Exam 1 Flashcards
What is neuropathy?
*pathology of nerves, pain (paresthesia, anesthesia) that you feel that results from damage to nerve compressed
What type of damage causes neuropathy?
*compressed nerve or viral infection to nerve
What is neuropathy a result of?
*incorrect signal to brain that makes it think its pain (brain interprets it as pain)
What type of pain is neuropathy?
*often deep pain
What are dermatomes involved in?
*outbreaks of certain diseases
How do people get shingles/ where does the virus live?
*they had chicken pox and then the virus migrated into axons of spiral nerves and live there in the spinal ganglion
At what age do people get shingles?
*40’s to early 50s
What can shingles lead to?
*blindness on face or 2nd bacteria infection (rare)
How can you cure shingles?
- resolve in number of weeks, can take antiviral
* zostavex vaccine available
What is post herpetic neuroigia?
*pain remains after shingle sores go away (13% or people)
Can you get shingles more than once?
*yes, but not common
What cushions the spinal cord?
*cerebrospinal fluid
What is inside the vertebral canal?
*spinal cord
Where does the spinal cord end?
*L2 vertebral level
What is held in the lumbar enlargement?
*cell bodies of motor neurons
How many spinal nerves are there?
31
Where can variation in the number of spinal nerve occur?
*sacral region
What is a peripheral nerve?
*every spinal nerve
What is a spinal nerve?
*somatic motor and sensory and visceral motor (has al of these)
What is a named nerve?
*fibers from different spinal segments (ex. Thoracolumbar nerve)
Where is the Dural Sac located?
*L2-S2
What is a plexus?
*fibers from different spinal segments that blend together
What are the 4 plexus of spinal nerves?
*cervical, brachial, lumbar, sacral
Where is the cervical plexus located?
*C1-C4
Where is the brachial plexus located?
*C5-T1
Where is the lumbar plexus located?
*L1-L4
Where is the sacral plexus located?
*L4-S4
What fluid is in the lumbar cistern?
*cerebrospinal fluid
Where does the lumbar cistern go to?
*S2
Where do the cervical and lumbar plexus emerge from?
*cervical enlargement and lumbar enlargement
What is the cauda equine?
*spinal nerve roots (from lumbar and sacral part)
What is the Pia mater bound to and how thick is it?
- tightly bound to neural tissues
* 1-2 cell layers thick
What are meninges?
*CT coverings of CNS
Where is CSF made?
*in ventricle of brain in choroid plexus
Where does CSF circulate?
*in sub-arachnoid place and gets reclaimed in A. granulations
What blends into the epineuron?
*dural root sheath
What covers the arachnoid space and is where CSF flows (circulates around)?
*arachnoid trabeculae
What is the Dura-arachnoid interface (subdural space)?
*potential space (empty) or fluid can fill it up (real space)
What does the dura mater cover?
- very tough, doesn’t stretch much
* covers entire spinal cord and wraps it in dural sheath
What does the dura mater flare and attach to?
- bump of intervertebral foramen
* attached inside vertebral column
How is the spinal cord held?
*lateral by denticulate ligaments
What is the dura mater tightly bound to?
*bone (anchored to skull)
What is the BS to the spinal cord?
*spinal artery (1 anterior and 2 posterior)
The spinal branch ends as?
- radicular artery
* segmental medullary artery
What does the radicular artery supply blood to?
*spinal nerves of cell and spinal cord proper
What supplies the spinal branches of the thoracic region?
*posterior intercostal artery
What supplies blood to the spinal branches of the cervical region?
*vertebral artery, ascending cervical and deep cervical
What supplies the blood to the spinal branches of the lumbar region?
- lumbar artery
* median sacral artery
What supplies the blood to the spinal branches of the sacral region?
*lateral sacral artery
What is the filum terminal externum part of and what does it anchor?
*end of dural sac, anchores it to the coccyx
What is in the filum terminal internum?
*pia mater, and neural tissue
What does the vertebral column do?
