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Neurology Flashcards

1
Q

The brain is supplied with blood by two pairs of vessels, what are they?

A
  1. Internal carotid arteries

2. Vertebral arteries

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2
Q

Which of the cerebral arteries supplies the greatest cortical territory?

A

Middle cerebral

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3
Q

The vertebral artery arises from what?

A

Subclavian artery

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4
Q

What are the 4 main physiological divisions of the peripheral nervous system? Are they sensory or motor?

A
  1. Somatic - sensory and motor
  2. Autonomic - sensory and motor
  3. Branchial - motor
  4. Special - sensory
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5
Q

What are the branchial nerves and from what pharyngeal arch does what nerve arise?

A

Branchial nerves are the nerves that originate from the pharyngeal arches, each arch is innervated by a nerve:

  1. V2 and V3 of trigeminal
  2. Facial (VII)
  3. Glossopharyngeal (IX)
  4. Vagus (X)
  5. Vagus (X)
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6
Q

What is a dermatome?

A

Volume of skin supplied by a single spinal nerve

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7
Q

Top of the arm is supplied by what dermatome?

A

C5

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8
Q

Bottom of the arm is supplied by what dermatome?

A

T2

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9
Q

The nipple is supplied by what dermatome?

A

T5

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10
Q

The umbilicus is supplied by what dermatome?

A

T10

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11
Q

Suprapubic region is supplied by what dermatome?

A

T12

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12
Q

Pubic region is supplied by what 2 dermatomes mainly?

A

L1 (front 1/3)

S2 (back 2/3)

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13
Q

All muscles of the hand are supplied by what myotome?

A

T1

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14
Q

What cranial nerves have a parasympathetic function?

A

3,7,9,10

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15
Q

The sympathetic nervous system provides stimulation to the whole body, where does the parasympathetic nervous system function?

A

Eyes and viscera

Not to muscles or blood vessels

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16
Q

In what layer of the meninges is CSF found?

A

Sub arachnoid

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17
Q

At what level does the spinal cord terminate?

A

L1-L2

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18
Q

Where are the nerve cell bodies of afferent neurones located?

A

Dorsal root ganglion

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19
Q

Where are the nerve cell bodies of efferent neurones located?

A

Spinal grey matter

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20
Q

After leaving the intervertebral foramina, spinal nerves divide to form a thin dorsal ramus and a larger ventral ramus. What do each of these supply?

A

Dorsal = muscles and skin of the back region

Ventral = muscle and skin of the front of the body and also the limbs

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21
Q

A prolapsed intervertebral disc in the cervical spine can lead to what symptoms?

A
  1. Pain in the neck - radiating to arm and hand
  2. Paraesthesia, weakness and wasting of the muscles in the radicular distrubution
  3. Numbness of the skin corresponding to that dermatomal distrubution
  4. Loss of tendon reflexes served by that root
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22
Q

A prolapsed intervertebral disc in the lumbar spine can lead to what symptoms?

A
  1. Back pain

2. Radiation of pain into legs (sciatica)

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23
Q

A lumbosacral prolapsed disc or lesion can lead to what symptoms?

A
  1. Paralysis of the bladder and incontinence
  2. Muscle weakness, wasting, fasciculation (LMN)
  3. Areflexia of lower limbs (LMN)
  4. Sensory loss below level of lesion and sensory ataxia
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24
Q

The spinal cord terminates at L1-L2 but this is not where the arachnoid or dural sheaths (and therefore CSF) continue on to, where do they end?

