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A/P > Lecture 10; 9/18 > Flashcards

Lecture 10; 9/18 Flashcards

Test 2

1
Q

What is in the subarachnoid space?

A

That is the potential space

2 subarachnoid blood vessles

Nothing else

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2
Q

Describe the epidural space

A

Above the dura layer

Filled with fat tissue and blood vessles

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3
Q

In what area do you give a spinal block?

A

Subarachnoid space

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4
Q

What risks do you run with doing a spinal block?

A

Puncture of the spinal cord because closer in the subarachnoid space

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5
Q

Why does a spinal block work faster than an epidural?

A

Epidural is given in the epidural space which has lots of fat so medication spreads slower

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6
Q

Where do you give an epidural?

A

In the epidural space

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7
Q

What risks do you run with giving medications in the epidural space?

A

Lipidphillic drugs get sucked into fat tissue and have longer onset and take longer to wear off

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8
Q

What are the venous blood vessels called in the epidural space?

A

Posterior/anterior internal vertebral venous plexus

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9
Q

If we run the risk of puncturing the spinal cord during a spinal then….

A

Its best we do a spinal in a place after the physical cord ends

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10
Q

Where does the spinal cord start?

A

Medula Oblongata

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11
Q

Where are your spinal cord enlargements?

A

C3-C6

T11-L1

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12
Q

Where does the spinal cord end?

A

Conus Medullaris
L1

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13
Q

Where is the cervical enlargement? Why do we have this?

A

C3-C6

Extra neurons d/t the brachial plexus (shoulder)

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14
Q

Where is your lumbar enlargement? Why do we have this?

A

T11-L1
Extra neurons d/t lumbar plexus and siatic nerve

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15
Q

What is under the conus medullaris?

A

After L1 is spinal roots that form spinal nerves

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16
Q

T/F: The dura layer goes all the way down to the bottom of the sacrum

A

T

Even though the cord ended, the spinal roots will have dura on them

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17
Q

What are the spinal roots called that flow after the conus medullaris?

A

Cauda Equina
“Horse Tail”

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18
Q

What is the Internum Filum Terminale?

A

Extension of pia mater

connective tissue inside the dursal sac that anchors the end of the cord to the end of the dural sac

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19
Q

What is the externum Filum terminale?

A

External anchor that connects the end of the dural sac to the coccyx

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20
Q

What is the purpose of the internum and externum filum terminales?

A

To keep the spinal cord from retracting up

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21
Q

What is another name for the dural sac?

A

Lumbar Cistern

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22
Q

What is in the dural sac?

A

Cauda Equina and CSF

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23
Q

Where does the dural sac end?

A

S2

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24
Q

Why is L4 area a great place for a spinal block?

A

Less risk of spinal cord puncture because the cord itsself ends at L1

We can easily find it via the illiac crest

Easier access midline

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25
Q

Where is the conus medullaris in a newborn?

A

L3

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26
Q

Where can CSF get stale in the spine at?

A

L-spine

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27
Q

What are the access points to give meds in the S spine?

A

S2 posterior sacral foramina
Sacral hiatus (Not used often)

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28
Q

Why do we want to give drugs at a 15 degree angle shift vs directly midline?

A

Incomplete fusion of the ligamentum flava

If it didnt completely fuse you’ll be missing the middle of it.

Going off center counteracts that

If you go midline with an incomplete fusion, you’ll go right through because you never felt that change in resistance, possibly piercing the spine

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29
Q

Where is the grey matter loacted on the brain?

A

More superior

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30
Q

Why are the blood vessles in the brain more superior?

A

Because the grey matter is more superior and its metabolism is higher because its where the decisions are being made

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31
Q

What is an epidural hematoma?

A

A bleed above the dura layer

Arterial bleed from cranial bone Fx

Moreso stays in one place but still bad

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32
Q

What is the Arachnoid trabeculae?

A

Pillars between the arachnoid layer and pia mater that has blood vessles and CSF

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33
Q

What is a subdural hemorrhage?

A

Bleed under the dura layer

Venous bleed from the sinouses in the brain

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34
Q

What is a subarachnoid hemorrhage?

A

Bleed under the arachnoid layer

Arterial… usually worse than a epidural bleed

Diffuses into tissues

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35
Q

What are the containers for CSF called?

A

Ventricles

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36
Q

What is normal ICP

A

10mmHg

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37
Q

Where is CSF produced?

A

In the choroid plexus in the ventricles

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38
Q

How many CSF ventricles are there?

A

4

39
Q

Where is CSF reabsorbed back into the CVS? And why does this happen?

A

Arachnoid granulations

To keep the CSF within normal range

40
Q

What are arachnoid granulations?

A

Pressure blow off valves that help equalize the pressure of CSF circulating

41
Q

Where is the arachnoid granulations located?

A

Above the longitudinal fissure

42
Q

What happens if the arachnoid granulations are blocked?

