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DCCJP Final Prep > Module 2, Year 1 - Clinical Anatomy II > Flashcards

Module 2, Year 1 - Clinical Anatomy II Flashcards

1
Q

Describe the role of the Alar Ligaments

A

Limit atlas rotation, create normal coupled motion with C2 with lateral flexion (tilting right creates left C2 rotation and vice versa)

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2
Q

Which is stronger, a membrane or a ligament?

A

Ligaments tend to be stronger

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3
Q

Explain the paradoxical motion of C1

A

During deeper cervical flexion, limitation of the flexibility of the ligamentum nuchae pulls on C1 and causes the craniocervical junction to go into extension.

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4
Q

What divides the anterior and posterior triangles in the neck?

A

SCM

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5
Q

How many triangles are within the anterior triangle?

A

4

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6
Q

How many triangles are within the posterior triangle?

A

2

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7
Q

Which triangle contains the carotid artery?

A

Carotid triangle

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8
Q

What notable arterial supply is found in the cavernous sinus? Where does it originate from?

A

The carotid syphon is located in the cavernous sinus. When the internal carotid artery becomes the middle cerebral artery, it curves forming the carotid syphon.

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9
Q

What innervates the dura mater?

A 
CN V (supratentorial)
CN X (infratentorial)
C1-C3 (sensory)
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10
Q

Does the jugular vein drain more when you lie down or stand? By how much?

A

Lying down, up to 10x more drainage

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11
Q

What is a cistern?

A

A dilation of the subarachnoid space that contains CSF, nerves, and blood vessels.

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12
Q

What is an arachnoid cyst? What are the most common locations to see one?

A

Dilations of the subarachnoid space, usually congenital. Typically, are asymptomatic and no intervention is needed.

Most commonly, they are found in the middle fossa or posterior fossa.

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13
Q

Describe the Monro-Kellie Doctrine

A

If there is more fluid coming in and not draining, the nervous tissue will be compressed. Chonically, this leads to brain shrinkage due to cells dying from excitotoxicity.

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14
Q

Where does the cervical plexus reside?

A

Ventral rami of C1-C4

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15
Q

Where does the phrenic nerve reside?

A

C3-C5

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16
Q

What is the function of the superior oblique muscle?

A

Moves the eye down and out (or abduction, intorsion, depression)

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17
Q

Which ligament is responsible for coupled motion at the CCJ?

A

Alar ligament

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18
Q

What is meant by paradoxical motion of atlas?

a. At the end of cervical flexion, C1 extends
b. At the end of cervical flexion, C1 flexes
c. At the end of cervical flexion, C1 rotates
d. A & C
e. B & C

A

a. At the end of cervical flexion, C1 extends

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19
Q

Evidence supports the existence of a myodural bridge at which muscles?

A

Rectus capitis posterior minor
Rectus capitis posterior major
Obliquus capitis inferior

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20
Q

Myodural bridges seen at C1 and C2 are considered to be extensions of what ligament?

A

Meningovertebral ligament

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21
Q

Which of the following is false concerning the myodural bridge?

a. It may play a role in maintaining proper CSF with head movement.
b. It may contribute to postural control
c. It is made up of collagen type II fibers
d. It is seen most consistently between the rectus capitis posterior minor, rectus capitis posterior major, and the obliquus capitis inferior.
e. There is some evidence to suggest it may exist at rectus capitis anterior and nuchal ligament.

A

c. It is made up of collagen type II fibers.

This is not a true statement. Myodural bridges are made up of collagen type 1 fibers.

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22
Q

Which of the following are epidural ligaments?

a. Dentate ligaments
b. Meningovertebral ligaments
c. Hoffman’s ligaments
d. A & B
e. B & C

A

e. B & C

Both dentate and hoffman’s ligaments are epidural ligaments

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23
Q

The carotid siphon is a continuation of which part of the carotid artery? Where is it located?

A

Internal carotid artery; cavernous sinus

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24
Q

The superior sagittal sinus receives fluid from which of the following?

a. Lateral lacunae
b. Inferior cerebral veins
c. The straight sinus
d. Superior cerebellar veins
e. None of the above

A

a. Lateral lacunae

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25
Q

Which is NOT an influence of CSF movement?

a. Respiration
b. Cardiac system
c. Head movements/posture
d. Traube-Herring Mayer waves
e. None of the above

A

e. None of the above

Respiration, heart rate, head movement, and Traube-Herring Mayer waves all contribute to CSF movement.

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26
Q

Following a motor vehicle accident, a patient presents with an unrelenting dilated pupil and reports abnormal smell and taste sensations. Where might the lesion be?

a. The caudal pons affecting CN VII
b. The mesencephalon affecting CN IV
c. An uncal herniation of CN III
d. The cribriform plate affecting CN I
e. The tentorial notch affecting CN VI

A

c. An uncal herniation affecting CN III

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27
Q

Which of the following tracts carry proprioceptive information?

a. Spinocerebellar and spinothalamic tracts
b. Spinothalamic and dorsal column medial lemniscus tracts
c. Spinocerebellar and dorsal column medial lemniscus tracts
d. All of the above
e. None of the above

A

c. Spinocerebellar and dorsal column medial lemniscus tracts

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28
Q

Which of the following is false concerning the spinocerebellar tracts?

a. They enter the cerebellum via the superior and inferior peduncles
b. They carry conscious proprioceptive information
c. They are considered a primary ascending tract
d. They carry ipsilateral information about the body
e. None of the above

A

b. They carry conscious proprioceptive information.

