital nerve
7
Q
The 4 cranial nerves that are mixed are derived from. . .
A
Pharyngeal arches
8
Q
Which CN are derived from pharyngeal arches?
A
V, VII, IX, X
9
Q
What is the only saddle joint?
A
Carpometacarpal joint of thumb between trapezium/base of first metacarpal
10
Q
T/F: There are no white rami above/below T1 and L2/3 levels
A
T
11
Q
T/F: Postganglionic sympathetic fibers in the grey rami rejoin spinal nerves at all levels
A
T
12
Q
Sympathetic fibers leave in __ rami to enter paravertebral trunk
A
White
13
Q
Eccrine sweat glands and erectile tissues are triggered by ___
A
Ach (SNS)
14
Q
Physiologic sensations other than pain travel with sensory fibers nearby to ___
A
Parasympathetic axons in vagus or pelvic splanchnic nerves
15
Q
Baroreceptors in the arteries controlled by ___
A
PNS
16
Q
Chemoreceptors in the stomach, arteries controlled by ___
A
PNS
17
Q
Visceral pain fibers accompany ___ nerves
A
Sympathetic nerves back to CNS
18
Q
Most visceral pain is referred to ___ dermatomes
A
T1 to L2
19
Q
Horner’s syndrome triad
A
Ptosis, miosis, anhydrosis
20
Q
Pathophysiology of Shy Drager Syndrome
A
Degeneration of preganglionic sympathetic/parasympathetic neurons in brainstem & spinal cord, degeneration of neurons in most ganglia
21
Q
Sx of Shy Drager Syndrome
A
Impotence, urine retention, dizziness on standing, blurred vision, inability to sweat
22
Q
Reflexes include at minimum ___ and ____
A
1 sensory neuron and 1 motor neuron linked at synapse
23
Q
Describe muscle stretch reflex
A
Muscle spindles in skeletal muscle stimulated by stretch –> reflex contraction
24
Q
Describe autonomic reflex
A
Sensory stimuli cause reflex contraction of smooth muscle/secretion of gland/change in rate or force of contraction of heart
25
Arteries that lack collateral circulation
Central artery of retina and interlobular arteries of kidney
26
Pathophysiology of Raynaud's
Hyperconstriction of arteriovenous shunts in fingers/toes
27
Where does lymph enter the venous system?
Junction of IJV and subclavian vein at neck by way of right lymphatic duct (R) and thoracic duct (L)
28
Vertebral arch consists of ____
2 pedicles and 2 laminae that form a spinous process
29
Spina bifida is a failure of ___
laminae to fuse to form spinal process
30
Kyphosis
Abnormal increase in posterior curvature of the spine
31
Lordosis
Abnormal increase in anterior curvature of the spine
32
Scoliosis
Abnormal increase in lateral curvature of spine
33
Zygapophyseal (facet) joints
Between superior and inferior processes at junction of each pedicle and lamina
34
Zygapophyseal (facet) joints permit ___ motion
Gliding
35
Disc components
Fibrocartilaginous annulus fibrosus surrounding semigelatinous nucleus pulposus
36
Anterior longitudinal ligaments
Covers anterior and lateral parts of vertebrae; limits extension
37
Posterior longitudinal ligaments
Covers posterior parts of vertebrae; limits flexion; weaker than anterior counterpart
38
Ligamentum flavum
Extends between laminae of adjacent vertebrae; limits flexion
39
Intervertebral foramina
Transmit dorsal and ventral roots of spinal nerves; bounded by pedicles/facets/bodies
40
Dura mater ends at ___ level
S2
41
Arachnoid mater extends to ___ level
S2
42
____ space contains CSF and has a normal pressure of approximately ____ mm H2O
Subarachnoid; 100
43
Denticulate ligaments
Lateral extension of pia that anchor spinal cord to dura
44
Filum terminale
Pia extending from L2 to S2
45
First 7 cervical nerves exit ___ to cervical vertebrae with same #
superior
46
Most nerves exist ___ to vertebrae of same #
inferior (below T1)
47
Cauda equina
Dorsal and ventral roots of lumbar/sacral spinal nerves extending inferior at L2 vertebra
48
Lumbar puncture sampled between ___
L4 and l5
49
Normal LP will puncture ___ ligaments
Supraspinous and interspinous
50
Midline LP will puncture ____
Ligamentum flavum
51
Radiculopathy
Compression of roots of spinal nerve resulting in pain and paresthesias along dermatomes supplied by compressed sensory roots
52
Spondylitis
Additional bone growth by osteophytes at margins of vertebral bodies; ALL and sacroiliac joints may become calcified ("bamboo spine", ankylosis)
53
Spondylosis
Degenerative changes in intervertebral disks
54
Herniated disc
NP protrudes at posterolateral part of annulus fibrosis; compresses roots of lower cervical or lower lumbar spinal nerves; most common at C6/C7
55
Herniated disc at C5-C6 will compress the ___ root
(more inferior) C6
56
Small bodies, short spinous processes with bifid tips, transverse processes transmitting vertebral a.
