Neuroanatomy Flashcards

1
Q

Where are multipolar neurones typically present?

A

Skeletal muscle

ANS

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2
Q

Where are the soma of multipolar neurones typically found?

A

In CNS (presynaptic neurone for ANS)

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3
Q

Where are the soma of unipolar/pseudounipolar neurones found?

A

PNS - Dorsal root ganglion

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4
Q

What is the name for a collection nerve cell bodies in the CNS?

A

Nucleus

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5
Q

What is the name for a collection nerve cell bodies in the PNS?

A

Ganglion

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6
Q

What is the name for a bundle of axons in the CNS?

A

Tract

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7
Q

What is the name for a bundle of axons in the PNS?

A

Nerve

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8
Q

Where are spinal nerves located?

A

Only within the intervertebral foraminae

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9
Q

How do spinal nerves connect to the soma?

A

Via rami

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10
Q

How do spinal nerves connect to the spinal cord segment of the same number>

A

Via roots and rootlets

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11
Q

Which are bigger, posterior rami or anterior rami?

A

Anterior

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12
Q

What is the course of a sensory axon?

A

Passes from the spinal nerve…
…into the posterior root…
…into the posterior rootlets…
…into the dorsal horn of the spinal cord

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13
Q

What is the course of a motor axon?

A

Passes from ventral horn of the spinal cord…
…into the anterior rootlets…
…into the anterior root…
…into the spinal nerve

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14
Q

Where does the spinothalamic tract decussate?

A

In spinal cord (Usually 1-2 spinal levels above point of entry)

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15
Q

What dermatomal map is used in Dundee?

A

Foerster map

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16
Q

What does each segment of the body wall receive in terms of nervous supply?

A
General sensory supply (to all structures)
Motor supply (to skeletal muscles)
Sympathetic supply to:
- Skin
- Smooth muscles of all arterioles
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17
Q

What spinal level is the male nipple?

A

T4

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18
Q

What spinal level is the umbilicus?

A

T10

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19
Q

What spinal levels supply the posterior scalp, neck and shoulder?

A

C2-C4

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20
Q

What spinal levels supply the upper limb?

A

C5-T1

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21
Q

What spinal levels supply the lower limb, gluteal region and perineum?

A

L2-Coccygeal segment

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22
Q

What spinal levels make up the cervical plexus?

A

C1-C4

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23
Q

What does the cervical plexus supply?

A

Posterior scalp
Neck wall
Diaphragm

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24
Q

What spinal levels make up the brachial plexus?

A

C5-T1

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25
Q

What does the brachial plexus supply?

A

Upper limb

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26
Q

What spinal levels make up the lumbar plexus?

A

L1-L4

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27
Q

What does the lumbar plexus supply?

A

Lower limb

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28
Q

What spinal levels make up the sacral plexus?

A

L5-S4

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29
Q

What does the sacral plexus supply?

A

Lower limb
Gluteal region
Perineum

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30
Q

What segments of the spinal cord have lateral horns?

A

T1-L2

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31
Q

Why do some spinal cord segments have lateral horns?

A

For soma of the next SNS neurone in the chain

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32
Q

Presynaptic axons providing sympathetic outflow to the heart synapse where?

A

T1 or Cervical paravertebral ganglia

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33
Q

Postsynaptic axons providing sympathetic outflow to the heart travel in what nerves?

A

Cardiopulmonary splanchnic nerves

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34
Q

Where do postsynaptic sympathetic axons travel to in the heart?

A

SA node
AV node
Myocardium

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35
Q

Presynaptic axons providing sympathetic outflow to the lungs synapse where?

A

Upper thoracic paravertebral ganglia

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36
Q

Postsynaptic axons providing sympathetic outflow to the lungs travel in what nerves?

A

Cardiopulmonary splanchnic nerves

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37
Q

Where do postsynaptic sympathetic axons travel to in the lungs?

A

Bronchiolar smooth muscle

Mucous glands

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38
Q

Presynaptic axons providing sympathetic outflow to the foregut synapse where?

A

Celiac ganglion of the celiac plexus

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39
Q

Presynaptic axons providing sympathetic outflow to the kidney synapse where?

A

Aorticorenal ganglion

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40
Q

Presynaptic axons providing sympathetic outflow to the midgut synapse where?

A

Superior mesenteric ganglion of the superior mesenteric plexus

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41
Q

Presynaptic axons providing sympathetic outflow to the hindgut and pelvic/perineal organs synapse where?

A

Inferior mesenteric ganglion of the inferior mesenteric plexus

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42
Q

Presynaptic axons providing sympathetic outflow to the adrenal medulle synapse where?

A

Directly onto adrenaline/NA secreting cells of the adrenal medulla (pas through aorticorenal ganglion without synapsing

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43
Q

Why is there ipsilateral ptosis in Horner’s syndrome?

A

Lack of SNS innervation to levator palpebrae superioris smooth muscle

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44
Q

Why is there ipsilateral miosis in Horner’s syndrome?

A

No SNS innervation to dilator pupillae

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45
Q

What causes Horner’s syndrome?

A

Cervical sympathetic chain compression

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46
Q

What lung tumour causes Horner’s syndrome?

A

Pancoast tumour (most are non-small cell)

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47
Q

How do parasympathetic fibres reach the eye?

A

Via the ciliary ganglion

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48
Q

Parasympathetic fibres which travel through parasympathetic ganglia in the head travel to what structures?