No, while proprioceptive, it is non-conscious.

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29
Q

The spinotrigeminal tract carries sensory information for the face and consists of three primary nuclei: the mesecephalic nucleus, the chief nucleus, and the spinotrigeminal nucleus. Which of htese nuclei are responsible for carrying information about pain and temperature?

a. Mesencephalic nucleus
b. Chief nucleus
c. Spinotrigeminal nucelus
d. A & B
e. A & C

A

c. Spinotrigeminal nucleus

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30
Q

A lesion of the subthalamic nucleus may result in:

a. Resting tremor
b. Hypokinesia
c. Muscle rigidity
d. Chorea
e. All of the above

A

D. Chorea

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31
Q

A lesion at the level of the rostral pons may present with which of the following:

a. Extended head posture and reduced ability for cervical flexion
b. Flexion of the trunk
c. Reduced reflexive head movement to auditory and visual stimuli
d. A & C
e. B & C

A

d. A & C

Head posture will be extended, flexion limited. Reflex to auditory and visual stimuli will negatively be affected.

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32
Q

Damage to the reticular formation may result in which of the following?

a. Difficulty staying awake
b. Poor ability to maintain an upright posture
c. Loss of coordination of respiratory musculature
d. Loss of pain regulation
e. All of the above

A

e. All of the above

Reticular formation damage would negatively affect sleep, upright posture, respiratory muscles, and pain regulation.

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33
Q

The presence of vertical nystagmus is always pathological. Where might the lesion be when vertical nystagmus are present?

a. The primary visual cortex (Brodmann’s area 17)
b. Midbrain
c. The prefrontal cortex
d. Pons
e. Medulla

A

b. Midbrain

34
Q

The C1 myotome is responsible for which of the following actions?

a. Cervical flexion
b. Cervical extension
c. Cervical lateral flexion
d. Cervical rotation
e. Shoulder girdle elevation

A

a. Cervical flexion

35
Q

What muscle is involved with accommodation? Explain how its functions are innervated.

A

The ciliaris muscle works regulate eye accommodation by means of thickening or relaxing the lens for near vision, via CN III (parasympathetic), and by thinning or contracting the lens for far vision, via CN V1 (sympathetic)

36
Q

Which muscles are involved with pupil dilation? Constriction? What innervates each?

A

Sphincter pupillae muscle (CN III) both constricts and dilates the pupil
Iris dilator pupillae muscle (CN V1) dilates the pupil
Iris constrictor pupillae muscle (CN III) constricts the pupil

37
Q

Which eye movement muscles are innervated by CN III?

A

Inferior rectus
Medial rectus
Superior rectus
Inferior Oblique

38
Q

During adduction of the eye, which muscle is responsible for the depression of the eye?

A

Inferior rectus

39
Q

Which eye muscle is innervated by CN VI?

A

Lateral rectus

40
Q

What is the function of the superior rectus muscle?

A

Elevation, intorsion and adduction of the eye

41
Q

What is the function of the inferior oblique muscle of the eye?

A

Rotation outwards, superiorly, laterally away from the nose

42
Q

What is the function of the superior oblique muscle of the eye?

A

Laterally away from the nose, inward medial rotation, depression inferiorly

43
Q

What nerve innervates the superior oblique muscle? What makes this nerve unique?

A

CN IV - Trochlear nerve

This is the only cranial nerve that originates on the posterior side of the brainstem.

44
Q

What is the function of the inferior rectus?

A

Rotation, medial movement towards the midline, movement inferiorly. During adduction of the eye, responsible for the depression of the eye.

45
Q

Which cranial nerve is the only one to originate from the posterior side of the brainstem?

A

CN IV - Trochlear

46
Q

Which of the “-glossus” muscles is innervated by CN X instead of CN XII?

A

Palatoglossus muscle

47
Q

Attaches dura to the ligamentum flavum/lamina between C2-C6.

A

Dorsal meningovertebral ligaments

48
Q

What is unique about the C1 and C2 dorsal meningovertebral ligaments?

A

They are thicker and become known as myodural bridges.

49
Q

What physiological functions have been inferred to be partly due to the myodural bridges?

A

Sensorimotor function
Postural control
Maintenance of the integrity of the subarachnoid space and the cerebellomedullary cistern
Source of CSF dynamic flow
Dysfunction - tension and cervicogenic headaches

50
Q

What makes up myodural bridges?

A

Type 1 collagen fibers

51
Q

How much CSF is typically in the cranial vault? Vertebral column?

