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MY AMMO FOR BOARDS > Neuro-RIBS-Part1-Part2-part3 & RIBS-Spinal Anatomy-Dr. Dirks > Flashcards

Neuro-RIBS-Part1-Part2-part3 & RIBS-Spinal Anatomy-Dr. Dirks Flashcards

1
Q

Neuro-RIBS-Part1

1–Central Nervous System = Brain and
Spinal Cord

2–Peripheral nervous system = cranial
and spinal NERVES

A

know

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2
Q

Neuro-RIBS-Part1

Peripheral nervous system:
2 Parts= (LOWER MOTOR NEURON)

1-• Somatic INNERVATES Skeletal muscle

2–• Autonomic INNERVATES Smooth muscle “Visceral”
(POST GANGLIONIC NEURON)

NEUROTRANSMITTORS =

1–SYMPATHETIC = __________________

2–PARASYMPATHETIC OR SKELETAL MUSCLE = __________

A

NOREPINEPHRIN

ACETYLCHOLINE

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3
Q

Neuro-RIBS-Part1

________________ involves:
– 1) Formation of a neural plate
– 2) Neural plate becomes neural groove surrounded by crests
– 3) Groove becomes closed tube in highly ordered fashion

A

Neurulation = “CLOSURE OF THE TUBE”

***PLATE TO GROOVE TO TUBE!!!

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4
Q

Neuro-RIBS-Part1

THE (((ROSTRAL))) END OF THE NEURAL TUBE DIFFERENTIATES TO FORM THE THREE “VISICLES” THAT WILL GIVE RISE TO THE ENTIRE BRAIN!!

1–PROENCEPHALON OR ____________
2–MESENCEPHALON OR____________
3–RHOMBENCEPHALON OR__________

A

FOREBRAIN

MIDBRAIN

HINDBRAIN

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5
Q

Neuro-RIBS-Part1

1–Of the 3 vesicles MES stays “MES”..NO changes!! DOES NOT DIVIDE!
2–PRO = divides into _____ &_____
3–RHOMB = _____ &__ELENCEPHALON

**WHEN THE TUBE BECOMES THE SPINAL CORD, IT IS DIVIDED INTO TWO PARTS. THAT DIVIDING PART (INTO DORSAL AND VENTRAL PART) IS CALLED THE ________ ________

*BASAL PLATE = (aka bottom) VENTRAL TO SL = MOTOR

***ALAR PLATE = DORSAL TO SL = SENSORY

A

TEL and DIE

MET AND MY

SULCUS LIMITANS

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6
Q

Neuro-RIBS-Part1

Neural crest cell fate organized by ______ level

Somite = Division of _______ in developing embryo along the neural tube.

A

somite

mesoderm

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7
Q

Neuro-RIBS-Part1

Somites include:

A

Dermatome
Myotome
Sclerotome

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8
Q

Neuro-RIBS-Part1

Parasympathetic organization

• Sacral spinal cord (mostly S2 and S3)
• Cranial Nerves:
– III: Oculomotor
– VII: Facial
– IX: Hypoglossal
– X: Vagus —–___% of all parasympathe’c control is through CN X

A

75%

**REMEMBER PARASYMPATHETIC ARE

3….7..9…10!!!!

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9
Q

Neuro-RIBS-Part1

Enteric nervous system

• Nervous system of the GI tract
• Two intramural plexuses:
__________ & ______________

• ENS is a fully functional nervous
system on its own, functions like the CNS
– There is no ________ barrier

**More neurons reside in the gut than in the spinal cord

A

Myenteric

submucous

blood/ENS

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10
Q

Neuro-RIBS-Part 1

Applicaton of the basal and alar plate rules

• Rexed Laminae
– 10
– Top 5
– Bottom 2-3

A

know

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11
Q

Neuro-RIBS-Part 1 review slide 17!

ASCENDING TRACTS:
1–DORSAL PART OF SPINAL CORD divides into ______ ________ …which divides into FASC. GRACILUS AND FASC. CUNEATUS

2–LATERAL PARTS ARE DORSAL AND VENTRAL SPINOCEREBELLAR TRACT

DESC TRACT. = LATERAL CORTICOSPINAL WILL AFFECT THE LIMBS

VENTRAL CORTICAL SPINAL WILL AFFECT THE AXIAL SKELETON

A

DORSAL COLUMNS

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12
Q

Neuro-RIBS-Part 1

Organization of motor neurons in the
spinal cord = ???

A

PROXIMAL MUSCLES ARE MEDIAL AND DISTAL MUSCLES ARE LATERAL OFF THE SPINAL CORD

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13
Q

Neuro-RIBS-Part 1

Frontal lobe = contains ________ areas

• Precentral gyrus
• Superior	
• Middle	
• Inferior	
• Orbitofrontal 	cortex	
• Gyrus	rectus
• PRIMARY	MOTOR	CORTEX	(Area\_\_\_\_\_)
• PREMOTOR	and	SUPPLEMENTARY	MOTOR	
CORTEX	(Area	6)		
• BROCA’S	AREA	(Areas\_\_\_ \_\_\_\_ \_\_\_\_)
• PREFRONTAL	CORTEX	(Areas	9,	10,	11,	46)	
• Frontal	 eye 	fields	(Area	8)
A

motor

4

44, 45, 47)

