Clinical Flashcards
What will oculusion of anterior cerebral artery do
Sensorimotor function loss in lower limb and bladder weakness
What causes a headache- innervation
Dura mater is stretch sensitive Trigeminal nerve: V1: anterior and posterior cerebral falx and cerebellar tentorium V2: anterolateral reflections V3: lateral reflections
What will occlusion of middle cerebral artery do
Sensorimotor function loss primarily in face and hands
What will occlusion of posterior cerebral artery do
Visual disturbances
Possible sensory loss on one side of thalamus deprived of blood
What does frontal cortex do
Supplementary motor area
What does pre-central gyrus do/ what lobe
Primary motor area
Frontal lobe
What does the post central gyrus do and what lobe
Primary somatosensory cortex/ gustatory cortex
Parietal lobe
What does parietal lobe do
Somatosensory association area
What does temporal lobe do
Auditory and auditory association area
What does occipital lobe do
Visual cortex and visual association area
What does medial geniculate body do
Relays auditory impulses from inferior colliculus to primary auditory cortex
What does lateral geniculate body do
Relay visual impulses from optic tract to primary visual cortex
Lesion of olfactory nerve, how does it happen
Loss of smell
Fracture of cribiform plate
Lesion of optic nerve, and how
Loss of pupillary constriction
Visual field defects
Direct trauma to orbit, pressure on optic pathway
Lesion of oculomotor nerve and how
Dilated pupil Pstosis Eye turns down and out Pupillary reflex of side of lesion will be lost Fracture from cavernous sinus
Lesion of trochlear nerve and how
Inability to look down when eye is addicted
Nerve starches on brainstem, fracture of orbit
Lesion to trigeminal nerve and how
Loss of pain and touch sensations
Masseter and temporal is don’t collapse
Deviation of mandible to side of lesion with mouth open
Roof maxillary sinus, tri ganglion
Lesion of abducent nerve and how
Eye falls to move laterally
Dip optima on lateral gaze
Base of brain, fracture of cavernous sinus/orbit
Lesion to facial nerve and how
Paralysis of facial muscles, eyes remain open
Angle of mouth droops, forehead does not wrinkle
Laceration/confusion in parotid region, fracture of temporal bone
Lesion to vestibulocochlear and how
Progressive unilateral hearing loss
Tinnitus
Tumor of nerve
Lesion of Glossopharyngeal and how
Loss of taste posterior 1/3 of tongue
Loss of sensation on afferent side of soft palate
Brainstem lesion, deep laceration of neck
Lesion to vagus nerve and how
Sagging of soft palate
Deviation of uvula
Hoarseness owing to paralysis of vocal fold
Brainstem lesion, deep laceration of neck
Lesion to spinal accessory and how
Paralysis of scm, trapezius
Drooping of shoulders
Laceration of neck
Lesion to hypoglossal and how
Protruded tongue deviates towards affected side
Moderate dysarthria
Neck laceration, basal skull fracture
Where does sympathetic autonomic nervous system come from
Thoracolumbar region
Where does parasympathetic ans come from
Cranial sacral region
Post ganglionic fibres of sympathetic/parasympathetic
Sympathetic- long
Parasympathetic - short
Where are the pre-synaptic cell bodies of sympathetic nervous system
Lateral horn of grey matter t1-l2
Where are the prevertebral ganglia of sympathetic nervous system
Plexuses on abdominal aorta
Where does the visceral efferent motor (sympathetic) fibres exit
Grey rami communicante
Where does visceral efferent motor (sympathetic) fibres enter
White rami communicante into sympathetic trunk
What splanchic nerve carrys parasympathetic fibres
Pelvic splanchic
Where are the para vertebral ganglia
Adjacent to vertebral column
What cranial nerves do parasympathetic go through
III - oculomotor
VII - vestibucochlear
IX- Glossopharyngeal
X - vagus
What is horners syndrome
Increased parasympathetic
Lesion in pathway of sympathetic fibres to head
Clinical signs
Pstosis: drooping of upper eyelid
Miosis: pupillary constriction
Anhidosis: loss of sweating
Flushed, warm dry skin: vasodilation of subcutaneous arteries
What is innervation of nasal canal
Anterosuperior: ophthalmic
Posterior superior: maxillary
Special sense: olfactory
Where do the para nasal sinuses drain
Most into middle nasal meatus
Sphenoid sinus into sphenoethmoid recess
Where is frontal sinus pain referred to
Skin of forehead Meninges in anterior cranial fossa Falx cerebri Tentorium cerebelli Supra orbital nerve
Where does the maxillary sinus pain refer to
Maxillary dental arch
Infra orbital nerve
What is rhino sinusitis
Inflammation of paranasal sinuses (ethmoid and maxillary)
Caused by obstruction of nasal discharge
Nasal congestion, facial pain/pressure, fever, headache, painful maxillary teeth
What is ptosis caused by
Loss of sympathetic innervation to superior tarsus muscle- oculomotor nerve
What is a pudendal nerve block
S2-s4 dermatomes
Does not block superior park of vagina
Can feel uterine contractions
What is caudal epidural block
S2-s4 spinal nerve roots
Pain fibres from uterine body (superior to pelvic pain line)
Ascends to inferior thoracic-superior lumbar levels
Mother is aware of contractions
No headache
What is a spinal block
Needle into spinal subarachnoid space at l3/4 vertebral level
Severe headache is common
Vertebral epidural space is continuous with cranial epidural space
How does pain travel from sub peritoneal uterus and vagina (inferior to pain line)
Travels retrograde lye along parasympathetic pathway s2-4 spinal sensory ganglia
How does the pain from intro peritoneal uterus (superior to pain line) travel?