A

Lacrimal glands

Salivary glands

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49
Q

Parasympathetic fibres in the vagus nerve supply what structures?

A

Neck
Chest
Abdomen (as far as midgut)

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50
Q

Parasympathetic fibres in the sacral spinal nerves supply what structures?

A

Hindgut
Pelvis
Perineum

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51
Q

Where do the extrinsic back muscle attach?

A

Back

To the upper limb/pectoral girdle

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52
Q

What is the function of the extrinsic back muscles?

A

Move the upper limb

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53
Q

What are the main extrinsic back muscles? What is their nerve supply?

A

Trapezius (CN XI)
Latissimus dorsi (Thoracodorsal nerve/C5-C7)
Levator scapulae (Cervical nerve/C3-C4 and Dorsal scapular nerve/C5)
Rhomboids (Dorsal scapular nerve)

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54
Q

The erector spinae and transversospinalis muscles are what type of back muscles?

A

Intrinsic

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55
Q

What is the function of the erector spinae and transversospinalis muscles?

A

Maintain back posture

Move the vertebral column

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56
Q

What are the three muscle groups of the erector spinae? (From medial to lateral) What are there insertions?

A

Spinalis (spinous processes)
Longissimus (transverse processes)
Iliocostalis (ribs)

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57
Q

What is the inferior attachment of the erector spinae muscles?

A

Common tendon to the:

  • Sacrum AND
  • Iliac crest
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58
Q

Where is the transversospinalis located?

A

Within the deep grooves between the transverse and spinous processes

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59
Q

What do the transversospinalis muscles lie superficial to?

A

Laminae

Articular processes

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60
Q

What muscles are responsible for back extension?

A

Intrinsic back muscles

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61
Q

What muscles are responsible for back flexion?

A
Psoas major (main)
Rectus abdominis
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62
Q

Via what do pain signals from the facet joints and intervertebral discs travel?

A

Posterior rami

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63
Q

What ligament connects adjacent laminae posterior to spinal cord?

A

Ligamentum flavum

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64
Q

Where does the posterior longitudinal ligament attach to?

A

Posterior aspect of all:

  • Vertebral bodies
  • Intervertebral discs
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65
Q

What does the posterior longitudinal ligament prevent?

A

Over-flexion of spine

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66
Q

Where does the anterior longitudinal ligament attach to?

A

Anterior aspects of all:

  • Vertebral bodies
  • Intervertebral discs
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67
Q

Why is an intervertebral disc more likely to prolapse posteriorly than anteriorly?

A

Posterior longitudinal ligament is weaker and provides less support to the discs than the anterior longitudinal ligament

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68
Q

What does the anterior longitudinal ligament prevent?

A

Over-extension of the spine

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69
Q

What connects the tips of spinous processes?

A

Supraspinous ligament

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70
Q

What does the interspinous ligament connect?

A

Superior and inferior surfaces of spinous processes

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71
Q

Each cervical vertebra has a transverse foramina; why?

A

Passage of vertebral arteries

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72
Q

What is the special name given to:

  • C1
  • C2
  • C7
A
C1 = Atlas
C2 = Axis
C7 = Vertebrae prominens
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73
Q

What are the atlanto-ocipital joints between?

A

Occipital condyles AND

Superior articular facets of the atlas/C1

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74
Q

How many joints exist between the atlas and the axis?

A

3:

  • 2 facet joints
  • 1 between anterior arch of atlas and odontoid process
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75
Q

What is the sacral promontory? What does it articulate with?

A

Part of the border of the pelvic inlet (posteriorly)

Articulates with L5 (Sacrovertebral angle)

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76
Q

Instead of intervertebral foraminae, how does the sacrum permit the passage of anterior and posterior rami of the sacral spinal nerves?

A

Anterior sacral foraminae

Posterior sacral foraminae

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77
Q

What does the sacral canal contain?

A

Cauda equina

Meninges

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78
Q

What does the sacral canal end in?

A

Sacral hiatus

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79
Q

In the spinal canal, what is the dural sac surrounded by?

A

Epidural fat (in epidural space)

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80
Q

Where are extradural venous sinuses located?

A

In the epidural fat

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81
Q

Where does the spinal cord begin and end?

A

C1

L2

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82
Q

What is the name of the ending of the spinal cord?

A

Conus medullaris

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83
Q

Why might a laminectomy be carried out?

A

Relieve pressure on cord/roots due to:

  • Tumour
  • Herniated disc
  • Bone hypertrophy
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84
Q

How does a spinal nerve connect to a sympathetic ganglion?

A

Via grey and white rami communicantes

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85
Q

What are somatic general sensory symptoms?

A
Pain (neuralgia)
Paraesthesia
Anaesthesia
Hyperaesthesia
Hot/Cold
Ataxia (loss of balance/coordination)
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86
Q

What are somatic motor symptoms?

A

Muscle stiffness/tightness/spasm
Hypotonia (LMN) or Hypertonia (UMN)
Reduced power
Ataxia

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87
Q

Where is a common locations of CVAs that may result in sensory pathology?