*takes weight of head and upper limb and distributes it to vertebrae, protects spinal cord, restrict/allow movement
How many vertebrae are there?
*33
What is the curvature of the cervical, thoracic, lumbar and sacral region?
- C: convex
- T: concave anteriorly
- L: convex
- S: concave
Only primary curvatures are?
*concave
What are primary curvature due to?
*wedge shape of vertebrae (concave anteriorly)
What are secondary curvature due to?
*different growths of vertebrae disk (anterior vs posterior parts
Convex anteriorly is called?
*Lordosis
Where is excessive kyphosis typically found and due to?
- thoracic spine in elderly women
* due to osteoporosis
Where/what is excessive lordosis typically found?
- ant. pelvic tilt
- found in obese people (who lack muscle tone in abdominal)
- temporarily found in pregnancy
What is scoliosis and what causes it?
- left or right slant of spine
* hemivertebrae and imbalance in muscle tone (myopathic)
What are the parts of the vertebral foramen?
*pedicle, lamina, and post. body
What are some things that compress spinal nerves and where are they found?
- osteophytes, herniated disk, osteoporosis
* zygopophyseal joing
Where do spinal nerves originate?
*intervertebral foramen
What passes through the intervertebral foramen?
*spinal branches, fibers that innervate zygopophyseal joing, DRG
What limits spinal flexion?
- ligamentum flavum
* longitudinal ligament
The nucleus pulposus is?
*85% water
What is a fibrocartilage joint?
*intervertebral disc
What is more than half of the vertebrae covered in?
*anterior longitudinal ligament
What is the anterior longitudinal ligament and what does it limit and cover?
- heavy band of CT
- limit of extension
- covers IVD, keeps it from failing
Where are the interspinous/ supraspinous ligaments heaviest in and what do they do?
- cervical region
* limit flexion
The pelvic girdle is there for?
*stability, not designed to move freely though
What links the anterior most halves of hip bone?
*pubic symphysis
What is the anterior part of the thigh for?
*flex hip, extend knee
What is the medial part of the thigh for?
*adduction of lower limb
What is the posterior part of the thigh for?
*extend hip, flex knee
What does the gluteal region do?
- abduct lower limb
What holds down the tendons of dorsiflexors?
*retinacula
The sciatic nerve is divided into 2 division?
*fibular and tibial
What are the BS of the medial comp. of thigh?
*obturator artery, and perforating art
What is the name of an artery that enters a bone?
*nutrient artery
What is the regional BS of the spinal cord?
*lumbar artery
The internal and external vertebral venous plexus goes from?
*sacrum to large veins (in. dural venous sinus) in skull
What drains the brain?
*int. dural venous sinus
What is a valveless network of veins that is probably how prostate cancer spreads to the brain?
*int. dural venous sinus
Where can you access the sacral hiatus route?
*S4-S5
What is the route the needle travels during a lumbar puncture?
*interspinous route (midline route)
Where does the spinal cord end in most people?
*L2
Where should you do a lumbar puncture and where can it never be above?
- L3 or L4
* L2 or above
Why would you obtain a sample of CSF?
*check for infection, diagnosis sub arachnoid hemorrhage, and check pressure
Where would you introduce epidural anesthetic?
*into lumbar cisterne or in around nerve roots (cauda equine, into fat)
What are the risks of a lumbar puncture?
- epidural hematoma (can cause sensory deficit)
* subdural hematoma (in potential space or real space, sensory or motor deficit)
What do you go through during a lumbar puncture to take out CSF and inject anesthesia?
*dura
During a herniated disk, what can the nucleus pulposus do?
*blast into vertebral body
What is the typical herniated disk?
*postural lateral
What can a herniated disk cause?
*sensory and motor deficit (pinches both roots)
Why do disk herniate?
- degeneration of disk with age (height decreases)
* traumatic (accident, lift and twist)
Where do most herniated disk happen?