A

Communicative hydrocephalus

Increased ICP

43
Q

What does the cerebellum do?

A

responsible for coordination

44
Q

Where does the 4th ventricle empty CSF?

A

Median aperture
Lateral apertures
Central canal

45
Q

What is the cerebellomedullary cistern?

A

Pool of CSF from the median aperture that circulates CSF around the cerebellum

46
Q

What is communicating hydocephalus vs noncommunicating?

A

Communicating: CSF not being reabsorbed (arachnoid granulations); high pressures everywhere

Non communicating: Pathway blockage; enlarged ventricle

47
Q

What is another name for the median aperature of the 4th ventricle?

A

Foramen of magendie

48
Q

what is the exit point for CSF?

A

Central Canal

49
Q

What is another name for the Cerebral aqueduct?

A

Aqueduct of sylvius

50
Q

What does the cerebral aqueduct do

A

circulates CSF from 3rd to 4th ventricle

51
Q

What is the other name for the interventricular foramen?

A

Foramen of Monroe

52
Q

What does the foramen of monroe do?

A

CSF from lateral ventricles to 3rd ventricle

53
Q

What are the lateral apertures?

A

exit point for CSF

Circulates CSF around the subarachnoid space

54
Q

What is another name for Cerebellomedullary cistern?

A

Cisterna magna

55
Q

Explain CSF flow

A

CSF is created in the choroid plexus of the ventricles

Lateral ventricles

Interventricular foramen (foramen of monroe)

3rd ventricle

cerebral aqueduct (aqueduct sylvius)

4th ventricle

median aperture (foramen of magendie), central canal, or lateral apertures (foramen of Luschka)

56
Q

What is another name for later apertures?

A

Foramen of Luschka

57
Q

What perfuses the brain?

A

Cranial Sinuses

58
Q

Crainal Sinuses: Superior Sagittal Sinus

A

Midline

most superior

59
Q

Crainal Sinuses: Inferior Sagittal Sinus

A

Midline

Inferior to superior sigattal sinus

60
Q

Crainal Sinuses: Straight sinus

A

Tail end of inferior sagittal sinus

connects superior and inferior sagittal sinuses

61
Q

Crainal Sinuses: Sinus Confluence

A

Where superior and inferior sinuses connect via straight sinus and connects with transverse sinus

62
Q

Crainal Sinuses: Transverse Sinus

A

Lateral exit point for the straight sinus

63
Q

Crainal Sinuses: Sigmoid Sinus

A

Makes hairpin turn

where blood flows into internal jugular vein

64
Q

Crainal Sinuses: Cavernous sinus

A

Venous collection pool in front middle part of brain

feeds into sigmoid sinus to internal jugular vein

65
Q

What is Falx cerebri?

A

Connective tissue between the L and R hemispheres

Also between superior and inferior sagittal sinuses

66
Q

Where does the occipital lobe sit?

A

Tentorium cerebelli

67
Q

What is inferior to the tentorium cerebelli?

A

Cerebellum

68
Q

Where does the sigmoid sinus empty into?

A

Internal Jugular vein

69
Q

How many jugular veins do we have on 1 side?

A

2- external and internal

external is small

70
Q

What does the lateral apertures do?

A

Move CSF to the subarachnoid

71
Q

What is arterial blood flow?

A

750 ml/min

50ml/min per 100grams of brain tissue

72
Q

How much of our body weight is our brain?

A

2/3%

73
Q

How much of our cardiac output does our brain use?

A

15%

74
Q

How much of blood flow is for grey matter?
White matter?

A

80%

20%

75
Q

What happens when we metabolic activity in the brain increases

A

Blood flow increases

76
Q

Why does white matter have less blood flow?

A

20%

efficient at cell signaling

77
Q

CSF composition: pH

A

7.31

78
Q

The brain is carefully regulated by glial cells__________

A

astrocytes

79
Q

CSF composition: Na+

A

140

80
Q

CSF composition: Cl-

A

140

81
Q

CSF composition: K+

A

40% LESS than plasma values

82
Q

CSF composition: Mg++

A

Higher than plasma

83
Q

CSF composition: Glucose

A

60mg/dL

84
Q

CSF composition: color

A

clear

85
Q

CSF composition: RBC

A

None

86
Q

CSF composition: protein

A

No large amounts

87
Q

CSF composition: volume

A

150ml

88
Q

How much CFS is produced in a day?

A

500ml

89
Q

How often is CSF replaced?

A

About 3 times per day

90
Q

What is a chorois plexus made of?

A

ependymol cells

91
Q

What are ependymol cells permeable to?

A

Na, Cl, H2O

and they have Na+ pumps and Cl- pumps

92
Q

What does the ependymol cells do?

A

Separate CVS from CSF circulatory system

has access to blood, water, electrolytes, etc

93
Q

What happens if we increase the Na in the Na+ pump in the ependymol cells?

A

We increase the amount of CSF produces

A/P (25 decks)

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