A

Internal capsule

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88
Q

C2 dermatome

A

Back of scalp and Adam’s apple

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89
Q

C3 dermatome

A

Back of neck and jugular notch

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90
Q

C4 dermatome

A

Clavicle and shoulder tip

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91
Q

C5 dermatome

A

Regimental badge area

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92
Q

C6 dermatome

A

Thumb

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93
Q

C7 dermatome

A

Middle finger

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94
Q

C8 dermatome

A

Little finger

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95
Q

T1 dermatome

A

Medial forearm

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96
Q

T2 dermatome

A

Medial arm and sternal angle

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97
Q

T4 dermatome

A

Male nipple

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98
Q

T8 dermatome

A

Ziphoid process

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99
Q

T10 dermatome

A

Umbilicus

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100
Q

T12 dermatome

A

Pubic symphysis

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101
Q

L1 dermatome

A

Groin (‘hands in pockets’)

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102
Q

L2 dermatome

A

Anterior thigh

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103
Q

L3 dermatome

A

Anterior knee

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104
Q

L4 dermatome

A

Medial malleolus

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105
Q

L5 dermatome

A

Dorsum of foot

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106
Q

S1 dermatome

A

Heel

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107
Q

S2 dermatome

A

Posterior knee

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108
Q

S3 dermatome

A

Buttocks

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109
Q

S4 dermatome

A

Perineum

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110
Q

S5 dermatome

A

Perianal skin

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111
Q

What is the cutaneous innervation of the lesser occipital (C2) nerve?

A

Skin posterior to external ear

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112
Q

What is the cutaneous innervation of the greater auricular (C2, C3) nerve?

A

Skin over angle of mandible and some of external ear

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113
Q

What its the cutaneous innervation of the transverse cervical (C2, C3) nerve?

A

Skin on anterior neck

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114
Q

What is the cutaneous innervation of the supraclavicular (C3, C4) nerve?

A

Skin over clavicle and shoulder tip

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115
Q

Where is the ‘nerve point’ of the neck? Why is this clinically important?

A

Midpoint of the posterior border of the SCM

Take cure during biopsy - cervical plexus

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116
Q

The anterior rami of T2-T11 spinal nerves are called what?

A

Intercostal nerves

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117
Q

The spinal nerves of T7-T11 continue as what?

A

Thoracoabdominal nerves

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118
Q

The T12 anterior ramus forms what nerve?

A

Subcostal nerve

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119
Q

What does the bifurcation of the anterior rami of L1 spinal nerves form?

A

Iliohypogastric nerves

Ilioinguinal nerves

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120
Q

How can we assess the cervical plexus?

A

Neck postural and strap muscles

Diaphragm

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121
Q

How can we assess the brachial plexus?

A

Upper limb muscles

Extrinsic back muscles

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122
Q

What supplies the motor control to the strap muscles?

A

Cervical plexus (C1-C3)

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123
Q

What supplies the diaphragm?

A

Phrenic nerve (C3, C4 and C5)

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124
Q

What supplies the SCM and trapezius?

A

CN XI

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125
Q

What supplies the pharyngeal muscles and the intrinsic laryngeal muscles?

A

CN X

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126
Q

What nerve supplies the deltoid and the teres minor?

A

Axillary nerve (C5, C6)

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127
Q

What nerve supplies the anterior arm compartment (biceps, brachialis, coracobrachialis)?

A

Musculocutaneous nerve (C5-C7)

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128
Q

What does the radial nerve supply?

A
Triceps (posterior arm)
Posterior forearm:
- Brachioradialis
- Supinator
- All extensors of carpus and digits
- Abductor pollicis longus
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129
Q

What nerve roots form the radial nerve

A

C5-T1 (entire brachial plexus)

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130
Q

What does the median nerve supply?

A
Anterior forearm:
- Pronators
- Flexor carpi radialis
- Palmaris longus
- Flexor digitorum superficialis
- Lateral half of flexor digitorum profundus
- Flexor pollicis longus
Muscles of the hand:
- Thenar
- Lumbricals 1 and 2
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131
Q

What does the ulnar nerve supply?

A
Anterior forearm:
- Flexor carpi ulnaris
- Medial half of flexor digitorum profundus
- Adductor pollicis
Muscles of the hand:
- Hypothenars
- Lumbricals 3 and 4
- All the interossei (dorsal and palmar)
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132
Q

What does the femoral nerve supply?

A

Anterior thigh:
- Quadriceps
- Sartorius
Pectineus

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133
Q

What does the obturator nerve supply?

A

All of medial thigh:

  • All adducttors (brevis, longus and magnus)
  • Gracilis
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134
Q

What does the tibial nerve supply?

A
Posterior thigh (True hamstrings):
- Semimembranous
- Semitendinosus
- Long head of biceps femoris
Posterior leg:
- Gastrocnemius
- Soleus
- Plantaris
- Popliteus
- Tibialis posterior
- Flexors of digits (Digitorum and hallucis longus)
All intrinsic sole muscles
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135
Q

What does the common fibular nerve supply?

A

Short head of biceps femoris

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136
Q

What does the superficial fibular nerve supply?

A

Lateral leg:

  • Fibularis longus
  • Fibularis brevis
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137
Q

What does the deep fibular nerve supply?

A
Anterior leg:
- Tibialis anterior
- Extensor digitorum and hallucis longus
- Fibularis tertius
Dorsum of the foot:
- Extensor digitorum brevis
- Extensor hallucis brevis
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138
Q

Where does the extracranial part of the olfactory nerve lie?

A

Olfactory mucosa

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139
Q

What is the cranial foramina for CN i?

A

Cribiform plate (anterior fossa)

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140
Q

Where do the olfactory nerves synapse?