A

60mL cranial vault

70mL vertebral column

52
Q

Most facial muscles are innervated by what?

A

CN VII

53
Q

Nerve responsible for far vision.

A

CN V1 sympathetic

54
Q

Nerve responsible for near vision.

A

CN III parasympathetic

55
Q

Contents of the cavernous sinus.

A

Internal carotid artery (including carotid siphon)

CN III, IV, V1, V2, VI

56
Q

From a venous flow perspective, what may lead to papilledema and exophthalmos? What else could be a problem?

A

The superior and inferior ophthalmic veins drain into the cavernous sinus, so any increase in pressure, likely from a tumor in this case) will impede venous drainage from the eye and orbit, possibly leading to papilledema and/or exophthalmos.

It’s worth noting compression of the cavernous sinus can result from oculomotor nerve (CN III) compression, manifested in extraocular muscle weakness.

57
Q

What contains the crista galli, frontal crest, and frontal lobe?

A

Anterior cranial fossa

58
Q

Contents in the tentorium notch.

A 
Midbrain
Substantia nigra
CN III
Posterior cerebral arteries
Superior cerebellar arteries
59
Q

How may the uncus be of clinical significance?

A

Increased pressure on the temporal lobe can press the uncus into the tentorial notch. Initially, uncus irritation creates the sensation of unpleasant odors, sometimes taste, “uncinate fits.” If pressure is severe, it may cause an uncal herniation, a more severe pressure that will likely affect CN III first, due to proximity, resulting in unilateral anisocoria (dilated pupil) and a degree of hemiparesis (if pressed on the corticospinal tract)

60
Q

Dura that covers the pituitary gland.

A

Diaphragma sellae

61
Q

These to cranial regions are covered by the tentorium cerebelli.

A

Middle cranial fossa and posterior cranial fossa

62
Q

Prior to reaching the anterior and middle regions of the brain, the internal carotid artery splits into what?

A

Anterior and middle cerebral arteries

63
Q

An obstruction to the anterior cerebral artery will cause what kind of issues?

A

Lower body issures

64
Q

An obstruction to the middle cerebral artery will cause what kind of issues?

A

Upper body issues

65
Q

When considering the vertebral artery, what kind of blood disruption could cause visual loss or dizziness?

A

The vertebral artery becomes the basilar artery and then the posterior cerebral artery. A disruption to this pathway may lead to these symptoms.

66
Q

Name the ascending tracts and their function.

A

Spinocerebellar - subconcious proprioception
Spinothalamic - light touch, pain & temperature
Dorsal Column Medial Lemnisal - light touch, concious proprioception, vibration/stereognosis

67
Q

Describe the spinocerebellar tract

A

Synapses when it enters cord, travels ipsilaterally in cord to cerebellum through the superior, middle (via pontocerebellar fibers entering contralaterally), and inferior peduncles, controls subconscious proprioception

68
Q

Describe the spinothalamic tract

A

Enters the cord and synapses, crosses at or close to where it enters, travels through the cord, then brainstem, then to the thalamus, controls pain, temperature and light touch

69
Q

Describe the dorsal column medial lemniscus.

A

Synapses, travels ipsilaterally through the cord and crosses over the caudal medulla travels to thalamus

70
Q

How would you note the difference between a cerebellar dysfunction and a basal ganglia dysfunction?

A

Cerebellar dysfunction create awkward movement. Basal ganglia dysfunctions create meaningless or unexpected movement

71
Q

Describe the reticular formation

A

Regulates arousal and consciousness
Modifies reflex activity and muscle tone
Modulates somatic and visceral sensation (and pain perception)
Coordinates respiratory centers that control the muscles of respiration
Works with vestibular apparatus to preserve muscle tone in antigravity muscles
Present bilaterally able to provide motor control to both sides of the brain when a person laughs or smiles

72
Q

Describe the visual pathway

A

Retina –> Optic nerve –> Optic chiasm (medial retina fibers cross) –> optic tract –> lateral geniculate body –> cortex

73
Q

Define miosis

A

excessive constriction of the pupil

74
Q

Define mydriasis

A

excessive dilation of the pupil

75
Q

Define anisocoria

A

single pupil difference

76
Q

Define anopia

A

visual field defect

77
Q

Define scotoma

A

blind spot

78
Q

Define IIH

A

Idiopathic intracranial hypertension

79
Q

Define Doll’s Eye

A

eyes lag behind head movement, any asymmetry or lack of response indicates brain stem damage

80
Q

What manifestation will be seen in an uncus hernation?

A

Eye dilated on one side, unresponsive to light, dilated eye not responsive to cold caloric (medial rectus) on opposite side

81
Q

A left lesion to Broadmann’s area 8 on the left will affect what anatomy and what function?

A

Left medial rectus (CN III) and right lateral rectus (CN IV); stops the ability to look right

82
Q

What is the function of each part of the semicircular canal?

A

Ant/Sup - nodding (sagittal plane)
Lat/Transverse - rotation (transverse plane)
Posterior - tilting (coronal)

DCCJP Final Prep (9 decks)

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