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xB12W4 > PBL 1 > Flashcards

PBL 1 Flashcards

1
Q

whats the cutaneous innervation to the upper medial leg?

A

obturator nerve

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2
Q

whats the cutaneous innervation to lateral thigh?

A

lateral cutaneous nerve of the thigh

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3
Q

whats the cutaneous innervation to anteromedial thigh?

A

anterior cutaneous nerve - branch of femoral nerve

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4
Q

whats the cutaneous innervation to the posteromedial thigh?

A

posterior cutaneous nerve of thigh from sacral plexus

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5
Q

whats the cutaneous innervation for the anteromedial half of the leg?

A

saphenous branch of femoral nerve

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6
Q

whats the cutaneous innervation of between big toe and 2nd metatarsal?

A

deep branch of common fibular nerve

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7
Q

whats the cutaneous innervation to medial half of plantar foot?

A

medial plantar nerve (branch of tibial)

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8
Q

what innervates the skin of the lateral half of the plantar foot?

A

lateral plantar nerve (branch of tibial nerve)

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9
Q

what innervates skin over ball of foot?

A

medial calcaneal branches (branch of tibial nerve)

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10
Q

what innervates bottom half of lateral leg?

A

superficial branch of common fibular nerve

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11
Q

what innervates top half of lateral leg?

A

lateral cutaneous nerve of the calf (branch of Common Fibular)

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12
Q

what innervates the lateral posteriorlower half of the leg?

A

sural nerve

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13
Q

outline the order of branches in the lumbar plexus?

A 
iliohypogastric
ilioinguinal
genitofemoral
lateral cutaneous
femoral
obturator
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14
Q

what is the root for iliohypogastric nerve?

A

T12 and L1

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15
Q

what does the iliohypogastric nerve innervate?

A

motor - internal oblique and transversus abdominis

sensory - posterolateral gluteal skin on pubic region

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16
Q

whats the nerve root for the ilioinguinal nerve?

A

L1

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17
Q

what does the ilioinguinal nerve innervate?

A

motor - internal oblique and transversis abdominis

sensory - superoanteromedial thigh, penis, mons pubis, anterior scrotum, labia majora

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18
Q

whats the nerve root for the genitofemoral nerve?

A

L1, L2

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19
Q

what des the genitofemoral nerve split into?

A

genital and femoral branches

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20
Q

what does the genital branch innervate?

A

motor - cremasteric muscle

sensory - anterior scrotum, mons pubis and labia majora

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21
Q

what does the femoral branch of the genitofemoral nerve innervate?

A

sensory - upper anterior thigh

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22
Q

whats the nerve roots for lateral cutaeous nerve?

A

L1, L2

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23
Q

what does the lateral cutaneous nerve innervate?

A

sensory - anteror and lateral thigh down to knee

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24
Q

whats the nerve roots for the femoral nerve?

A

L2, L3, L4

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25
Q

wht does the femoral nerve innervate?

A

motor - muscles of anterior thigh

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26
Q

what does the femoral nerve split into?

A

anterior cutaneous nerve and saphenous nerve

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27
Q

what does the anterior cutaneous branch of the femoral nerve innervate?

A

skin of anteromedial thigh

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28
Q

what does the saphenous branch of the femoral nerve innervate?

A

skin of medial leg and foot

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29
Q

what are the nerve roots for the obturator nerve?

A

L2, L3, L4

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30
Q

what does the obturator nerve innervate?

A

motor - muscles of medial thigh

sensory - skin over upper medial thigh

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31
Q

what are the branches of the sacral plexus?

A

superior gluteal, inferior gluteal, sciatic, posterior femoral and pudendal

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32
Q

what are the nerve roots of the superior gluteal nerve?

A

L4, L5, S1

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33
Q

what are the nerve roots of thr inferior gluteal nerve?

A

L5, S1, S2

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34
Q

what are the nerve roots of the sciatic nerve?

A

L4, L5, S1, S2, S3

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35
Q

what are the nerve roots of the posterior femoral cutaneous nerve?

A

S1, S2, S3

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36
Q

what are the nerve roots of the pudendal nerve?

A

S2, S3, S4

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37
Q

what does the superior gluteal nerve innervate?

A

gluteus medius, gluteus minimus, tensor fascia lata

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38
Q

what does the inferior gluteal nerve innervate?

A

gluteus maximus

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39
Q

what does the tibial portion of the sciatic nerve innervate?

A

posterior compartment of thigh muscles and hamstring part of adductor magnus
all muscles in posterior leg
sole of foot
skin on posterolateral leg (sural nerve), lateral foot (sural nerve), sole of foot (plantar nerves)

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40
Q

what does the common fibular branch of the sciatic nerve innervate?

A

anterior leg muscles (deep)
lateral leg muscles (superficial)

cutaneous - between 1 and 2 metatarsl (deep), lateral upper half of anterior leg (lateral cutaneous branch), lateral lower half of anterior leg (superficial)

41
Q

what does the posterior femoral nerve innervate?

A

the skin of the posterior surface of the thigh, leg, buttock, and also the perineum.

42
Q

what does the pudendal nerve innervate?

A

motor - various pelvic muscles, the external urethral sphincter and the external anal sphincter

sensory - external genitalia of both sexes and the skin around the anus, anal canal and perineum

43
Q

what is the myotome for hip flexion?

A

L2

44
Q

what is the myotome for hip extension?

A

S1

45
Q

whats the myotome for knee extension?

A

L3

46
Q

what is the myotome for knee flexion?

A

S2

47
Q

whats the myotome for ankle dorsiflexion?

A

L4

48
Q

whats the mytome for ankle plantar flexion?