A

Olfactory bulb

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141
Q

How do the olfactory nerves get to the cortex?

A

Via olfactory tracts

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142
Q

What is the cranial foramina for CN ii?

A

Optic canal (middle fossa)

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143
Q

What is the intracranial path of CN ii?

A

Travels around pituitary stalk to optic chiasm

Forms optic tract

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144
Q

Where does CN ii connect to the CNS?

A

Diencephalon

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145
Q

What are the functions of CN iii?

A

Motor - Eye movement

PNS - Pupil constriction

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146
Q

Where does CN iii connect to the CNS?

A

Midbrain (mesencephalon)

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147
Q

Where do CNs iii, iv and vi leave the skull?

A

Superior orbital fissure (middle fossa)

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148
Q

What is the intracranial course of CNs iii, iv and vi?

A

Travels towards orbit in lateral wall of cavernous sinus

149
Q

What muscles does CN iii supply?

A
Medial rectus
Superior rectus
Inferior rectus
Inferior oblique
Levator palpebrae superioris
150
Q

What muscle does CN iv supply?

A

Superior oblique

151
Q

What muscle does CN vi supply?

A

Lateral rectus

152
Q

What is the extracranial part of CN viii?

A

Axons from cochlear and vestibular apparatus

153
Q

What is the cranial foramina for CN viii?

A

Internal acoustic meatus (posterior fossa)

154
Q

What is the intracranial path of CN viii?

A

Travels posteromedially from IAM to the pontomedullary junction

155
Q

Where does CN xi connect to the CNS?

A

Cervical spinal cord

156
Q

What is the intracranial path of CN xi?

A

Ascends through foramen magnum

Travels towards jugular foramen

157
Q

Where does CN xi leave the cranium?

A

Jugular foramen (posterior fossa)

158
Q

Where does CN xii join the CNS?

A

Via rootlets lateral to the pyramids of the medulla

159
Q

What is the intracranial path of CN xii?

A

Travels anteriorly to hypoglossal canal (posterior fossa)

160
Q

What is the extracranial pathy of CN xii?

A

Descends lateral to carotid sheath
At level of the hyoid:
- Turns anteriorly
- Moves towards lateral aspect of tongue

161
Q

What is the one tongue muscle CN xii doesn’t supply?

A

Palatoglossus

162
Q

What is the CNS connection of CN v?

A

Pons:

  • Laterally
  • Midway between medulla and midbrain
163
Q

What is the intracranial path of CN v?

A

Inferior to edge of tentorium cerebelli (between posterior and middle fossae)

164
Q

Where does CN v leave the cranium?

A

v1 - Superior orbital fissure
v2 - Foramen rotundum
V3 - Foramen ovale

165
Q

What cranial nerve forms the afferent part of the corneal reflex?

A
Ophthalmic nerve (CN v1)
(Long ciliary nerve)
166
Q

What sinus does the ophthalmic nerve not supply?

A

Maxillary

167
Q

What cranial nerve supplies the anterior and posterior cranial fossae?

A

Ophthalmic nerve (CN c1)

168
Q

What cranial nerve supplies the middle cranial fossa?

A

Mandibular nerve (CN v3)

169
Q

Which of the muscles supplied by CN v3 is the jaw opening muscles?

A

Lateral ptyergoid

170
Q

Apart from the jaw opening/closing muscles, what other two muscles does CN v3 supply?

A

Tensor veli palatini

Tensor tympani

171
Q

Where does CN vii connect to the CNS?

A

Antertolaterally at pontomedullary junction

172
Q

What is the cranial foramina for CN vii?

A

Temporal bone:

  • IMA (in)
  • Facial canal
  • Stylomastoid foramen (out)
173
Q

What does CN vii give motor supply to?

A

Most fibres pass through parotid gland (but do not supply it)
Muscles of facial expression

174
Q

In the stylomastoid foramen, what nerve modality is CN vii carying?

A

ONLY somatic motor (to muscles of facial expression)

175
Q

What branches off before the stylomastoid foramen (CN vii)? What is its function?

A

Chorda tympani:

  • Special sensory to anterior 2/3 of tongue
  • PNS to sublingual and submandibular
176
Q

What is the general sensory supply of CN ix?

A
Posterior third of tongue
Mucosa of naso- and oropharynx
Mucosa of some of laryngopharynx
Palatine tonsils
Eustachian tube
Middle ear cavity
177
Q

What is the special sensory supply of CN ix?

A

Vallate papillae on posterior third of tongue

178
Q

What are the visceral afferent (sensory) supply of CN ix?

A

Carotid sinus:

  • Baroreceptors
  • Chemoreceptors
179
Q

What muscle does CN ix give motor supply to?

A

Stylopharyngeus

180
Q

What do the PNS fibres in CN ix supply?

A

Parotid gland

181
Q

What is the CNS connection of CN x?

A

Lateral aspect of medulla (immediately inferior to CN ix)

182
Q

What is the path of CN x in the neck?

A

Runs in carotid sheath posterior to and between:

  • Common carotid
  • Internal jugular
183
Q

What branch of CN x supplies the laryngeal muscles?

A

Recurrent laryngeal

184
Q

What is the route of the CN x branch supplying the laryngeal muscles?

A

Left - Curves under aorta

Right - Curves under right subclavian artery

185
Q

In the thorax, where does the right CN x run along?

A

Lateral aspect of trachea

186
Q

In the thorax, where does the left CN x run along?