*in cervical and lumbar spine (L4-L5 disk, and L5-S1 disk)
What are the symptoms of the herniated disks?
- cervical and lumbar pain (intensify when cough and sneeze)
* neuralgia, numbness, pain, pins and needles
If the IV disc L4/L5 is herniated what does it affect?
*L5 nerve root
If the IV disc L5/S1 is herniated what does it affect?
*S1 nerve root
What are the treatments for herniated disk?
- nothing (goes away in 6-8 weeks)
- antinflamatory, cortisone injection
- spinal fusion (helps 50%)
- framamectomy- grind out vertebral foramen so its large
How many hip bones do we have until puberty?
*3
What attaches to the ischial tuberosity?
*sacral tuberous ligament
What holds the lesser sciatic notch?
*sacral spinous
What are lined up on the hip bone?
*ASIS and pubic tubercle
What are the artery/vein/nerve of the gluteal region?
*superior/inferior gluteal artery/vein/nerve
What is the innervation of the superior gluteal nerve?
*sup. glut max, med, min, and tensor of fascia
What delivers blood to the superior gluteal nerve?
*superior gluteal artery
What is the innervation of the inferior gluteal nerve?
*inferior glut max
What delivers blood to the inferior gluteal nerve?
*inferior gluteal artery
Where does the sciatic nerve arise from?
*L4 to S4 (lumbarsacral plexis)
Where does the sciatic nerve emerge from?
*inferior to piriformis
Where does the sciatic nerve split at?
*popliteal region
What is the main hip abductor and keeps the hips level?
*glut medius
What is an inconstant muscle?
*not everyone has them
What are the superficial muscles of the gluteal region?
*glut. max, med, tensor fascia
What do the superficial muscles of the gluteal region do?
*extend hip, laterally rotate hip, abduct hip (glut med, glut min, and tensor fascia)
What do the deep muscles of the gluteal region do?
- lateral rotators of hip
* often fused
What are the muscles of the deep muscles of the gluteal region?
*piriformis, sup gemellus, inf gemellus, quadratus femoris
What do 12% of people have and what is it blamed for?
- fibular division separates and pierces the piriformis
* blamed for piriformis syndrome
What do fewer than 1% of people have?
*fibular division superior to piriformis
What do 87% of people have?
*fibular division below the piriformis
What is sciatica?
*neuropathy of the path itself (from L4 to S4)
Where is Sciatica felt?
*pain in butt that goes down posterior thigh and can go down to foot
What can sciatica cause?
*foot drop
How is sciatica diagnosed?
*straight leg raise
What causes sciatica?
- lumbar disc trauma/degeneration
- piriformis syndrome
- idiopathic (don’t know what causes it)
- improper intergluteal injection
What are the treatment of Sciatica?
- do nothing (go away in 6-8 weeks)
- antiinflamatory
- surgical alt (discectomy, remove bulge part of disc)
- spinal fusion (space out vertebrae)
- stenosis (narrowing of passageway )
What happens if you hit the sciatic nerve during a intragluteal injection?
- damage nerve
* destroys axons and glia cells
What is an improper intragluteal injection also called?
*accidental interneural injection (most common injury)
What are the signs and symp of hiting the sciatic nerve?
- pain and numbness
- felt in whole projection of sciatic nerve
- difficulty walking, foot drop
What is foot drop?
*can’s dorsiflex the foot
What are the treatment after hitting the sciatic nerve?
- immediate surgical correction
- neurosis- cut nerve and flood drug out
- transacral nerve block (to help with pain)
What is gluteus medius paralysis?
*hip drops from opp side of injury
How do people with a gluteus medius paralysis compensate?
*gluteal gate- swing leg out as walk
What is a trendelengurg sign?
*dropping of hip
What is held by the rotator cuff muscles?
*glenohumeral join (shoulder joint)
What is the elbow joint like?
- a hinge joint
* almost like bone to bone joint that locks
What is the glenohumeral joint like?
*planar and ball joint
What is the elbow joint for?