Cervical vertebrae
57
Heavy facet joints of C3-C7 oriented at 45 degree angle permit ____
Flexion, extension, lateral bending, rotation
58
Whiplash
Strongly extended-->strongly flexed (may cause anterior dislocation)
59
Uncinate processes (vertebrae)
Bodies of C3-C7 vertebrae, form uncovertebral synovial joints with superior bodies
60
No body or spinous process; posterior and anterior arches
C1 vertebra (atlas)
61
"Yes" joints
Superior articular processes of atlas + occipital condyles of skull
62
"No" joint
Dens of C2 (axis) with anterior arch of atlas
63
Spondyolysis
Defect or fracture of isthmus with no anterior displacement of body ("Scotty dog" with collar)
64
Spondylolisthesis
Unilateral or bilateral fracture of isthmus with anterior displacement (Beheaded "Scotty dog"); most common in L5 vertebra
65
Sx of L5 spondylolisthesis
Bilateral lower back pain radiating to lower limbs and weakness of leg muscles
66
Dens attaches to atlas via _____
Transverse ligmaent of atlas
67
Dens attaches to margins of foramen magnum by ____
Alar ligaments
68
___ vertebra has long spinous process and small transverse formina that do not transmit arteries
C7
69
Sx of compression of C7 spinal nerve
Referred pain to neck and shoulder; pain and paresthesias in index, middle fingers; weakness of radial n. muscles
70
Sx of compression of C8 spinal nerve
Pain in neck and shoulder; pain and paresthesia in ring and little fingers; weakness in hypothenar and interosseous muscles of hand
71
____ may be compressed from cervical rib causing ____
Subclavian artery and T1 nerve /// diminished radial pulse/pain and paresthesias in medial forearm, Horner's syndrome
72
Heart-shaped bodies, long oblique spinous processes, costal facets on bodies/transverse processes
Thoracic vertebrae
73
Thoracic facet joints tilt at 60 degrees and permit ___
Lateral bending and rotation; limited flexion/extension by ribs
74
Large kidney-shaped bodies, short/horizontal spinous processes, long transverse processes
Lumbar vertebrae
75
Lumbar facet joints are perpendicular to transverse plane and permit ___
Flexion and extension and lateral bending; no rotation
76
Superior and inferior articular processes of lumbar vertebrae connected by ___
Isthmus (pars interarticularis)
77
Compression of L5 spinal nerve roots
Sciatica, pain/paresthesia in posterior thigh, anterolateral leg, dorsum of foot; weakness in hallicus extension and dorsiflexion
78
Compression of S1 spinal nerve roots
Sciatica, pain/pares in posterolateral leg, heel, lateral foot; weakness in flexion of knee, planarflexion, tendon reflex
79
Epidural block
Anesthetic to sacral hiatus; diffuses thru meninges and blocks roots of sacral (S5)/coccygeal spinal nerves in cauda equina
80
Diaphragm attaches to the ___ of the sternum
Xiphoid process
81
What happens at the sternal angle? (List 3)
Trachea bifurcates; arch of the aorta arises from ascending aorta and continues as descending aorta; azygos vein drains into SVC
82
True ribs during inspiration move like ____
Pump handle (increase AP diameter)
83
False ribs during inspiration move like ___
Bucket handle (increase transverse diameter)
84
Rib fracture MC occurs anterior to ___ of rib and may cause ___
Angle; PTX
85
Formal name of ventral rami of T1-T11 nerves
Intercostal n.
86
Formal name of ventral ramus of T12
Subcostal n.
87
L posterior intercostal vein drains into ___
Hemiazygos vein (--> azygos)
88
R posterior intercostal vein drains into ___
Azygos vein (--> SVC)
89
Organization of neurovascular bundle on ribs
Superior part of intercostal space; VAN (sup-->inf)
90
Most breast adeno is ____ and emerges in the ___ quadrant
Ductal; upper lateral
91
___ may be damaged in mastectomy leading to scapular winging
LTN
92
Breast adeno metastasizes to _____
Opposite breast, axillary nodes, parasternal nodes, and anterior abdominal wall nodes
93
Radical mastectomy
Removes breast, pectoralis major/minor, axillary LN and vessels
94
Lung extends into ____
Root of neck superior to medial one third of clavicle and first rib (cupula)
95
Thoracocentesis is usually performed on top of the ____
10th rib
96
Inferior extent of lungs at midclavicular line, midaxillary line, and paravertebral line?