A

Lateral aspect of aortic arch

187
Q

In the thorax, both CN x pass posterior to what to run alongside what?

A

Pass posterior to lung root

Onto oesophagus

188
Q

What structure does CN x pierce and at what spinal level?

A

Diaphragm

T10

189
Q

In the abdomen, what structure does CN x pass onto?

A

Stomach

190
Q

In the abdomen, where do the last branches of CN x pass to?

A

Splenic flexure of colon

191
Q

What are the five layers of the scalp?

A
S - Skin
C - Connective tissue (contains named scalp arteries)
A - Aponeurosis
L - Loose connective tissue
P - Pericranium
192
Q

What bones form the pterion?

A

Frontal
Parietal
Temporal
Sphenoid

193
Q

What courses over the deep aspect of the pterion?

A

Middle meningeal artery

194
Q

What causes the pain in meningitis?

A

Stretching of the dura

195
Q

What provides sensory supply to the dura?

A

CN v

196
Q

What does the dura enclose?

A

Dural venous sinuses

197
Q

What are arachnoid granulations?

A

Extensions of arachnoid into the dural venous sinuses

198
Q

What is the function of arachnoid granulations?

A

Reabsorb CSF from subarachnoid space into the venous system

199
Q

What is the diaphragm sellae?

A

Tough sheet of dura over pituitary fossa

200
Q

What is the tentorium cerebelli?

A

Tough sheet of dura over the cerebellum

201
Q

Where does the tentorium cerebelli attach?

A

Ridges of petrous temporal bones

202
Q

Why does the tentorium cerebelli have a central gap?

A

To allow passage of the brainstem

203
Q

What is the falx cerebri?

A

Midline structure made of dura

204
Q

Where does the falx cerebri attach?

A

Deep aspect of skull:

  • Crista galli of ethmoid (anteriorly)
  • Internal aspect of sagittal suture
  • Internal occipital protuberance (posteriorly)
205
Q

What is the function of the falx cerebri?

A

Separates the right and left hemispheres

206
Q

Where does the superior sagittal sinus lie?

A

Superior border of falx cerebri

207
Q

Where does the inferior sagittal sinus lie?

A

Inferior border of falx cerebri

208
Q

What do the inferior sagittal sinus and great cerebral vein form?

A

Straight sinus

209
Q

Where does the confluence of the sinuses lie?

A

In the midline at the internal occipital protuberance

210
Q

What veins make up the confluence of the sinuses?

A

Superior sagittal sinus
Straight sinus
(Occipital sinus)

211
Q

Where does the confluence of the sinuses drain to?

A

Transverse sinus

212
Q

Where do cerebral veins drain to?

A

Superior and inferior sagittal sinuses

213
Q

What is the sigmoid sinus?

A

Continuation of the transverse sinus

214
Q

Where does the sigmoid sinus drain and at what foramen?

A

Internal jugular veins at the jugular foramen

215
Q

What is the danger triangle?

A

Facial vein is very superficial and drains to internal jugular
Risk of spread of infection

216
Q

Via what does the internal carotid enter the cranium?

A

Carotid canal

217
Q

From what artery do the vertebral arteries branch off?

A

Subclavian arteries

218
Q

How do the vertebral arteries enter the skull?

A

Via foramen magnum

219
Q

What structures do the vertebral arteries supply?

A

Meninges

Cerebellum

220
Q

What do the anterior cerebral arteries supply?

A

Medial aspects of the cerebral hemispheres

221
Q

In anterior cerebral artery syndrome (eg due to stroke) what symptoms are seen?

A

Hemiparesis and sensory loss of contralateral lower limbs
Apraxia
Anosmia
Urinary incontinence

222
Q

What do the middle cerebral arteries supply?

A

Lateral aspects of the cerebral hemispheres

223
Q

In middle cerebral artery syndrome (eg due to stroke) what symptoms are seen?

A

Hemiparesis and sensory loss of:
- Contralateral lower half of face
- Contralateral upper limbs (and lower limbs)
Ataxia of contralateral side (greatest in face and upper limbs)
Aphasia
Anosognosia

224
Q

What do the posterior cerebral arteries supply?

A

Posterior aspects of cerebral hemisphers

Visual cortex

225
Q

In posterior cerebral artery syndrome (eg due to stroke) what symptoms are seen?

A

Contralateral loss of pain and temperature sense
Contralateral hemianopia with macular sparing
Ipsilateral deficits of CN iii
Horner’s syndrome

226
Q

Where is the Circle of Willis located?

A
Inferior to the midbrain
Close to:
- Pituitary stalk
- Optic chiasm
Within subarachnoid space
227
Q

What vessels make up the Circle of Willis?

A
Anterior cerebral arteries
Posterior cerebral arteries
Anterior communicating arteries
Posterior communicating arteries
Internal carotid arteries
(Basilar artery)
228
Q

What volume of CSF circulates in the subarachnoid space daily?

A

400-500ml

229
Q

What produces CSF?

A

Choroid plexuses of the ventricles

230
Q

Where can CSF be obtained and how?

A

L3/L4 or L4/L5

Via LP

231
Q

Where does the subarachnoid space close?

A

S2

232
Q

Where are the lateral ventricles located?

A

In their respective hemispheres

233
Q

Where is the third ventricle located?

A

In the midline in the diencephalon

234
Q

Where is the fourth ventricle located?