Travel retrogradely along sympathetic pathway
To inferior most thoracic and superior lumbar spinal ganglia
Explain cardiac referred pain
Afferent pain fibres run centrally in the middle and inferior cervical branches
Axons of these primary sensory neurons enter spinal cord at segments t1-4/5 especially on left
Injury to recurrent laryngeal nerves and what is the course of left nerve
Supply all intrinsic muscles of larynx
Left recurrent laryngeal winds around arch of aorta and ascends
Describe renal entrapment syndrome
Left renal vein transverses acute angle between superior mesenteric artery anteriorly and abdominal aorta posteriorly
Downward tract to superior mesenteric artery can compress renal vein
What vertebral level do the celiac, superior mesenteric and inferior mesenteric artery originates
Celiac - t12
Superior mesenteric - l1
Inferior mesenteric - l3
What vertebral level does supra renal, renal and gonadal originate
Supra renal - l1
Renal - l1
Gonadal - l2
How do hiccups occur
Involuntary spasmodic contraction of diaphragm
Sudden inhalation that are rapidly interrupted by spasmodic closure of glottis
Result from irrational of afferent/efferent nerve endings or medullary nerves in brainstorms that control diaphragm
What happens when the phrenic nerve gets sectioned
Complete paralysis and eventual atrophy of muscular part of corresponding half of diaphragm
Why is female urethra more susceptible to infection
Shorter
More distensible
Open to exterior through vestibule of vagina
What’s important to avoid during a tracheostomy
Inferior thyroid veins
Left brachiocephalic vein
Thyrus
Lesion of cervical sympathetic trunk
Horners syndrome
Miosis: contraction of pupil
Ptosis: levatornpalpebrae apple brae superiosis
Vasodilation and absense of sweating
Injury to supra scapular nerve
Vulnerable to injury middle third of clavicle
Results on loss of lateral rotation humerous at glenohumeral joint
Ability to initiate abduction also affected
What are he two most commonly fractured facial bones and why
Nasal- prominence
Mandible - vulnerability
What type of joint it tmj
Synovial
During life threatening haemorrhage where is best place to apply pressure
Like crown to occlude superficial temporal artery, supra trochlear artery, occipital artery
What are the two paired arteries entering calvaria to supply brain
Vertebral artery
Internal carotid
How does sinusitis cause a headache localised to anterior and middle cranial fossa
Refered pain
Sensory innervation of sinuses is same as dura in anterior and middle cranial fossa
What muscle opens eyelid
Levator palpebrae superiosis
What eye open the eye in fright
Superior tarsal muscle
What muscle closes the eye
Orbicularis oculi
Corneal reflex innervation
Afferent: ophthalmic
Efferent: facial
Pupillary light reflex innervation
Afferent: optic nerve
Efferent: oculomotor
Why are maxillary sinuses most commonly infected
Because Ostia has to drain into middle nasal meatus
Is at the superior end of sinus and point medially
Sinus has to be very full to drain or when lying down most superior sinus will drain
Internal and external surface of tympanic membrane innervation
Internal: Glossopharyngeal
External: branch of cnv3 (auriculotemporal)
Cleaning ear wax- what nerve
Cnv3 and vagus
Which muscles contract to open pharyngotympanic tube
Tensor veil palatine
Elevator veil palatine
A deviated uvula would indicate lesion of what cranial nerve
Vagus
What innervates the general sense of the toungue
Anterior 2/3 - trigeminal
Posterior 1/3- Glossopharyngeal
Pharynx - vagus
What innervates taste of the toungue
Anterior 2/3- facial (chorea tympanii)
Posterior 1/3- Glossopharyngeal
Pharynx: vagus
What autonomic fibres innervate salivary glands
Parasympathetic
Submandibular and sublingual innervation by what nerve
Facial
Parotid gland innervation by what nerve
Glossopharyngeal
What is in the common sheath
Internal jugular vein
Vagus nerve
Common carotid artery
Internal jugular vein lies anterior and adjacent to what muscle
Scm
The cervical plexus emerges from middle of posterior border of which muscle
Scm
What does the phrenic nerve lie on top of
Anterior scalene
Describe the pathway of sympathetic nerves
Adjacent to thoracic urethra in posterior mediastinum
Fibres contribute to cardiac and oesophageal plexus on anterior surface of oseophagus
Describe the path of the vagus nerve
Pass through neck in carotid sheath
Enter through anterior to subclavian artery