*stability, but not a lot of movement
What kind of fascia is at the wrist?
*flexor/extensor retnaculae
What is the anterior compartment of the arm?
*flexor compartment
What is the BS and innervation of the anterior part of the arm?
- BS: brachial art
* inn: musculocutaneous nerve
What are the muscles of the anterior compartment of the arm?
*brachialis, coracoid brachialis, and biceps brachii
What does the posterior compartment of the arm?
*extensor of elbow
What is the BS and inn of the posterior compartment of the arm?
- BS deep art of arm
* inn: radial nerve
What are the muscles of the posterior comp. of the arm?
*triceps brachii (3 heads)
What is the BS and inn of the anterior part of the forearm?
- BS: radial and ulnar art
* inn ulnar and median nerves
What does the anterior part of the forearm do?
*flexor and pronator
What does the posterior part of the forearm do?
*extensor
What is the BS and inn of the posterior part of the forearm?
- BS: post interosseous art
* inn: radial nerve
What is lymphedema?
*removing lymph nodes
How does lymph flow and where does it end up?
- to trunk
* ends up in axillary lymph nodes (collect from pectoral region)
Where does the radial nerve run close to?
*humerus
What does the ulnar nerve innervate?
*muscles of forearm and hand
What is the innervation of the musculocutaneous nerve?
- motor innervation
* cutaneous inn to lateral forearm
What is the innervation of the median nerve?
- motor inn to forearm and hand
* superficial in elbow
What are the lateral and medial rotator of the scapular region?
- L: teres minor
* M: teres major
What are the rotator cuff muscles?
*subscapularis, supraspinatus, infraspinatus, teres minor
What do mesenchyme cells do and can convert to?
- loosely organized
- migrate to different parts of body
- can convert to epithelium
What is differential gene expression also called?
*differential cell lineage
What is transduction?
*when an external signal is changed to an internal signal
What is paracrine?
*diffuse over short distance
What is juxtacrine?
- signal doesn’t leave cell membrane
What can transduction be?
*mechanical (stretch or squish) or it can be electrical
What is a paracrine morphogen?
*shape changer
What does a nodocord release and induce?
*a sign and induces tissues above it to roll up in a tube which becomes brain and spinal cord
What is induction?
*chem signal of some cells influence the rate of nearby cells (often are reciprocal)
What is a ligand?
*signal
What are the signaling gene families?
- hedgehog (nerv and vert column)
- TGF (transforming growth factor)
- WNT (wingless and integrated)
- FGF (fibroblast growth factor)
- neurotransmitter (serotonin)
When is the embryo most likely to get a malformation?
*week 3-8 (embryogenesis)
What are the causes of malformation during pregnancy?
- environmental things (teratogens)
* alcohol, VPA (acts like estrogen), drugs, plant toxins, charred meat, poor diet
What are the big events in embryogenesis?
*formation of the blastocyst, bilaminar germ disc, trilaminar disc, and nervous system
What are the 3 germ layers and what are they derived from?
- sensing layer (ectoderm)
* movement layer (mesoderm) *absorbing layer (endoderm)
What does the sensing layer give rise to?
*epidermis and derivatives, melanocytes, facial skelet.
What does the sensing layer become?
*nervous system and enamel of teeth, adrenal medulla
What does the movement layer give rise to?
*muscle, bone, cartilage, ligaments, tendons, fascia, urogenital system, membrane lining the body cavity, blood and immune cells
What does the endoderm give rise to?
*lining of gut, accessory organs of gut (liver), glands lining GI tract
Why do half of blastocyst not implant?
*chromosomal abnormalities
What is everything we recognize as us?
*inner cell mass
What is trophoblast?
*tissues that contact mother, placenta
What do trophoblast differentiate into and when does it happen ?
- syncytrotrophoblast
- cytotrophoblast
- week 2
The inner cell mass turns into?
*epiblast and hypoblast
What does the epiblast become and give rise to and when?