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14
Q

Neuro-RIBS-Part 1

Parietal lobe contains ____________
areas

• Postcentral gyrus
• Superior	lobule	
• Inferior	lobule	
– Supramarginal gyrus
– Angular	gyrus
• Precuneus
• Primary somatosensory cortex	(Areas\_\_\_ \_\_\_\_ \_\_\_)
• \_\_\_\_\_ \_\_\_\_\_ (around	border	with temp.,	frontal)	
• Spatial	orientation	and	perception
A

somatosensory

1,2,3

Language comprehension

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15
Q

Neuro-RIBS-Part 1

Temporal lobe contains _____ areas

  • Superior
  • Middle
  • Inferior
  • Fusiform
  • Primary auditory cortex (Areas___ _____)
  • Wernicke’s Area (Area 22)
  • Ventral stream of “_____”
  • Learning and ________
A

auditory

41, 42

what?

Memory

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16
Q

Neuro-RIBS-Part 1

Occipital lobe contains ______ areas

• Cuneus
– V1	(primary	visual cortex)	
– Area	\_\_\_\_
• V2	(visual association	cortex)	
– Area \_\_\_\_	
• Calcarine sulcus
• Occipital pole	=\_\_\_\_\_\_\_\_
A

visual

17

18

fovea

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17
Q

Neuro-RIBS-Part 1

Limbic lobe involves _______ and
______
• __________ gyrus
• Parahippocampal gyrus

A

memory

emotion

Cingulate

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18
Q

Neuro-RIBS-Part 1 - Association and commissural fibers

1) ______ Fibers = pass from one part of a SINGLE hemisphere to another
2) ________ Fibers = Link matching areas of the two hemispheres
3) ________ Fibers = Run to subcoritcal nuclei

A

Association

Commissural

Projection

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19
Q

Neuro-RIBS-Part 1

What is the developmental fate of neurons in
the alar plate?

A

The alar plate specifically later on becomes the dorsal gray of the spinal cord, and develops into the SENSORY nuclei of cranial nerves V, VII, VIII, IX, and X.

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20
Q

Neuro-RIBS-Part 1

What is the developmental fate of the metencephalon?

A

PONS AND CEREBELLUM

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21
Q

Neuro-RIBS-Part 1

What type of fibers make up the corpus callosum?

A

COMMISURAL

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22
Q

Neuro-RIBS-Part 1

What function is associated with Broadmann’s
Area 1?

A

PRIMARY SOMATOSENSORY CORTEX

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23
Q

Neuro-RIBS-Part 1

What are the major cell type in Rexed Lamina
VIII?

A

LOWER MOTOR NEURON

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24
Q

Neuro-RIBS-Part 1

What kind of information is carried in the
white ramus communicans?

WHITE RAMUS = T1–L2

GRAY RAMUS = THE WHOLE THING!

A

PRE-GANGLIONIC SYMPATHETIC

FYI***GRAY RAMUS IS POST-GANGLIONIC SYMPATHETIC

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25
Q

Neuro-RIBS-Part 1 —-last NEURO OF PART 1

What kind of information, sensory or motor, is
carried in the dorsal ramus of a spinal nerve?

A

BOTH

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26
Q

Neuro-RIBS-Part 2

Ipsilaterality and contralaterality

• Cortex is _________ to spinal cord signal
• Cortex and _____ are on the same side
• Basal ganglia and cortex are on the same side
• _____and spinal cord are usually on the same side
– So cerebellum is collateral to _____
• Think pontine nuclei

A

contralateral

thalamus

Cerebellum

cortex

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27
Q

Neuro-RIBS-Part 2

Right Side = Cortex…Thalamus..Basal Ganglia

Left Side = Spinal Cord…Cerebellum….Sensory Input….
……Motor Output

A

know

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28
Q

Neuro-RIBS-Part 2

Descending control of Pain

  • ALL points along this pathway are sensitive to ________ and enkephalins
  • Bilateral
A

endorphins

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29
Q

Neuro-RIBS-Part 2

Gamma Motor neurons alter ______ sensitivity

• Intrafusal fibers have minor role in contraction
• But innervated by Gamma motor neurons
– Purpose is to always keep the spindle _______ to a certain extent to signal status

A

spindle

stretched

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30
Q

Neuro-RIBS-Part 2-

-Dorsal Columns

–  Name of pathway
–  Type of information in pathway
–  Point of origin, receptors involved
–  Where primary cell bodies are located
–  Where 1st synapse is
–  Where in Spinal Cord it enters, travels
–  Where/if it decussates
–  Where second synapse is
–  Final destination
A

The posterior column (dorsal column) refers to the area of white matter in the middle to posterior side of the spinal cord. It is made up of the gracile fasciculus and the cuneate fasciculus and itself is part of the posterior funiculus. It is part of an ascending pathway that is important for well-localized fine touch and conscious proprioception called the posterior column-medial lemniscus pathway.

Joint capsules, tactile and pressure receptors send a signal through the posterior root ganglia up through the gracile fasciculus for lower body sensory impulses and the cuneate fasciculus for upper body impulses. Once the gracile fasciculus reaches the gracile nucleus, and the cuneate fasciculus reaches the cuneate nucleus in the lower medulla oblongata, they begin to cross over as the internal arcuate fibers. Upon reaching the opposite side, they become the medial lemniscus, which is the second part of the posterior column-medial lemniscus pathway.

