Past questions - long Flashcards
write short note on the scalp
constituents SCALP - Skin, Connective tissue (dense), Aponeurosis, Loose connective tissue, Pericranium
Blood supply - supraorbital artery and vein, supratrochlear artery and vein, superficial temporal artery and vein, posterior auricular artery and vein, occipital artery and vein
Nerve supply - Opthalmic nerve of front of scalp, greater occipital nerve from back of scalp, third occipital for inferior aspect of the posterior of scalp, lesser occipital and greater auricular nerve on lateral aspect, mandibular nerve of side of scalp, maxillary nerve
Write short notes of posterior triangle of neck
ii) Anterior boundary – posterior aspect of sternocleidomastoid (O: mastoid of skull I: sternum) for contralateral head rotation and head flexion
Posterior boundary – anterior margin of trapezium (O: occipital, ligamentum nuchae, spinous process from) for shoulder abduction rotation of scapula
Inferior boundary: middle 1/3 clavicle
Nerve supply – accessory nerve
Superior boundary – occipital bone posterior to mastoid process
Floor of posterior triangle – anterior scalene, middle and posterior scalene, levator scapular, splenius capitis.
Roof of posterior triangle – prevertebral layer for floor muscles, investing layer covering sternocleidomastoid and trapezius, platysma, skin
Content; nerves -accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
Content; vessels -third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Basal Ganglia
Constituents of
Nucleus accumbens - in medial forebrain
Caudate nucleus - comma shaped within lateral ventricle - head, body and tail. Ends anteriorly as amygdaloid nucleus separated from lentiform nucleus by internal capsule
Putamen - on lateral lower side of lentiform nucleus and fuses with caudate nucleus
Globus pallidus - older part of lentiform nucleus
Subthalamic nucleus - below thalamus
Substantia nigra - in midbrain
Basal ganglia forms part of the extrapyramidal system and contributes to control of muscle tone, posture, and involuntary movements
Give an example of hypokinetic syndrome
Parkinson’s disease loss of dopaminergic neurons in caudate nucleus, globus pallidus and substantia nigra.
describe the clinical features of hypokinetic syndrome
- Fine tremor 3-6 cycles a second
- Cogwheel rigidity increased muscle tone
- Akinesia – loss of associated movements, trouble starting movement and slow movements.
- Loss of blinking, loss of automatic arm swing
Describe circle of willis
Anterior communicating artery – from internal carotid artery supplies blood to medial and superior parts of frontal lobe and anterior of parietal lobe.
Anterior cerebral artery supplies – from internal carotid artery Orbital surface of frontal lobe, medial aspect of hemisphere (except occipital lobe), upper border of frontal & parietal lobes
Internal carotid artery – from common carotid artery through carotid canal
Middle cerebral artery – from internal carotid artery supplies most of temporal lobe, anterolateral frontal lobe parietal lobe, branches supply posterior limb of internal capsule
Posterior communicating artery – branch from basilar artery thalamus, hypothalamus, optic chiasm and mamillary bodies
Posterior cerebral artery – branch from basilar artery supplies occipital lobe, inferior part of temporal lobe, thalamus, and posterior limb of internal capsule.
A patient presents with muscle weakness and sensory loss in her left lower limb. Which blood vessel has most likely been blocked in this patient?
Right Anterior cerebral artery lesion. The body is represented in an inverted fashion on the motor cortex, nerves of the lower limbs and legs being residing on the inferior medial aspect stretching to superior part of the cerebral hemisphere and the upper limbs presented on the medial superior portion of the cerebral hemisphere and extending the lateral portion but the face represented in the inferior lateral side of the cerebral hemisphere.