- amniotic cavity and gives rise to “derm” layers
* week 3
What forms in the yolk sac?
*first blood cells and gomads
What does the hypoblast become?
*yolk sac
What cavities form in week 2?
- chorionic cavity
* amniotic cavity
What do you have at the end of week 2?
*head and tail end
What is the future mouth and anus of the fetus?
- A: cloacal membrane
* M: oropharyngeal membrane (buccopharyngeal membrane)
What is the primitive streak induced and maintained by?
*NODAL from TGFB
What is gastrulation and how long does it last and when does it happen?
- stomach making, start with bilaminar germ disk and end with trilaminar germ disk
- last 2 weeks, happens in week 3
- epiblast cells migrate toward primitive streak and they drop through it, makes 3 layer (mesoderm)
Where don’t mesoderm go?
*oropharyngeal and cloacal membrane, goes everywhere else
What happens in week 3?
- gastrulation
- neural crest cells migrate to form PNS
- somite development
- get 3 layers and cavities
*primitive streak disappears
What is a precursor to vertebrae, covering of deep back muscles and skin?
*somites
What induces neurulation (formation of neural tube)?
*induction of notochord
What becomes the brain and spinal cord?
*neural tube
What happens during neurulation?
- begins in week 3, ends week 4
* rolls up and pinches off into a tube (has ectoderm on top)
What chemical sign induces neurulation?
*sonic hedgehog
When is the critical period for the nervous system?
*week 3-11
What does the neural crest go from?
*epithelium cells to mesenchyme cells
What is the inducer of the prefrontal brain?
*prechordal mesoderm
What does the prechordal plate mesoderm become?
*heart and central tendon of diaphragm
What becomes somites?
*paraxine mesoderm
What does the intermediate mesoderm become?
*urogenital structures
What does the lateral plate mesoderm become?
*lining of body cavity
What does the extraembryonic mesoderm become?
*surrounds yolk sac and becomes part of umbilical cord
When does the cranioneural pore and caudal neuro pore close?
- CR: day 25
* CA: day 28
What causes somite differentiation?
*signals from notochord
What does the dorsal part of somites and ventral and middle part become?
- D: deep back muscles
- V: trunk muscles
- M: dermis
What does sclerotome become?
*vertebrae and migrate around neural tube and meninges
What is Raschisis and what does it lead to?
- meninges don’t form prop
- anencephaly (not enough tissue in brain)
- amniotic fluid destroys neural tissue
What is spina bifida occulta?
- post vertebrae don’t form ( vertebral foramen not complete)
- sometimes with cutaneous market
What is spina bifida cystica?
- development of sac or disk
* meninges herniate outside V. canal
What is meningocoele and where is it most common?
- part of neural tissues is herniated outside V. canal
* most common in lumbar (any higher more serious problem)
What is holoprosencephaly?
*missing midline structures (external and internal)
What surrounds the oropharengeal membrane and induces forebrain development?
*prochordal
What is convergent extension?
*lateral cells migrate inward which results in lengthening of embryo
What genes are necessary for convergent extension and what interferes with it?
- planar cell polarity
* alcohol (also interferes with sonic hedgehog)
What is a body cavity?
*potential space
What has a musculoskeetal wall and what does it do?
- thoracic
* protect organs, anchor for upper limb, and muscles necessary for ventilation
What is even with the 2nd rib?
*sternal angle
What surrounds the superior thoracic aperture?
*body of T1, 1st rib, sup. margin of manubrium, costal cart. of 1st rib
How are the floating ribs connected?
*through soft tissue
What is between ribs?
*intercostal muscles
What are the borders of the inferior thoracic aperture?
*body of T12, 12th and 11 rib, costal margin, and xiphoid
What depresses and elevates the ribs?
- E: external intercostal, and innermost intercostal
* D: internal intercostal
What is active during inhalation, and relaxes during exhalation?
*intercostal muscles
What is the pectoralis minor and major innervated by?
*medial and lateral nerves