Passes posterior to primary bronchi contribute to autonomic plexus
Describe path of phrenic nerves
Pass through neck anterior to anterior scalene muscle
Pass anterior to primary branch on lateral aspect of pericardium
Heads inferiorly to diaphragm
The intercostal neurovascular bundles are located between which two muscle layers
Innermost and inner intercostal
Posterior and subcostal arteries derived from what major blood vessel
Thoracic aorta
Internal thoracic and superior intercostal arteries derived from what major blood vessel
Subclavian aretry
Superior and lateral thoracic arteries derived from what major blood vessel
Axillary artery
Posterior intercostal veins drain to what vein
Hemiazygos/ Azygos
The medial arcuate ligament is thickening over the fascia of what muscle
Psoas muscle
Lateral arcuate ligament is thickening of fascia over anterior surface of what muscle
Quadratic lomborum
What’s in caval opening/what level
T8
Ivc, right phrenic nerve
What’s in oesophageal hiatus/ what level
T10
Oesophagus, vagus trunk
What’s in aortic hiatus/ what level
T12
Aorta,thoracic duct, Azygos vein
Innervation do the pleura of thorax
Costal
Mediastinal
Central and peripheral
Costal: intercostal nerve
Mediastinal: phrenic nerve
Central: phrenic
Peripheral: intercostal
Motor/sensory innervation of diaphragm and where does it refer
Motor: phrenic c3-c5
Sensory:
Central: phrenic.
Refers to supraclavicular region
Periphery: intercostal
Refers to costal margin of anterolateral abdominal wallLevel of splanchic nerves
Greater t5-9 Lesser t10-11 Least t12 Lumbar l1-2 Pelvic s2-4
Why do gondola arteries branch from aorta immediately inferior to renal arteries
Reflects their embryoial origin
Gonads and kidneys develop adjacent to each other on posterior abdominal wall
What nerve provides parasympathetic to abdomen/pelvis
Vagus/pelvic splanchic
What nerve pierces Psoas and describe pathway/what it innervates
Gentitofemoral
L1-2
Passes anterior because it entered the inguinal canal to innervate cremaster muscle, anterior scrotum and labia major
What nerve is major nerve of perineum and pathway
Pudenal s2-4
Exit pelvis via greater sciatic notch
Pass posterior to sacrospinous ligament and enters lesser sciatic notch into ischioanal fossa
What is the sympathetic and parasympathetic innervation of kidneys and abdominal part of ureter
Sympathetic: least and lumbar splanchic
Parasympathetic: vagus
Sympathetic and parasympathetic innervation of pelvic part of ureter and bladder
Sympathetic: lumbar and sacral splanchic
Parasympathetic: pelvic splanchic
How do visceral afferent fibres conduct pain from viscera superior to pain line
Sympathetic fibres travel retrogradely to inferior thoracic and superior lumbar dorsal root ganglia
How do Visceral afferent fibres conduct pain inferior to pain lime
Parasympathetic fibres to dorsal root ganglia s2-4
Which blood vessel does left ovarian vein drain to
Left renal vein
What blood vessel does right ovarian vein drain
Inferior vena cave
What blood vessel do ovarian arteries branch from
Abdominal aorta
What blood vessels do uterine and vaginal arteries branch fro,
Internal iliac arteries
What are the four nerves of lumbrosacral plexus and spinal cord segments that provide sensory innervation of scrotum of males and labia majora for females
1 ilio inguinal l1
2. Genital branch of genitofemoral l1-2
3. Posterior cutaneous nerve of thigh s1-33
4 pudendal nerve s2-4
Cremaster muscle reflex afferent and efferent
Afferent: ilio inguinal
Efferent: genital branch of genitofemoral
The obturator internis is what to levator ani muscle
Lateral
Pubococcygeus is what to puborectalis
Lateral
Bulospongiusus muscle is what to ischicavernous
Medial
The ilio Psoas passes what is inguinal ligament
Deep
Sacrospinous ligament runs what to sacrotuberous ligament
Deep
The sciatic nerve exits pelvis between what two muscles
Pisiformis and coccygeal
What are the fetal adaptions in the body
- Foramen ovale closes to form fossa oval is
- Ductus arteriesus degenerates to form ligamentum arteriosum
- Ductus venosus degenrstes to form ligamentum venosum
- Umbilical artery degenerates to form umbilical fold
- Umbilical vein degenerates to form round ligament of liver
What nerve is damaged during vaginal delivery that can lead to denier action of external urethral and anal sphincter and why
Pudendal
Sits medial to ischial spine as it re-enters pelvis
Sits in perineum which is superficial hence likely to be injured
