Exam 2 Material (Spine/Spinal Cord) Flashcards by Cody Prentice

Which section of the spine is the most mobile for flexion and extension, lateral motion and rotation?
A. Cervical
B. Thoracic
C. Lumbar
D. Sacral
E. Coccyx

A. Cervical

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Which vertebrae have bifid spinous processes?

Cervical

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Which vertebrae have facets for ribs to articulate?

Thoracic

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Which vertebrae are used to support body weigh?

Lumbar

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Sacral vertebrae are ______ with 5 foramina for nerves to exit.

Fused

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What vertebrae is the lowest disc at?

L5 and Sacrum

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The atlas is the first vertebrae, which the occipital bone rest upon. The superior facet articulates with what of the occipital bone?

Occipital condyle

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Does the atlas have a spinous process?

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Name the joint that the atlas and axis rotate with.

Atlanto-axial joint

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Axis has a projection called what?

Odontoid process (dens)

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Curvature:
Cervical and lumbar __________osis.
Thoracic and sacral _______osis.

Lordosis

Kyphosis

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Which ligament of the spine joins the lamina of adjacent vertebra, limiting flexion and providing postural support?
A. Anterior longitudinal ligament
B. Posterior longitudinal ligament
C. Ligamentum flavum

C. Ligamentum flavum

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Extension of the spine/head is which direction?

Backwards

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Flexion of the spine and head is which direction?

Forward

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Which ligament prevents hyperextension backwards?
A. Ligamentum flavum
B. Posterior longitudinal ligament
C. Anterior longitudinal ligament

C. Anterior longitudinal ligament

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Costco-vertebral joint is onto what? While the costo-transverse joint is where and allows for movement of ribs during respiration?

Vertebral body, above and below

Transverse process

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Intervertebral discs:
Outer ring called?
Inner ring?

Annulus fibrosis

Nucleus pulposus

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The anterior longitudinal ligament limits _________ while the posterior longitudinal ligaments and ligamentum flavum limit______.

Extension (back)

Flexion (forwards)

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Spinal cord injury without radiographic abnormality SCIWORA
Most children and elderly
Typically due to MVA or sports injury
Can present as complete spinal cord injury (loss of sensation and movement)
What ligaments usually tear in an accident like this (think MVA when head whips forward)?

The posterior ligaments get stretched and tear, so it’s the :
Ligamentum flavum
Posterior longitudinal ligament

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How many cervical nerves are there?

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C1 nerve emerges between what?

While C8 nerve emerges below what vertebrae?

Skull and atlas (C1)

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C2-C7 nerves emerge above/below respective vertebrae?

Above

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All lower spinal nerves emerge above/below respective vertebrae?

Below

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How many sacral nerves are there?

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How many coccygeal nerves are there?

The conus medullaris is between what 2 vertebrae in an adult?

T12-L1

Neonate cord terminates between what vertebrae? | Compared to adults, whose cord terminates where?

L1-L3 | L1

How many pairs of spinal nerves are there?

``` Let’s see if we can do basic math, shall we? 8 cranial 12 thoracic 5 lumbar 5 sacral 1 coccygeal = 31 pairs of spinal nerves ```

The conus medullaris, which is the end of the spinal cord and beginning of the string-like cauda equina, is located where in adults?

T12 to L2

The conus medullaris in neonates can be as low as what lumbar vertebrae?

L4. Important for LP’s because you need to go lower on neonates.

The spinal cord has enlargements in the cervical spine for which nerve plexus?

Brachial

The spinal cord has enlargements in the lumbar spine for which two plexi?

Lumbar and sacral plexus

Basic organization of spinal cord: | The anterior or ventral horn (grey matter) carries what type of neurons bodies?

Motor

The posterior or dorsal horn of grey matter carries what neuron cell bodies?

Sensory

A spinal nerve is formed by the junction of what two nerve roots that join after the sensory dorsal root ganglion leading to the periphery?

Dorsal and ventral roots, or sensory and motor.

What is the name of the neuron that connects the dorsal and ventral roots?

Internuncial

These type of receptors are responsible for picking up pressure changes, such as proprioception, touch, vibration, pressure, and 2 point discrimination.

Mechanoreceptors

These type of receptors are responsible for picking up heat/cold.

Thermoreceptors

These receptors pick up pain.

nociceptors

``` Pain and temperature are carried by the: A. Anterior spinothalamic tract B. Lateral spinothalamic tract C. Dorsal column medial lemniscus D. Spinocerebellar tracts ```

B. Lateral spinothalamic tract LSTT ASTT carries crude/light touch, pressure DCML carries tactile discrimination, fine touch, vibration, pressure, conscious proprioception Spinocerebellar carries unconscious proprioception

Nociceptors have A-beta and A-alpha nerves that are _______, and A-delta and C fibers that are ______.