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31
Q

Neuro-RIBS-Part 2

Neospinothalamic
–  Name of pathway
–  Type of information in pathway
–  Point of origin, receptors involved
–  Where primary cell bodies are located
–  Where 1st synapse is
–  Where in Spinal Cord it enters, travels
–  Where/if it decussates
–  Where second synapse is
–  Final destination
A

The neospinothalamic tract has few synapses and constitutes the classical lateral spinothalamic tract (LST) (Figure 7.1). The first-order nociceptive neurons (in the DRG) make synaptic connections in Rexed layer I neurons (marginal zone). Axons from layer I neurons decussate in the anterior white commissure, at approximately the same level they enter the cord, and ascend in the contralateral anterolateral quadrant. Most of the pain fibers from the lower extremity and the body below the neck terminate in the ventroposterolateral (VPL) nucleus and ventroposteroinferior (VPI) nucleus of the thalamus, which serves as a relay station that sends the signals to the primary cortex. The VPL is thought to mainly be concerned with discriminatory functions. The VPL sends axons to the primary somatosensory cortex (SCI).

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32
Q

Neuro-RIBS-Part 2

Poorly localized pain in other pathways:

•  C-fibers
•  Polymodal receptors
•  Terminate in Brainstem, midbrain, hypothalmus
•  Called \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_  and/or
Archespinothalmic tracts
•  Slow
•  \_\_\_\_\_\_\_\_\_-related
A

Paleospinothalmic

Emotion

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33
Q

Neuro-RIBS-Part 2

***MOSSY FIBERS–in CEREBELLUM via spinal cerebellum path.

**CLIMBING FIBER–originate in INFERIOR OLIVARY NUCLEUS

***GRANULE CELLS&raquo_space;PARALLEL FIBERS SYAPSE ON PURKINJE CELLS AND THEN SEND TO DEEP CEREBELLAR NUCEI (DCN)

Sensory components of CN V

1–Main sensory – _________ discrimination
2–Spinal trigeminal – Light touch, pain, temperature
3– Mesencephalic – Proprioceptive

A

Vibrotactile

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34
Q

Neuro-RIBS-Part 2

Medial longitudinal fasciculus (MLF) a mixed pathway carried by the VESTIBULAR NERVE

***involves the __________ ABDUCENS AND THE
___________ OCCULOMOTOR NUCLEUS

A

Head moves right…eyes move left.

CONTRALATERAL

IPSILATERAL

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35
Q

Neuro-RIBS-Part 2

Pyramidal Tract

Decussates (Mostly)
– 80% CROSSING OVER at caudal medulla
= “_______ corticospinal tract”
• Limbs, digits (stuff needing fine motor control)
– 20% continue ipsilateral DOES NOT CROSS OVER
• “________ or ventral corticospinal tract”
• Axial muscles
• Some of these will decussate some won’t
• These travel until thoracic spinal cord

A

Lateral

anterior

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36
Q

Neuro-RIBS-Part 2

Upper motor neuron control of lower motor neurons

A---•  4 brainstem pathways: related to posture: “\_\_\_\_\_\_\_\_\_\_\_\_\_”
1– Vestibular (vestibulospinal) 
2– Reticular (reticulospinal)
3– Red nucleus (rubrospinal) 
4– Superior colliculus (tectospinal)

B–• 2 cortical pathways: related to limbs, facial muscles
1– Direct
2– Indirect
(via first synapsing in the brainstem—”__________”)

A

extrapyramidal

corticobulbar

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37
Q

Neuro-RIBS-Part 2

Typical signs of LOWER motor neuron damage

1--•  Paralysis or paresis 
2--•  AREFLEXIA
– Loss of muscle tone (related to areflexia) 
3--•  \_\_\_\_\_\_\_\_\_\_\_
– Due to denervation and disuse
4- •  Twitching
A

Atrophy

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38
Q

Neuro-RIBS-Part 2

UPPER motor neuron damage

1–• _________ ________
– Toes point upward instead of downward due to loss of Upper motor neuron control

2–• Spasticity
– ___________ influences probably are somewhat inhibitory to the brainstem control of postural muscles—relaxes them a bit.

3–• Loss of fine motor control
– Due to corticospinal damage

A

Babinski’s sign

Corticospinal

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39
Q

Neuro-RIBS-Part 2

Where is the first synapse for ascending pain info of the face?

Which thalamic nucleus receives tactile information from hands and feet?

A

SPINAL TRIGEMINAL NUCLEUS

THE VPL

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40
Q

Neuro-RIBS-Part 2

Which pathway controls the vestibulo-ocular reflex?

What cerebellar pathway(s) carry unconscious prorpioceptive info about the upper half of the body?

A

THE MLF

THE CUNEAL ROSTRAL CEREBELLAR

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41
Q

Neuro-RIBS-Part 2

Paleospinothalmic pain information is carried ipsilaterally, bilaterally or contralaterally through the spinal cord?

A

BILATERAL

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42
Q

Neuro-RIBS-Part 2—last one

What are some examples of extrapyramidal pathways?