Rib 6, Rib 8, Rib 10 (parietal pleura is 2 beneath, i.e. 8-10-12)
97
____ is filled by lingula of superior lobe of L lung in maximal inspiration
Costomediastinal recess
98
Does parietal pleura or visceral pleura feel pain?
Parietal - intercostal nerves/phrenic nerves
99
Sx of costal pleurisy
Sharp pain localized over adhesion site increased with inspiration
100
Mediastinal and diaphragmatic pain is referred to ____
Supraclavicular region (C3-C5)
101
Tension pneumothorax
Heart and mediastinal structures moved progressively to other side, compressing opposite lung and impeding CO/venous return --> "valve" effect with closing of wound and increased intrapleural pressure during expiration
102
Organization of hilus of R lung
Upper lobar bronchus superior to PA/PV
103
Organization of hilus of L lung
PA superior to main bronchus and PV
104
R main bronchus is ____ compared to L main bronchus
Shorter, wider, and more vertical (and more apt to take a foreign body)
105
Foreign body tends to be lodged in ____ if patient was standing/sitting
Posterobasal segment of inferior lobe of R lung
106
MC site of spontaneous pneumothorax
Visceral pleura of superior lobe of lung
107
Enlarged R supraclavicular node indicates malignancy of ____
Thorax
108
Enlarged L supraclavicular node indicates malignancy of ____
Thorax, abdomen, or pelvis
109
Pancoast tumor may cause ____ syndrome
Thoracic outlet - compression of sympathetic trunk, subclavian vessels, recurrent laryngeal n., and inferior trunk of brachial plexus
110
Sx of thoracic outlet syndrome
Horner's syndrome, decreased radial pulse, hoarseness/dysphagia, paresthesia in forearm/hand
111
Sx of SVC syndrome
Headache, head/neck edema, prominent superficial veins, cyanosis
112
Branches of arch of aorta
L subclavian, L common carotid, brachiocephalic artery
113
Ligamentum arteriosus
Between L PA and arch of aorta
114
Coarctation of the aorta (infantile form)
PROXIMAL to LA; blood pressure reduced in lower limbs, elevated in upper limbs
115
Coarctation of the aorta (adult form)
DISTAL to LA; blood pressure reduced in lower limbs, elevated in upper limbs; "notching" of ribs due to dilation of anterior/posterior intercostal a. due to retrograde flow into descending aorta
116
L recurrent laryngeal n. hooks under ___
Arch of aorta posterior to LA
117
R recurrent laryngeal n. hooks under ___
R subclavian a.
118
Kussmaul's sign
Distension of neck veins on inspiration (paradoxical)
119
Pericardiocentesis is performed at ___
Left xiphocostal angle (passes skin/fascia/rectus sheath/rectus abdominis/fibrous layer/serous layer of parietal pericardium)
120
The smooth-walled part of the RA is ___
Sinus venarum
121
The rough-walled part of the RA is ____
Pectinate muscle-containing
122
The _____ separates the sinus venarum from the pectinate muscles
Crista terminalis
123
The smooth part of the RV is ___
Conus arteriosus or infundibulum
124
The rough part of the RV is ___
Trabeculae carneae
125
The RV contains ___ (#) papillary muscles
3; anterior, left, right
126
Papillary muscles attach via _____ to leaflets
Chordae tendinae
127
Where is the right bundle branch of the bundle of His?
Moderator band (base of anterior papillary muscle-->IV septum)
128
The pulmonary veins empty into the ___ aspect of the LA
Posterior
129
The trabeculae carneae of the LV are ___ size of those of the RV
2x
130
The LV contains ____ (#) papillary muscles
2; anterior & posterior
131
The aortic valve contains ___ (#) leaflets
3; Right, left, and posterior
132
Coronary arteries arise from ___
Aortic sinuses of ascending aorta (distal to semilunar cusps of AV)
133
RCA supplies. . .
AV/SA nodes, RA, RV (marginal branch), posterior interventricular artery (right/left ventricles; posterior IV septum)
134
LCA supplies. . .
R/LV and 2/3 of IV septum (LAD), LA/LV (circumflex artery), LV (marginal branch)
135
Collateral circulations in the <3
(1) Between anterior/posterior IV arteries in posterior IV sulcus ; (2) between circumflex branch and RCA in posterior coronary sulcus
136
Frequency of occlusions
LAD > RCA > LCx