Fast | Slow

``` A-alpha and A-beta are fast, myelinated neurons. What do they signal? A. Dull, burning pain, poorly localized B. Aching pain, temp, and crude touch C. Visceral pain D. Acute, sharp pain, localized ```

D. Acute, sharp pain, localized

A-delta and C fibers (unmyelinated) are slow neurons that carry: A. Acute, sharp pain, localized B. Dull, burning pain, poorly localized

B. Dull, burning pain, poorly localized

What are the 4 types of cutaneous tactile mechanical receptors?

Light/crude touch (ASTT) but also (DCML) Fine/discriminatory touch (DCML) Pressure (DCML) Vibration (DCML)

Proprioception arises from mechanoreceptors in what 3 places?

Muscle spindles Golgi tendon organs Joint receptors

Fast nerve fibers (alpha) are large and carry info needed quickly, such as proprioception, position sense, and _______.

Temperature

Slow nerve fibers, ____ and ____carry aching pain, temp, and crude touch. ______ pain (ie stomach ache) is also carried by slow fibers (stretching and/or distinction of viscera, ischemia)

Delta and C | Visceral/organ

Pain and temperature travel in the ____________ tract and do not have direct somato-sensory connection. They must stop in the _______ first.

LSTT | Thalamus (hence lateral spinothalamic tract)

Sensory pathways are usually a three or more neuron pathway. First order cell bodies are in the ____ _____ _____. Second order sensory neurons are in the _____ _____ . Third order synapse with second order in the _________ before radiating to the cortex.

Dorsal root ganglion Spinal cord Thalamus

LSTT carries ___ and ____ while the ASTT carries ____ ?

Pain and temp | Light/crude touch/pressure

lateral corticospinal motor, aka ________ carries? | Ventral, aka ________, carries?

Pyramidal: Volitional motor activity (intention) Extrapyramidal: modulation and regulation of movement

LSTT decussates where?

At or near cord entrance level (pain and temp)

ASTT decussates where?

At level of entrance to cord and up to 10 levels above

DCML decussates where?

Medulla (conscious proprioception, fine touch/pressure, vibration)

Motor (corticospinal tracts) decussate where?

Medulla

Dorsal and ventral spinocerebellar tracts decussate where?

They don’t, ipsilateral tracts (unconscious proprioception going to cerebellum)

DCML decussate in medulla. How do you test for this in PE?

Stereognosis Romberg Close eyes, touch nose

ASTT carries light/crude touch/pressure. How do you test for this in PE?

Stroking skin with wisp of cotton

LSTT decussates at or near cord entrance level and mediates pain and temp. How do you test for this in PE?

Pin prick | Warm/cold water

Sensory dermatomes: | C1

No supply to skin

Sensory dermatomes: | C2

Second cervical= sleep pillow

C4 sensory dermatome

Four, football shoulder pad

C5-6 sensory dermatome

Radial side of arm, bicep, forearm, hand, thumb

C7 sensory dermatome

Tricep, pointer, middle, and ring finger

C8 sensory dermatome

Ulnar side of forearm | pinky finger

T4 sensory dermatome

Nipple level

T8 sensory dermatome

Rib margin (bottom)

T10 sensory dermatome

Umbilicus

T12-L1

Groin

Inguinal ligament

Medial calf, great toe

Lateral calf and shin, middle toes

S1 sensory dermatome

Distal posterior lower leg/heel area | Pinky toe

S2 sensory dermatome

Posterior thigh/hamstring | Center of posterior calf

S3 sensory dermatome

Buttocks

S4-S5 sensory dermatome

Perineum and coccyx (not the anus)

90% of the pyramidal (intentional motor) lateral corticospinal decussates where? The remainder that do not decussate make up the what tract?

Medulla oblongata | Anterior corticospinal tract

Motor ______ tracts have direct innervation of muscles, while the _______ tract modulates/regulates movements.

Pyramidal (Lateral and anterior corticospinal tracts) | Extrapyramidal (rubrospinal, reticulospinal, vestibulospinal, olivospinal)

Whereas sensory are usually a 3 neuron system, motor pathways are typically ___ neurons. The upper motor neuron cell body is in the ____ and fibers descend to the ventral/anterior horn (they may synapse with interneurons). The lower motor neuron cell body is in the _____ ______ and fibers proceed to skeletal muscle.

2 Cortex Ventral/anterior horn (grey matter)

Upper motor neuron (UMN) lesions are associated with _____ and _____ while lower motor neuron (LMN) lesions are associated with _______ and _______.

Hypertonicity and spasticity | Hypotonicity and flaccidity

UMN lesion PE findings will be _____ if lesion is above decussation and ____ if below decussation. Because UMN decussate in the medulla.

Contralateral | Ipsilateral

The polio virus has an infectious predilection for the _____ horn cells of the gray matter of the spinal cord and motor nuclei of the brain stem.

Anterior (motor)

Pain reflex: | Impulses go the the spinal cord where they synapse with both _____ and _____ neurons.

LSTT | Internuncial

Pain reflex: _____neurons synapse with internuncial neurons Internuncial neurons synapse with ____ neurons. Internuncial neurons may cross over the cord Internuncial neurons may _____ or ____ the cord. Internuncial neurons can recruit a number of ______ responses to the painful stimulus Examples: ______ reflex, ______ reflex

``` Sensory Motor Ascend or descend Muscle Corneal reflex, withdrawal reflex ```

muscle stretch/deep tendon reflex: Evaluation of spinal segments: S1, L2-4, C5-7 ``` Test for S1 DTR where? Test for L2-4 DTR where? Test for C5 DTR where? Test for C6 DTR where? Test for C7 DTR where? ```

``` S1 at Achilles L2-4 at inferior patellar tendon C5 at bicep C6 at radialis C7 at triceps ```

Posturing: signs of UMN lesion/damage ______: arms flexed on chest, plantar flexion ______: arms adducted and pronated position, wrist flexion (brainstem damage below pons)

Decorticate | Decerebrate

Spinal cord lesions: Polio is where? ALS is where? Ventral/anterior spinal artery occlusion is where?

Polio:Anterior horn gray matter (motor) ALS: anterior horn gray matter, and lateral corticospinal (motor pathways) Ventral spinal artery occlusion: everything except dorsal column medial lemniscus and small part of dorsal horn gray mater.

Exam 2 Material (Spine/Spinal Cord) Flashcards

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