A

Between the cerebellum and the pons

235
Q

Describe the circulation of CSF

A
  1. Secreted by choroid plexus into lateral and third ventricles
  2. Travels via the left and right Foraminae of Munro…
  3. Into the third ventricle
  4. It then flows into the cerebral aqueduct (in midbrain)
  5. Then flows into the fourth ventricle
  6. Then flows into SA space (mainly) OR the central canal of the spinal cord
236
Q

How is hydrocephalus treated?

A

Ventricular peritoneal shunt

237
Q

What kind of intracranial haemorrhage can occur due to middle meningeal artery injury?

A

Epidural/Extradural

238
Q

What typically causes a subdural haemorrhage?

A

Torn cerebral veins - Falls in the elderly

239
Q

What typically causes a subarachnoid haemorrhage?

A

Ruptured berry aneurysm

Ruptured congenital aneurysm

240
Q

What layers are passed through for epidural anaesthesia?

A
Skin
Subcutaneous fat
Supraspinous ligament
Intraspinous ligament
Ligamentum flavum
Epidural space (fat and veins)
241
Q

In a lumbar puncture, what layers are passed through?

A
Skin
Subcutaneous fat
Supraspinous ligament
Intraspinous ligament
Ligamentum flavum
Epidural space (fat and veins)
Dura and subarachnoid (simultaneously)
242
Q

What can damage to the epidural venous sinuses cause?

A

Epidural haemorrhage

243
Q

When would we not carry out an LP? Why?

A

In situations were ICP is raised (idiopathic)

May cause uncal (transtentorial herniation

244
Q

When might an LP be carried out in raised ICP?

A

To lower ICP (therapeutic) when an obstruction (eg. of the third ventricle) has been ruled out

245
Q

How many visible swellings are visible initially in the development of the nervous system?

A

3 vesicles (neural tube)

246
Q

What happens that results in 5 vesicles?

A

1st and 3rd vesicles subdivide

247
Q

What secondary vesicle forms the cerebral hemispheres?

A

Telencephalon

248
Q

What secondary vesicle forms the thalamus and hypothalamus?

A

Diencephalon

249
Q

What secondary vesicle forms the midbrain?

A

Mesencephalon

250
Q

What secondary vesicle forms the pons and cerebellum?

A

Metencephalon

251
Q

What secondary vesicle forms the medulla?

A

Myeloncephalon

252
Q

What is the function of astrocytes?

A

Support

Maintain BBB and homeostasis

253
Q

What shape are astrocytes?

A

Star

254
Q

What is the function of oligodendrocytes?

A

Produce myelin in CNS

255
Q

What shape is the nucleus in oligodendrocytes?

A

Round

256
Q

What is the function of microglia?

A

Immune monitoring and Ag presentation

Haemopoietic origin - similar to macrophages

257
Q

At rest, what shape are mircroglia?

A

Long nucleus

Short, spiny cell processes

258
Q

When activated, what shape are microglia?

A

Round

259
Q

What is the function of ependymal cells?

A
Line ventricles (ciliated cuboidal/columnar epithelium)
Produce CSF
260
Q

What is a folium?

A

The equivalent of a gyrus but in the cerebellum

261
Q

Where is the grey matter in relation to the white matter in the brain?

A

External

262
Q

Where is the grey matter in relation to the white matter in the spinal cord?

A

Internal

263
Q

Why is white matter white?

A

Myelin

264
Q

Which lobe is anterior to the central sulcus and superior to the lateral sulcus?

A

Frontal lobe

265
Q

Which lobe is posterior to the central sulcus, superior to the lateral sulcus and anterior to a line from the parieto-occipital sulcus to the preoccipital notch?

A

Parietal lobe

266
Q

Which lobe is posterior to a line from the parieto-occipital sulcus to the preoccipital notch?

A

Occipital lobe

267
Q

Which lobe is inferior to the lateral sulcus and bordered posteriorly by a line from the parieto-occipital sulcus to the preoccipital notch?

A

Temporal lobe

268
Q

What does the insular lobe play a role in?

A

Experience of pain

269
Q

Where is the myenteric plexus found?

A

Between the outer layers of smooth muscle in the gut

270
Q

Where is the submucosal plexus found?

A

In submucosa of the walls of the gut

271
Q

How are the posterior roots enlarged when they pass through the intervertebral foraminae?

A

By dorsal root ganglia

272
Q

How does the conus medullaris continue? What is it anchored to?

A

Filum terminate

Anchored to dorsum of coccyx

273
Q

What is the function of the denticulate ligament?

A

Suspends spinal cord in the spinal canal

274
Q

Where is the denticulate ligament located?

A

On the lateral aspects of the spinal cord

275
Q

What makes up the denticulate ligament?

A

Pial and arachnoid tissues

276
Q

What is white matter composed of in the spinal cord?

A

Longitudinally orientated axons
Glial cells
Blood vessels

277
Q

What is contained in the grey matter in the spinal cord?

A
Soma
Cell processes
Synapses
Glia
Blood vessels
278
Q

How is the grey matter in the spinal cord divided?

A

Left
Right
Posterior
Anterior

279
Q

What is the horizontal part of the ‘H’ of the grey matter in the spinal cord called?

A

Dorsal and ventral grey commisures

280
Q

What are the three main longitudinal arteries of the spinal cord?

A

Anterior spinal artery

2 posterior spinal arteries

281
Q

Where do the three longitudinal arteries arise?