A

1–TECTO
2–VESTIBULO
3–RETICULO

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43
Q

Neuro-RIBS-Part 3

The neuroendocrine hypothalamus

1–• Nuclei involved in release of hormones through the hypophysis

2–• Neurohypophysis (_______ pituitary)
– Direct neuroendocrine release

3–• Adenohypophysis (________ pituitary)
– Release via a vascular link within the ant. pituitary

A

posterior

anterior. A = A tip

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44
Q

Neuro-RIBS-Part 3

Neurohypophysis

1–• 2 hypothalamic nuclei: supraoptic and paraventricular
– Magnocellular
2–• ______ (vasopressin)
– Water reabsorption
3–• ________ = Milk letdown reflex, uterine contractions

A

ADH

Oxytocin

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45
Q

Neuro-RIBS-Part 3

Signaling molecules through adenohypophesis

Releasing Hormone
CRH
TRH
GHRH
GnRH
Dopamine
Anterior Lobe Hormone
ACTH
Thyrotropin
Growth hormone
FSH/LH
Prolactin

Parvocellular neurons release the “__________ hormones”

A

releasing

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46
Q

Neuro-RIBS-Part 3

What’s the limbic system again?

• Base of the ________—sits on top of ___________ structures…named ajer boundary or borders

A

cortex

subcortical

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47
Q

Neuro-RIBS-Part 3–last one

Papez circuit

1—• Original circuit tied to ________

• Cingulate gyrus— hippocampus— fornix—mammillary body—ant nuc. Thal.—cingulate gyrus

A

emotion

48
Q

RIBS: SPINAL ANATOMY—-START!!

SOME VERTEBRAL LEVELS

1–C3 = hyoid bone
2– C4,5= Thyroid Cartilage
3– ____ = cricoid cartilage

A

C6

49
Q

RIBS: SPINAL ANATOMY

SOME VERTEBRAL LEVELS

4–C6,7, T1 = Thyroid gland
5–• T2 = superior angle of scapula
6–• ______ = base of spine of scapula standing and lying down

A

T3/4

50
Q

RIBS: SPINAL ANATOMY

SOME VERTEBRAL LEVELS

7–T6/7 = inferior angle of scapula standing and lying down
8–• T4/5 IVD= trachea bifurcation and Sternal angle
9–• _____= xiphoid process

A

T10

51
Q

RIBS: SPINAL ANATOMY

SOME VERTEBRAL LEVELS

10–T8, T10, T12= IVC, esophagus and aorta pierces diaphragm
11–• L4 = tubercle of iliac crest
12–• _____ = PSIS

A

S2

52
Q

RIBS: SPINAL ANATOMY

SOME VERTEBRAL LEVELS

13–T4 dermatome = nipple line
14–____ dermatome = umbilicus

A

T10

53
Q

RIBS: SPINAL ANATOMY

How many vertebra are there in an adult spine? Spinal column?

 How many pairs of spinal nerves are there?

 How many dermatomes are there?

A 
ADULTS = 24.....26
KIDS = 33

31

30

54
Q

RIBS: SPINAL ANATOMY

THE AXIAL SKELETON

1–Cranial bones, ossicles of inner ear, ribcage, and spinal column

A

Know

55
Q

RIBS: SPINAL ANATOMY

THE AXIAL SKELETON

Spinal column

1- 24 true and 2 false vertebra (sacrum and coccyx)
2-23 IVDs
3- Begins between C2 & C3
4- Ends between L5 & S1
5-Named for the vertebrae \_\_\_\_\_\_\_

6- 31 pairs spinal nerves
7- Begins between Occiput & C1
8-Ends with Co1 at sacral hiatus at S5 segment

A

ABOVE

  • **CERVICAL BULGE = ABOVE
  • **LUMBAR BULGE = BELOW
56
Q

RIBS: SPINAL ANATOMY

THE AXIAL SKELETON

Ribcage

 1-6 true ribs (attach to sternum), 7-10 false (indirect attachment to sternum), 11 and 12 floating ribs (no attachment)

Sternum =
 Manubrium
 Body
 Xyphoid process

A

KNOW THAT 11 AND 12 DO NOT HAVE COSTOTRANSVERSE FACETS…ALL OTHER THORACIC VERTEBRAE DOES!

57
Q

RIBS: SPINAL ANATOMY

SPINAL NERVES

1–Cervical Spine: 8 pairs
– Nerves exit ________ thru IVF, disc protrusion effects nerve ABOVE as it passes

2—Thoracic: 12 pairs

3– Lumbar: 5 pairs
–Nerves exit ________ thru IVF, disc protrusion effects nerve BELOW as it passes

A

inferiorly

superiorly

58
Q

RIBS: SPINAL ANATOMY

SPINAL NERVES

4–Sacrum: 5 pairs
5–Coccyx: 1 pair
6–ONLY ___ DERMATOMES (none for C1)

A

30

59
Q

RIBS: SPINAL ANATOMY

 Key phrases
 C3,4,5 keeps the diaphragm alive./ NERVE = ____
 L2,3,4 walks you out the door./NERVE =____&______
 S2,3,4 keeps your “FUCKEN COCK” off the floor
NERVE = ____________

A

PHRENIC

FEMORAL AND OBTURATOR

PUDENDAL

60
Q

REVIEW QUESTIONS

1– What are the two plexuses that provide peripheral nerves to the upper and lower extremities?

2– What are the spinal nerve levels for each?

3– What are the terminal branches of each?

A

BRACHIAL AND LUMBAR SACHRIAL PLEXUS

C5 TO T1

T12–S4

61
Q

Study slide 7!!!