A

S2

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25
At what level is a lumbar puncture done? What kind of a needle is used?
L2-L3 or L3-L4 Sharp, to pierce dura and arachnoid
26
Where is the subarachnoid space?
Between pia and arachnoid
27
At what level is an epidural delivered? What kind of needle is used?
L2-L3 or L3-L4 Blunt needle is used to ensure it doesn't pierce dura
28
What is grey and white matter? Which is on the inside around the central canal in the spinal cord?
Grey = nerve cell bodies, dendrites and synaptic contacts White = ascending and descending nerve fibres Grey is found on the inside in the spinal cord
29
The dorsal horn is the main site of the termination of what?
Primary afferent fibres
30
The dorsal horn contains the centre which is important for the transmission of nociceptive impulses to the brain. What is it called?
Substantia gelatinosa
31
The ventral horn contains what?
Lower motor neurones (cell bodies lie here)
32
Quadriceps reflex (knee jerk) depends on what spinal cord segments?
L3/4
33
Achilles tendon reflex (ankle jerk) depends on what spinal cord segments?
S1/2
34
What are the two main ascending spinal tracts and what impulses do they carry?
Dorsal columns - proprioception (movement and joint position sense) and fine touch. (Generally pleasant) Spinothalamic tracts - Pain and thermal sensation as well as course touch and pressure and tickle (generally unpleasant)
35
Fasciculus gracilis and fasciculus cuneatus consist of fibres that join the cord at what levels?
``` Gracilis = lower levels (lower limb) Cuneatus = upper levels (upper limb) ```
36
The second order neurones of dorsal columns decussate where?
Medulla
37
If there is a lesion of the spinal cord affecting the dorsal columns e.g Tabes dorsalis (late manifestation of syphilis) or subacute combined degeneration of the spinal cord in B12 deficiency, what are the clinical signs often seen?
Sensory ataxia | high steppage and unsteady gait
38
In MS there is often loss of proprioception to the hands and fingers, leading to loss of dexterity and ability to identify the shape of objects by touch alone. What is the pathology behind this?
Damage to fasciculus cuneatus of dorsal columns
39
Secondary neurones of spinothalamic tract decussate where?
At the level they enter the spinal cord
40
Spinocerebellar tracts carry what information?
Information from muscle spindles, mechanoreceptors and tactile receptors to the cerebellum for control of posture and coordination of movement. Is very similar information to that carried in gracilis and cuneatus but doesn't reach consciousness
41
Give an example of a lesion that would result in impairment of pain, temperature, touch and pressure sensitivity on the contralateral side?
Syringomyelia
42
If there was a lesion in the spinal cord on the left hand side of the body, would pain, pressure and temperature sensation be lost on the left or the right hand side?
Right
43
If there was a lesion in the spinal cord on the right hand side of the body, would light touch and proprioception be lost on the right or left side of the body?
Right
44
What is Friedrich's ataxia?
Inherited degenerative disease in which spinocerebellar tracts are disordered, leading to profound incoordination of the arms and wide based, reeling gait. Disease starts in childhood and patient is wheelchair bound by 20.
45
What are the main descending spinal tracts and what motor control do they have?
1. Corticospinal - control of voluntary, discrete, skilled movement 2. Rubrospinal - tone of limb flexor muscles 3. Vestibulospinal - control extensor muscle tone in anti-gravity maintenance of posture
46
Alternative name for corticospinal tracts?
Pyramidal tracts
47
What proportion of corticospinal tract fibres decussate at the medulla?
80%
48
Of the 15-20% of corticospinal tract fibres that do not decussate at the medulla, what proportion go on to decussate at the point that they leave the spinal cord?
5-10%
49
The fibres of the corticospinal tract effectively innervate and control the movement of what side of the spinal cord?
Contralateral
50
What signs and symptoms are seen in a UMN lesion?
Hyperreflexia, spasticity (increased tone), up going plantars (Babinski reflex)
51
What signs and symptoms are seen in a LMN lesion?
Hyporeflexia, reduced tone, down going plantars
52
What is ataxia?
Group of neurological conditions that affect balance, coordination and speech
53
What signs and symptoms would a thoracic spinal cord lesion elicit?
UMN - hyperreflexia, spasticity, extensor plantar responses | Incontinence, sensory loss below the level of the lesion and sensory ataxia
54
What is the motor function of the trigeminal nerve?
Innervates muscles of mastication for chewing and supplies tensor tympani for tension on the tympanic membrane
55
What are the motor, sensory and parasympathetic functions of the seventh cranial nerve (facial)?
Motor: Supplies muscles of face for facial expression as well as stapedius to put tension on bones on middle ear Sensory: Anterior 2/3 of the tongue (taste) Parasympathetic: Salivary (submandibular gland) and lacrimal glands
56
Which cranial nerve provides motor innervation to the tongue? And which two cranial nerves provide sensory innvervation to the tongue?
``` Motor = Hypoglossal Sensory = facial and glossopharyngeal ```
57
What are the motor, sensory and parasympathetic functions of the ninth cranial nerve (glossopharyngeal)?
``` Motor = Stylopharygeus - for swallowing Sensory = Pharynx, posterior third of the tongue (taste), Eustachian tube, middle ear and carotid body (chemoreceptors) and carotid sinus (baroreceptors) Parasympathetic= Parotid salivary gland ```
58
What are the motor, sensory and parasympathetic functions of the tenth cranial nerve (vagus)?
Motor = Soft palate, pharynx, larynx and upper oesophagus - for speech and swallowing Sensory = Pharynx, larynx, trachea, oesophagus, external ear, thoracic and abdominal viscera, and aortic bodies (chemoreceptors) and aortic arch (baroreceptors) Parasympathetic - Thoracic and abdominal viscera innervated
59
What is the motor function of the eleventh cranial nerve (accessory)?
Movement of head and shoulders (sternocleidomastoid and trapezius)
60
Which two cranial nerves provide innervation to the salivary glands?
Facial and glossopharyngeal
61
What is the most common cause of a bitemporal hemianopia?
Pituitary tumour (optic chiasm lies above the pituitary)
62
Patient has a left homonymous hemianopia, where has the lesion occurred?
Right optic tract
63
What structures lie within the cavernous sinus?
3,4,5i ii, 6 and the internal carotid artery
64
What are the equivalent of Schwann cells in the CNS?
Glial cells- in particular oligodendrocytes
65
What is the function of astrocytes in the CNS?
Biochemically support neurones and repair if damage occurs
66
Which nerves innervate the branchial arches?
``` 1 V2 and V3 of trigeminal (maxillary and mandibular) 2 Facial 3 Glossopharyngeal 4 Vagus 6 Vagus ```
67
Circle of willis lies in what layer of the meninges?
Subarachnoid

Clinical sciences (10 decks)

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