A

From the vertebral arteries

282
Q

Where are the segmental arteries derived from?

A

Vertebral, intercostal and lumbar arteries

283
Q

What arteries travel along dorsal and ventral roots?

A

Radicular arteries

284
Q

What veins drain the spinal cord?

A

Longitudinal and segmental veins

285
Q

What can a CVA of the internal capsule cause?

A

Lack of control of the corticospinal tract:

  • Spastic paralysis
  • Hyperflexion of the upper limbs
  • Decorticate posturing
286
Q

What tract is thought to play a role in decerebate posturing?

A

Vestibulospinal tract

287
Q

What are the motor consequences of Brown-Sequard’s Syndrome?

A

Ipsilateral paralysis
Ipsilateral hyperreflexia
Extensor plantar reflex

288
Q

What are the sensory consequences of Brown-Sequard’s Syndrome?

A

Ipsilateral loss of proprioception and vibratory sense

Contralateral loss of pain and temp. sensation

289
Q

What separates the anterior and posterior lobes of the cerebellum?

A

Primary fissure

290
Q

What runs through the posterior lobe of the cerebellum?

A

Horizontal fissure

291
Q

The posterior fissure separates the posterior lobe of the cerebellum from what lobe?

A

Flocculonodular lobe:

  • Nodule
  • Flocculus
292
Q

How is the cerebellum attached to the brainstem?

A

Via 3 peduncles

293
Q

What are the cerebellar vermises?

A

Medial, corticonuclear zones of the cerebellum

294
Q

What parts of the cerebellum form the spinocerebellum?

A

Mainly the vermis (ie medial part)

295
Q

What parts of the cerebellum form the vestibulocerebellum?

A

Flocculonodular lobe

296
Q

What parts of the cerebellum form the cerebrocerebellum/pontocerebellum?

A

Lateral parts of the hemispheres

297
Q

Deep grey matter has white matter ‘foliage’ known as?

A

Folia

298
Q

What is the deep grey matter of the cerebellum called?

A

Deep cerebellar nuclei

299
Q

The cortex is divided into 3 layers. What are they?

A
Molecular layer (outer)
Purkinje cell layer (middle)
Granular layer (inner)
300
Q

What afferent projections come to the cerebellum?

A
Spinal cord:
- Somatic proprioception
- Pressure
Cerebral cortex (via pons)
Vestibular apparatus (via vestibular nuclei)
301
Q

What layer do most inputs into the cerebellum go?

A

Granular layer

302
Q

What layer do all outputs of the cerebellum leave through?

A

Purkinje cell layer

303
Q

What do cerebellar outputs contribute to?

A

Coordinating ALL motor tracts:

  • Corticospinal
  • Rubrospinal
  • Vestibulospinal
304
Q

When cerebellar efferents leave, where do they decussate and synapse?

A

Most in the thalamus

305
Q

What are the signs/symptoms of a midline cerebellar lesion?

A

Disturbance in posture control

Falling when standing/sitting despite preserved limb control

306
Q

What are the signs/symptoms of a unilateral hemispheric cerebellar lesion?

A

Disturbance of limb coordination
Intention tremor:
- Broad and low frequency (~5Hz)
Unsteady gait

307
Q

What are the signs/symptoms of bilateral cerebellar dysfunction?

A

Dysarthria (slow, slurred speech)
Cerebellar ataxia:
- Bilateral incoordination of the arms
- Wide based gait

308
Q

What substance can cause bilateral cerebellar dysfunction?

A

Alcohol

309
Q

What are the functions of the basal ganglia?

A
Facilitates purposeful movement
Inhibits unwanted movements
Role in:
- Posture
- Muscle tone
310
Q

What parts of the basal ganglia form the striatum?

A

Caudate nucleus
Putamen
(NB Both are homonymous in function)

311
Q

What parts of the basal ganglia form the lenticular/lentiform nucleus?

A

Putamen

Globus Pallidus

312
Q

What parts of the basal ganglia form the corpus striatum?

A

Caudate nucleus
Putamen
Globus Pallidus

313
Q

What five structures make up the basal ganglia?

A
Caudate nucleus
Putamen
Globus Pallidus
Subthalamic nucleus
Substantia nigra
314
Q

What separates the lentiform nucleus and the caudate nucleus?

A

Internal capsule

315
Q

What causes Parkinson’s Disease?

A

Degeneration of the dopaminergic neurones of the substantia nigra

316
Q

How does the basal ganglia enhance movement?

A

Direct pathway enhances thalamic outflow

317
Q

How does the basal ganglia inhibit movement?

A

Indirect pathway inhibits thalamic outflow

318
Q

Do unilateral lesions of the basal ganglia affect the ipsi- or contralateral side of the body?

A

Contralateral

319
Q

What signs/symptoms are present in basal ganglia lesions?

A

Motor signs:

  • Changes in muscle tone
  • Dyskinesias (Tremor, chorea [distal limbs], myoclonus)
320
Q

What causes Huntington’s Disease?

A

Progressive degeneration of basal ganglia and cerebral cortex

321
Q

What can the signs and symptoms of basal ganglia lesions be referred to as?

A

Extrapyramidal

322
Q

Where are the nuclei of CN iii located?

A

Midline of superior colliculus (Edinger-Westphal Nucleus and Oculomotor nucleus)

323
Q

Where is the nucleus of CN iv?