BRACHIAL PLEXUS (C5-T1)

A

Asap

62
Q

BRACHIAL PLEXUS (C5-T1)

1-Musculocutaneus (C5- C6)
2-Median (C5-T1)
3- Ulnar (C8-T1)
4- \_\_\_\_\_\_\_ (C5-T1)
5- Axillary (C5-C6)
6- Phrenic (C3-5)
7- Long thoracic (C5-7)
8- Dorsal Scapular (C5-6) 
9-Suprascapular (C6)
10- Subscapular 
11- Upper (C5-7)
12-Middle (Thoracodorsal) (C6-8)
13- Lower (C5-7)
14- Medial Pectoral (C8-T1) 
15- Lateral Pectoral (C5-7)
A

Radial

63
Q

LUMBOSACRAL PLEXUS (T12-S4)

THE ASS AREA

  • Iliohypogastric (T12,L1)
  • Ilioilguinal (L1)
  • Genitofemoral (L1,2)
  • Lateral Femoral Cutaneous (L2,3)
1- Femoral (L2-4)
2- Obturator (L2-4)
>>Superior GLUTeal (L4-S1)
>>Inferior GLUTeal (L4-S1)
>>Sciatic (L4-S3)
3- Tibial (L4-S3)
 4-Common Peroneal (L4- S2)
5- Deep Peroneal (L4- S2)
6- Superficial Peroneal (L4-S2)
>>Posterior Fermoral Cutaneous (S1-3)
>>\_\_\_\_\_\_\_\_\_ (S2-4)
A

Pudendal

64
Q

What type of curves are the thoracic ??
–and sacral curves?

Cervical ??
–and lumbar?

A 
T = Kyphotic / primary / accomodating
S = kyphotic and primary
C = LORDOTIC/SECONDARY/ COMPENSATORY
L = LORDOTIC/"/"--A BACKWARD "C"
65
Q

TYPES OF VERTEBRAL CURVES

1–Kyphotic / primary / accomodating
A. Thoracic: bodies are ________ posterior
B. Discs are _______ height

A

thicker

equal

66
Q

TYPES OF VERTEBRAL CURVES

2--Lordotic / secondary / compensatory
A.  Cervical: bodies are equal \_\_\_\_\_\_\_ 
-- Discs are wedged, greater anteriorly
B. Lumbar: varies
--Discs are wedged, greater \_\_\_\_\_\_\_\_
A

height

anteriorly

67
Q

TYPES OF VERTEBRAL CURVES

Vertebral canal (spinal canal) = __+ vertebral foramen in a row

A

2

68
Q

Which vertebra are typical in the cervical spine?

Atypical?

***What are the characteristics of a typical cervical vertebra?

A

C3»>C6

C1…C2..C7

***SEE NEXT SLIDE

69
Q

TYPICAL CHARACTERISTICS: CERVICAL

1–C3-C6
2–Oval body, triangular vertebral foramen
3– Facets: 45 degrees off horizontal, NO medial lateral rotation
4– Uncinate processes
5–Anterior/Inferior (A/I) ______
6– Costotransverse lamellae
—true and false transverse processes (ant/post tubercles)

A

lipping

70
Q

TYPICAL CHARACTERISTICS: CERVICAL

7--Bifid SPs
8-- Transverse Foramen
9-- Key concepts:
A. Vertebral artery travels in transverse foramen C6-C1 thru posterior vertebral groove
B.  Ligamentum nuchae: EOP to \_\_\_\_\_
A

C7

71
Q

ATYPICAL: CERVICAL

1–C1 atlas
A. Fovea dentalis, lateral masses, groove for vertebral artery

2–C2 Axis (___________)
A. Dens (_________), pivot joint with C1, first AI lipping

3–C7 (typical vertebral prominence)
A. Uncinates but no AI lipping, no bifid SP.

4–Normal ADI

    • .5 to 3mm in adults
    • 3 to 5mm in children
A

epistopheus

odontoid

72
Q

Which vertebra are typical in the thoracic spine? Atypical?

What are the characteristics of a typical thoracic vertebra?

A

SEE NEXT SLIDE! =)

73
Q

TYPICAL CHARACTERISTICS: THORACIC

1—T___ to T____
2–______ = body, _______ = vertebral foramen
3–Facet orientation: 60 degrees off horizontal, 20 degrees lateral
4–4 demifacets (body), 2 costotransverse facets (TPs), costovertebral joints, costotransverse joint

A

T2–T8

Heart

circular

74
Q

TYPICAL CHARACTERISTICS: THORACIC

Keys concepts:

1–Ribs named after vertebra ______ (except Rib 1,10-12)

A. Ex: 5th rib HEAD articulates with inf demifacet of T4 and sup demifacet T5 and the RIB TUBERCLE with TP of T5

B. Radiate ligaments covers the costovertebral joint

A

BELOW

75
Q

ATYPICAL: THORACIC

1—T1
A. 2 full facets, 2 inferior demifacets, 2 costotransverse facets

2— T9
A. 2 superior demifacets, no inferior demifacets, 2 costotransverse facets

3–T10
A. 2 full facets, 2 costrotransverse facets

4–T11 , T12
A. 2 full facets, NO _________ facets

A

costrotransverse

76
Q

Which vertebra are typical in the lumbar spine?