- Describe the motor control pathway of the lower limb from the cerebral cortex to a muscle group
Superior medial area of cerebral motor cortex descends in anterior limb of internal capsule
Midbrain
Pons
Rostral medulla in pyramids
Decussation occurs in the pyramids of the medulla oblongata
Point from medulla to spinal cord is cervicomedullary junction in foramen magnum
Lateral corticospinal tract
Axons of lateral corticospinal tract enter spinal cord grey matter and synapse on anterior motor horn cells
Distal muscle to quadriceps
A 60-year old man presents at a physiotherapy clinic with unwanted weight loss and jaw pain. You suspect a temporo-mandibular joint problem. Describe the movements of the temporo-mandibular joint and muscles involved
Articulating surfaces
Temporal bone
Superior synovial cavity
[Disc]
Inferior synovial cavity
Condyle
Ligaments
Sphenomandibular ligament
Lateral ligament (temporomandibular)
Stylomandibular ligament
Muscles
Temporalis(O: Temporal fossa to inferior temporal line, I: coronoid process)
Medial Pterygoid(O: maxillary tuberosity and medial surface lateral pterygoid plate, I: medial rams of mandible)
Lateral Pterygoid(O:inferior temporal surface of greater wing of sphenoid, lateral aspect of lateral pterygoid of sphenoid, I: pterygoid fovea of neck of condylar process)
Masseter: (O: inferior and anterior w/ some posterior zygomatic arch, I: outersurface of mandibular rams and coronoid process)
describe cerebrocerebellum pathway
Starts at cerebral cortex through internal capsule (1)
Synapse in pontine nuclei in pons
Processed through cerebrocerebellar cortex by purkinjie cell layer (2)
Output from cortex travel to dentate nucleus
Decussate in dentate nucleus
Decussate in superior cerebellar peduncle
Pass through relay info at red nucleus
Synapse in thalamus
Output back to cerebral cortex
outline role of cerebellum
Cerebrocerebellum – muscle co-ordination, motor planning. Nucleus = dentate nucleus
Vestibulocerebellum – for balance and eye movement. Nucleus = fastigial
Problems: Posture problems & eye movements (nystagmus)
Spinocerebellum – muscle tone and posture, motor execution. Nucleus = globose and emboliform
A 72-year-old man is rushed by ambulance to hospital after acutely displaying the standard presentation of stroke: his facial muscles and arm are paralysed on the left side only, and his
speech is distorted.
The Right middle cerebral artery is affected in this man. The middle cerebral artery gives
blood supply to the lateral aspects of the cerebral hemispheres
Since the middle cerebral artery gives blood supply to the lateral portion, a stroke in the MCA will result in functional deficits of the face and arm.
Describe the course of the common carotid artery in the neck, including its bifurcation, and name the two structures which run beside it. What branches arise from the external carotid artery in the neck?
Arch of aorta -> subclavian artery + common carotid artery -> the external and internal carotid artery.
The internal carotid artery
-> anterior communicating artery, the cerebral communicating artery and middle cerebral artery of the circle of willis.
Internal jugular vein is a nearby structure of common carotid artery from temporomandibular joint and sternoclavicular joint.
Vagus nerve which branches in the superior laryngeal nerve to recurrent laryngeal nerve is another structure near common carotid artery.
External carotid artery leads to branches to lingual artery, facial artery, then as it further progresses to the face gives rise to maxillary artery, superficial temporal artery and posterior auricular artery.
- Describe the nuclei and course of all three divisions of the Trigeminal Nerve (5th Cranial Nerve). Where and what do each of these divisions supply?
Ophthalmic nerve (sensory)
Canal - move through superior orbital fissure
Function - scalp sensation and corneal reflex
Location - forehead and scalp, frontal and ethmoid sinus, upper eyelid, conjunctiva and cornea.
Maxillary (sensory)
Canal - through foramen rotundum
Function - for cheek malar sensation
Location - – lower eyelid, conjunctiva, cheeks, maxillary sinus, upper lip and superior palate.
Mandibular (motor)
Canal - through foramen ovale
Function – mandible sensation and motor function.
Location – mucous membrane of floor of oral cavity, external ear, lower lip, chin.
Sensory nuclei is found in mesencephalon and extends downward to upper part of spinal cord. Receive proprioceptive fibres of the face.
Principle sensory nuclei in pons that give rise to trigeminal ganglion near temporal bone in meckels cave, which receive touch fibre of the face
Spinal nucleus in the pons and medulla oblongata receive pain and temperature sensations from face
constituents of circle of willis
anterior cerebral artery
anterior communicating artery
internal carotid artery
middle cerebral artery
posterior cerebral artery
posterior communicating artery
anterior cerebral artery supplies
Orbital surface of frontal lobe, medial aspect of hemisphere (except occipital lobe), upper border of frontal & parietal lobes