A

Midline of inferior colliculus (lower midbrain)

324
Q

Where is the nucleus of CN vi?

A

Midline and very caudal in pons

325
Q

Where is the nucleus of CN xii?

A

In the midline

326
Q

Where is the sensory nucleus of CN v?

A

Stretches from midbrain down to upper 2 segments of cervical spinal cord

327
Q

What info does the mesencephalic nucleus receive from CN v?

A

Proprioceptive from chewing muscles

328
Q

Where is the mesencephalic nucleus?

A

Extends from upper pons to midbrain

329
Q

One pathway from the mesencephalic nucleus connect to the trigeminal motor nucleus. What function does this serve?

A

Jaw reflex

330
Q

What function does the pontine trigeminal/principal nucleus serve?

A

Processes discriminative touch and vibration

331
Q

What tracts does the pontine trigeminal nucleus project into?

A

Dorsal trigeminothalamic tracts (Bilateral to VPM)

332
Q

What function does the spinal nucleus serve?

A

Processes pain and temperature sensations

333
Q

What sensations enter more superiorly in the spinal nucleus?

A

Perioral

334
Q

What are the 3 components of CN vii?

A
Facial motor nucleus
Superior salivary nucleus (PNS)
Solitary nucleus (taste)
335
Q

What is the path of the motor CN vii axons?

A

Loop around CN vi

336
Q

What are the 4 components of CN ix?

A
Solitary nucleus (taste)
Commissural nucleus (visceral)
Inferior salivary nucleus (PNS)
Nucleus ambiguus (motor from stylopharyngeus)
337
Q

What are the 4 components of CN x?

A
Solitary nucleus (taste)
Commissural nucleus (visceral)
Dorsal motor nucleus (PNS)
Nucleus ambiguus (motor)
338
Q

What is the corticobulbar tract?

A

Part of the pyramidal tract:

- Motor supply to cranial nerves

339
Q

Where are PNS efferent inputs mainly from in regards to cranial nerves?

A

Hypothalamus

340
Q

What organs does the cochlea contain?

A

Organs of Corti (composed of hair cells)

341
Q

What do the cochlear nuclei span?

A

Pontomedullary junction

342
Q

What nuclei are important in sound localisation?

A

Superior olivary nucleus (pons)

Nucleus of lateral lemniscus

343
Q

What lobe is the primary auditory cortex located in?

A

Temporal lobe

344
Q

What is the function of Wernicke’s area?

A

Comprehension of spoken and written language

345
Q

Where is Wernicke’s area located?

A

Superior temporal gyrus

346
Q

What part of the auditory cortex do low frequency sounds travel to?

A

Anterolateral

347
Q

What part of the auditory cortex do high frequency sounds travel to?

A

Posteromedial

348
Q

What is Broca’s area responsible for?

A

Production of spoken and written language

349
Q

Where is Broca’s area located?

A

Inferior frontal gyrus

350
Q

What does damage to Broca’s area result in?

A

Expressive aphasia:

  • Using only a few words
  • Only saying the important words in a sentence
351
Q

What does damage to Wernicke’s area result in?

A

Receptive aphasia:

  • Words placed out of order
  • Meaningless words spoken
352
Q

To what structures does the vestibular nucleus connect?

A

Thalamus
CNs iii, iv and iv nuclei
Cerebellum
Spinal cord

353
Q

What areas receive vestibular input?

A
Posterior insula
Parietal lobe just posterior to postcentral gyrud
Midway between:
- Apex of brain AND
- Lateral fissure
354
Q

When the optic tract projects to the Lateral Geniculate Nucleus, where does it go?

A

To optic radiations and then to visual cortex

355
Q

What part of the occipital cortex receives the most inputs from the Lateral Geniculate Nucleus?

A

Layer 4

356
Q

How many layers are there in the occipital cortex?

A

6

357
Q

When the optic tract projects to the Superior Colliculus, where does it go?

A

Nuclei of CN iii, iv and vi
Motor nucleus of vii
Spinal cord

358
Q

Where else does the Superior Colliculus receive inputs from?

A

Visual cortex
Frontal eye fields
Spinal cord

359
Q

At what points in the visual pathway does decussation occur?

A

Optic chiasm

Optic tracts carry contralateral info

360
Q

What layers of the primary visual cortex form the visual association cortex?

A

Layers V2-V6

361
Q

Where is layer V1 concentrated?

A

Calcarine sulcus

362
Q

What gyrus are lower visual fields projected to?

A

The gyrus superior to the calcarine sulcus

363
Q

Where does the macula project to in the visual cortex?

A

Posterior pole

364
Q

What eye movements does the visual cortex provide?

A

Movements in response to visual stimuli:

  • eg. Tracking a moving objext
  • Smooth eye motions
365
Q

What eye movements do the frontal eye fields provide?

A

Movements of command:

  • Independent of moving stimuli
  • Saccadic (jerky) eye motions
366
Q

What is the direct pupillary light reflex?

A

When light is shone into one eye, the ipsilateral pupil constricts

367
Q

What is the consensual pupillary light reflex?

A

When light is shone into one eye, the contralateral pupil also constricts

368
Q

When light is shone into one eye, why do both pupils constrict?

A

Pretectal fibres project bilaterally to the Edinger-Westphal nucleus

369
Q

The accommodation reflex requires inputs to what structures?

A

Oculomotor nucleus

Edinger-Westphal nucleus