Atypical?

What are the characteristics of a typical lumbar vertebra?

A

SEE NEXT SLIDE

TWO SLIDES FROM HERE

NEXT SLIDE

77
Q

TYPICAL CHARACTERISTICS: LUMBAR

1-- L1-4
2--Facet orientation: 90 degrees off horizontal, 45 degrees med
3-- Mamillary processes (multifidii)
4-- Accessory processes
5-- \_\_\_\_\_\_\_\_ vertebral foramen
6-- \_\_\_\_\_\_\_\_ shaped body
A

Triangular

Kidney

78
Q

ATYPICAL: LUMBAR

1-L5
2-Shorter SP points more ______
3- Inferior APs face almost in the coronal plane to articulate with the sacrum
4-Larger and ________

A

horizontal

Wider

79
Q

The lateral sacral crest is made by the fusion of what component of the vertebra?

A

SACRAL GROOVE = LAMINAE

80
Q

TYPICAL CHARACTERISTICS: SACRUM AND COCCYX

1–Sacrum
A. __ ______ vertebra (adult)

B. Base, apex, ala, anterior and posterior sacral foramen, cornu, hiatus,
median (SP)/intermediate(AP)/lateral(TP sacral crests, sacral groove (lamina)

A

5 fused

81
Q

TYPICAL CHARACTERISTICS: SACRUM AND COCCYX

B. Coccyx

1-__fused vertebra
2-Base, apex, cornu

***study slide 24!! Look now!!

A

4

Do it!!

82
Q

OSSIFICATION CENTERS VERTEBRAE

1-- Primary ossification
A.  Cervical and Thoracic (\_\_)
--1 VB, 1 each Vertebral arch
B. Lumbar (5)
-- Gets an extra one for each mamillary process.
C.  Atlas (\_\_)
-- each lateral mass and anterior arch
D. Axis (\_\_)
--1VB, 1 each vertebral arch, 2 odontoid

2– Secondary ossification (5)
A. 1 each epiphyseal plate
B. 1 each TP
C. 1 each SP

A

3

3

5

83
Q

THE CLAVICLE IS THE FIRST BONE TO BEGIN OSSIFICATION AT 7 ______ POSTOVULATORY

A

WEEKS

84
Q

IVFS

1– Cervical
A. __________
B. Angles laterally and anterior

2–Lumbar
A. ___________
B. Face laterally (as do thoracics)

  1. Boundaries: vertebral bodies, vertebral notches (pedicles), facets, IVDs.
  2. Contents: spinal nerve trunk, dorsal root ganglion, spinal artery, radicular and intervertebral veins, recurrent meningeal nerves, lymphatics, adipose.
  3. Recurrent ________ nerves: sensory innervation to the posterior aspect of the annulus fibrosus, PLL, and the ant dura matter
A

Smallest

Largest

meningeal

85
Q

BONES OF THE SKULL x 14

SKULL X 6

1–_____ bone (1): bone between the orbits, nasal cavity (superior and middle conchae).

2–Frontal bones–(2): roof of the orbit, anterior part of the cranial floor.

3–_______ bone (1): posterior and inferior part of the cranium.

A

Ethmoid

Occipital

86
Q

BONES OF THE SKULL x 14

SKULL X 6

4–_______ bones (2): sides and roof of the cranial cavity.

5–________ bone (1): part of the floor of the anterior, middle, and posterior cranial fossae; KEYSTONE of the cranial floor because it articulates with all the other cranial bones.

6– Temporal bones— (2): contains the organs of hearing.

A

Parietal

Sphenoid

87
Q

BONES OF THE SKULL x 14

FASCIAL X 8

1—Inferior Nasal Conchae (2)
2— _________ bone (2): medial wall of the orbit
3— _______ (1): largest and strongest bone of the face
4—Maxillae (2): upper jawbone, articulate with every bone of the face except the ________!
5— Nasal bones (2): fusion forms the superior part of the bridge of the nose.

A

Lacrimal

Mandible

mandible

88
Q

BONES OF THE SKULL x 14

FASCIAL X 8

6—Palatine bones (2): posterior part of the hard palate
7—_______ (2): forms the inferior and posterior of the nasal septum.
8—Zygomatic bones (2)

A

Vomer

89
Q

THE CALVARIUM X 8

1–________ suture: joins parietal bones
2– ________ suture: joins frontal and parietal bones
3– _______ suture: joins parietal bones and occipital bone
4– _______________ sutures (2): joins parietal bone and temporal bone
.

A

Sagittal

Coronal

Lambdoidal

Parietomastoidal

90
Q

THE CALVARIUM X 8

5–___:INTERSECTION of the sagittal and coronal sutures
6–___: INTERSECTION of sagittal and lambdoid suture
7– __________ : 4 bones articulate: frontal, parietal,temporal, and sphenoid
— Weakest part of the skull
—- Ant branch of middle meningeal artery runs under it
8–ASTERION: at END of parietomastoid suture

A

BREGMA

LAMBDA

PTERION

91
Q

BASE OF THE CRANIUM X 5
1– _____ Bone
– Foramen Cecum: emissary vein to sagittal sinus

2– ________ Bone
– Cribiform Plate: olfactory nerve bundles

3– _________ Bone

    • Sella turcica/hypophyseal fossa: Pituitary gland
    • Foramen rotundum: maxillary nerve
    • Foramen ovale: mandibular nerve, accessory meningeal artery, lesser petrosal nerve
    • Foramen spinosum: middle meningeal artery and vein, meningeal branch of mandibular nerve
    • Optic canal: optic nerve, opthlamic artery
A

Frontal

Ethmoid

Sphenoid

92
Q

BASE OF THE CRANIUM X 5

4– ___________ Bone
- Carotid canal: internal carotid artery and nerve plexus
- External auditory meatus and internal acoustic meatus: facial nerve, vestibulocochlear nerve
- Groove for occipital artery
- Greater and lesser petrosal nerve
- Jugular foramen: glossopharyngeal nerve, vagus nerve, Spinal accessory nerve, posterior
meningeal artery, internal jugular vein

5–_________ Bone

  • Hypoglossal canal: hypoglossal nerve
  • Foramen magnum: vertebral arteries, medulla oblangata
A

Temporal

Occipital

93
Q

CRANIAL NERVES X 12 ( O-O-O-T-T-A-F-V-F-V-S-H )

1– Olfactory- _________ plate

2– Optic- optic canal

3– Oculomotor- _________ orbital fissure

4–Trochlear- Superior orbital fissure

5– Trigeminal- X 3
V1: Superior orbital fissure
V2: Foramen Rotundum
V3: Foramen Ovale

A

cribiform

Superior

94
Q

CRANIAL NERVES X 12 ( O-O-O-T-T-A-F-V-F-V-S-H )

6–Abducens- Superior orbital fissure

7–Facial -Internal Auditory Meatus»> ______ Foramen

8– Vestibulocochlear- Internal Auditory Meatus

9– Glossopharyngeal- Jugular Foramen

10– Vagus- _________ Foramen

11– Spinal accessory - Jugular Foramen

12– Hypoglossal- Hypoglossal Canal

A

Stylomastoid

Jugular

95
Q

CRANIAL FOSSA

1— Anterior

  • Bordered by _________ wing of sphenoid and optic chiasm
  • Formed by frontal, ethmoid, and sphenoid bone

2— Middle

  • Separated from posterior by clivus and petrous crest
  • Contains _______ lobes of the brain

3– Posterior
- Located between tentorium cerebelli and foramen
magnum
- Contains ________ and cerebellum

A

lesser

temporal

brainstem

96
Q

What does the ALL become?

What does the PLL become?

What does the Supraspinatus ligament become?

A

SEE NEXT SLIDE

97
Q

SYNDESMOLOGY OF AXIAL SKELETON X 9

1—- Ligamentum nuchae (EOP to C7) > suprapinous&raquo_space;
superficial posterior sacrococcygeal
2— ______ __________ (STARTS at body of axis)
= Posterior longitudional (PLL)&raquo_space;>deep posterior sacrococcygeal
3– Anterior longitudinal (ALL)&raquo_space;> anterior __________
4– Ligamentum flavum (C2 to S1): elastic

A

Tectorial membrane

sacrococcygeal

98
Q

SYNDESMOLOGY OF AXIAL SKELETON X 9

5–_________ ________: surrounds facet joints
6–Intertransverse and interspinous
7– Atlantoaxial and Atlanto-occipital
8–___________: b/w C1 and C2
9– Alar: check ligaments (check rotation) around dens to the foramen magnum

A

Capsular ligaments

Cruciate

99
Q

ARTHROLOGY OF THE AXIAL SKELETON

CLASSIFICATION BY—————— MATERIAL————-

1—–______________
 Sutures
 Usually synarthrotic

2—- ___________ (fibrocartilage or hyaline)
 Manubrium/sternal joint
 Syncondroses, symphysis
 Amphiarthrotic

3—- __________
 Capsule filled with lubricating synovial fluid and joint
surfaces covered with hyaline cartilage

A

Fibrous

Cartilaginous

Synovial

100
Q

ARTHROLOGY OF THE AXIAL SKELETON

CLASSIFICATION BY——– MOVEMENT————–

1------\_\_\_\_\_\_\_\_\_\_
- Immovable
- Most are Fibrous joints
- Gomphosis (teeth), synostoses (cranial bones fused), 
synchondrosis (growth plates)

2—-__________

  • Slightly movable
  • Symphysis (IVD and pubic symphysis) and syndesmosis

3—-______________

  • Very mobile
  • Synovial joints (hinge, spheroid, pivot, etc)
A

Synarthoritic

Amphiarthrotic

Diarthrotic

101
Q

ARTHROLOGY OF THE AXIAL SKELETON

SYNOVIAL JOINTS X 6

  1. Ball and socket/_______: all movements
    - Ex: GH, hip
  2. ________: 2 planes of motion
    - Ex: C0C1, metacarpophalange
  3. _____:2 planes of motion
    - Ex: carpometacarpal, SC
A

spheroid

Condyloid

Saddle

102
Q

ARTHROLOGY OF THE AXIAL SKELETON

SYNOVIAL JOINTS X 6

  1. Hinge/ _________: 1 plane of motion
    - Ex: Humeral-ular
  2. Pivot/ ________: 1 plane of motion
    - Ex: radial-ulnar, atlanto-axial
  3. Planar/________: 1 plane of movement
    - Ex: Z-joints, AC, carpals
A

ginglymus

trochoid

GLIDING

103
Q

IVD

1— 25% height spinal column

2--- 3 parts
A.  Annulus fibrosus
-- \_\_\_\_\_\_\_\_  fibers attach annulus to vertebral bodies
--Mostly Type I collagen
B.  \_\_\_\_\_ pulposus
-- Mostly Type II collagen, proteoglycans and GAGs
C.   Vertebral endplates (cartilage)
-- Allow nutrition to IVD thru \_\_\_\_\_\_\_\_

3—Bulge, Protrusion, Extrusion, Sequestration

***SEE SLIDE 41

A

Sharpeys

Nucleus

IMIBIBITION

104
Q

MAIN MOTIONS
1— CO-C1 = _______
–Occipital condyles roll anterior and slide posterior during flexion and vice versa for extension
2— C1-C2 = ______
– ~____ % of total C/S rotation occurs here
– From C2/3 to C5/6 the amount of available flexion/ext increases
3– Thoracic = Rotation
–Movement increases at top and bottom of T/S
4– Lumbar = Flexion/extension
 Greatest mobility b/w L4 and S1

A

Nodding

Rotation

55

105
Q

MYOLOGY OF AXIAL SKELETON
1— Layer 1: latissmus dorsi, trapezius, levator

2— Layer 2-4: rhomboids, serratus posterior
inf/sup, splenius capitus/cervicis, quadratus
lumborum

3— Deep layers
A. Erector Spinae = Layer 5: ———–I love spaghetti!!!
I= Iliocostalis: lumborum, thoracics, cervicis
LOVE = Longissmus: thoracis, cervicis, capitis
SPAGHETTI = Spinalis: thoracis, cervicis, capitis

B. Interspinalii, intertransversarii, levator costarum

C. Layer 6: More Red Sauce
MORE = Multifidi (christmas trees),
RED = Rotators,
SAUCE = semispinalis

A

MEMORIZE LAYER 5 AND 6 WITH RHYMES ETC

106
Q

SUBOCCIPITAL TRIANGLE

Border X 3

1– Rectus capitis posterior major - above and ____

2– Obliquus capitis superior - above and ______

3—Obliquus capitis inferior - _____ and laterally

A

medially

laterally

below

107
Q

SUBOCCIPITAL TRIANGLE

Contents X 3

1–third part of _______ artery

2– dorsal ramus of nerve C1-___________ NERVE

3–Suboccipital venous plexus

A

vertebral

SUBOCCIPITAL

108
Q

DORSAL AND VENTRAL PRIMARY RAMI

1— DORSAL primary rami, ALWAYS only innervate the ____ of the back, and the _____ muscles of the back!

2—- VENTRAL Primary Rami innervate everything else, except the ______&______
Ex: brachial plexus, lumbar plexus

A

skin

deep

head and neck.

109
Q

This nerve provides articular branches to the
elbow and wrist joints and motor innervation to
the majority of the muscles of the anterior
forearm.
a. Ulnar
b. Radial
c. Median
d. axillary

A

c. Median

110
Q 
Which nerve roots unite to form the ansa
cervicalis of the cervical plexus?
a. C1 and C5
b. C2 and C3 
c. C3 and C4
d. C4 and C5
A

b. C2 and C3

111
Q

These nerves innervate the structures located on
the anterior aspect of the vertebral canal.
a. Lateral braches of the posterior primary
divisions
b. Recurrent meningeal nerves
c. Anterior primary divisions
d. Medial braches of the posterior primary
divisions

A

b. Recurrent meningeal nerves

112
Q

A 28 year old woman sustains an injury to the left
arm during a fall off of her bicycle. Radiographs
done at your clinic show an oblique fracture
through the mid shaft of the humerus. Which
nerve is most likely to be injured by the mid shaft
fracture of the humerus?
a. Radial nerve
b. Median nerve
c. Musculocutanous nerve
d. Ulnar nerve

A

a. Radial nerve

113
Q

You perform your exam and find that the patient has
sustained a lateral traction injury to the superior
roots of the brachial plexus. Which of the following
signs would you NOT expect to find in this patient?
a. Dropped left shoulder
b. Left scapula that falls laterally
c. Inability to rotate the humerus medially
d. Paresis of muscles of the anterior aspect of the
left arm

A

c. Inability to rotate the humerus medially

114
Q

Exam reveals a contusion around the head and
neck of the fibula. Which nerve is susceptible
to direct injury by a compression force applied
to the lateral aspect of the head and neck of
the fibula?
a. Common peroneal nerve
b. Tibial nerve
c. Obturator nerve
d. Saphenous nerve

A

a. Common peroneal nerve

115
Q

Choose the incorrect statement with regard to the brachial
plexus.
a. The flexors of the upper extremity are innervated by the
terminal branches of the medial and lateral cords
b. The cords of the brachial plexus are named according
to their relationship to the axillary artery
c. The brachial plexus is derived from dorsal rami of C5,
C6, C7, C8 and T1
d. The posterior cord is formed by the posterior divisions
of all 3 trunks

A

c. The brachial plexus is derived from dorsal rami of C5,

C6, C7, C8 and T1

116
Q 
Spinal nerve C7 exits the IVF located between 
which 2 of the following vertebrae?
a. C4, C5
b. C5, C6
c. C6, C7 
d. C7, C8
A

c. C6, C7

MY AMMO FOR BOARDS (4 decks)

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