A

S1

49
Q

whats the myotome for big toe extension?

A

L5

50
Q

whats the myotome for ankle eversion?

A

S1

51
Q

what is the cauda equina?

A

where the spinal cord ends at L2 but the nerves of lumbar, sacral and coccygeal regions have to travel further down, forming a nerve bundle

52
Q

what is cauda equina syndrome?

A

damage to the cauda equina

53
Q

what can cause damage to the cauda equine?

A

compression e.g. ruptured disc, stenosis, spinal lesion, tumour
trauma e.g. spinal infection or fracture
degenerative conditions e.g. ankylosing spondylitis

54
Q

what are symptoms of cauda equina syndrome?

A 
decreased bowel and bladder control
decreased sexual function
saddle anaesthesia
muscle weakness
loss of knee and ankle reflexes
paraplegia
sciatic like pain
back pain
gait disturbance
55
Q

how do you treat cauda equina syndrome?

A

if sudden onset e.g. disc herniation then you must have surgical decompression within 48 hours
if caused by degenerative diseases then treat with anti-inflammatory meds and corticosteroids

56
Q

what is a complication of untreated cauda equina syndrome?

A

permenant paralysis, impaired bladder/bowel control, loss of sexual sensation

57
Q

what do we call the symptoms of nerve root lesions?

A

radiculopathy

58
Q

what are some common causes of nerve root lesions?

A

herniated disc, degenerative disc, spinal stenosis

59
Q

what are some symptoms of radiculopathy?

A

pain
weakness
tingling
loss of reflexes

60
Q

what are ascending spinal tracts

A

sensory pathways that start at the spinal cord and stretch up to the cerebral cortex?

61
Q

what are the 3 main ascending spinal tracts?

A

dorsal column medial lemniscus pathway
spinothalamic system
spinocerebellar system

62
Q

what are the 3 other ascending spinal tracts?

A

spinotectal
spinoreticular
spino-olivary

63
Q

whats the function of the spinotectal tract?

A

turning towards the source of sensory stimulation

64
Q

what is the function of the spinoreticular tract?

A

inducing or maintaining wakefulness

65
Q

what is the function of the spino-olivary tract?

A

modified cerebellar activity in response to environmental change

66
Q

whats the function of the dorsal column medial lemniscus system?

A

vibration, proprioception, 2 point discimination, touch

67
Q

outline the structure of the dorsal column medial lemniscus pathway?

A

mechanoreceptors and proprioceptirs are stimulated and send sensory information through 1st order neurons to dorsal root ganglion
these enter the dorsal column and ascend in the gracilis fascicle (T6) up to the gracile/cuneate nuclei in the medulla.
Here they synapse with a 2nd order neurone which deccassates and then ascend via the medial lemniscus to the nuclei in the thalamus
here they synapse with the 3rd order neurons and ascend through the internal capsule up to the primary somatosensory cortex

68
Q

whats the function of the spinothalamic system?

A

crude touch, pain, pressure, temperature

69
Q

outline the structure of the spinothalamic system?

A

1st order neurons travel from from receptors to dorsal root ganglion, ascend 1-2 segments and synapse with 2nd order neuron in dorsal horn
they decussate to anterior and lateral spinothalamic tract and ascend to the thalamus where they synapse with 3rd order neurons
these neurones ascend through the internal capsule to the primary somatosensory cortex

70
Q

whats the difference between anterior and lateral spinothalamuc systems?

A

anterior - crude touch and pressure

lateral - pain and temperature

71
Q

whats the function of the spinocerebellar system?

A

to help coordinate muscles in trunks and limbs

72
Q

outline the structure of the spinocerebellar system?

A

proprioceptie info travels via 1st order neyrons to dorsal root ganglion, enter spinal cord and synapse with 2nd order nerons. Here they either decussate to ventral tract or remain ipsilateral as the dorsal tract. the dorsal tract ascends to inferior cerebellar peduncle, passes through and arrives at ipsilateral cerebellar cortex.
the ventral tract ascends to the cerebella peduncle, decussates again and arrives at the ipsilateral cerebellar cortex too

73
Q

what are descending spinal tracts?

A

motor pathways that control the muscles of the trunk and extremetieis - made up of upper and lower motor neurones

74
Q

what are the 2 categories of descending tracts?

A

pyramidal and extrapyramidal tracts

75
Q

what are the 3 pyramidal tracts?

A

anteror and lateral corticospinal tract

corticobulbar tract

76
Q

whats the function of the corticospinal tract?

A

primary motor activity for the somatic motor system from the neck to the feet.
lateral - limbs
anterior - trunk

77
Q

outline the structure of the anterior corticospinal tract?

A

descends from pyramidal cells in primary motor cortex to spinal cord, reaches desired spinal segment, decussates and synapses with LMN in ventral horn. Leave as peripheral nerves to reach muscles of the trunk

78
Q

outline the structure of the lateral corticospinal tract?

A

descends from pyramidal cells and decussates at decussation of pyramids in medulla, descends down contralateral spinal cord until it reaches the ventral horn where it synapses with a LMN. These leave as peripheral nerves to reach muscles of extremities

79
Q

whats the function of the corticobulbar tract?

A

upper motor neuron input to cranial nerves

80
Q

outline the structure of the corticobulbar tract?

A

UMN descends from motor cortex to brainstem where it synapses with LMN for cranial nerves and either remains contralteral or ipsilateral

81
Q

whats the function of the vestibulospinal tract?

A

maintain equilibratory reflexes from the input of the vestibular apparatus = balance

82
Q

whats the function of the reticulospinal tract?

A

locomotion and postural control

83
Q

whats the function of the tectospinal tract?

A

controlling the movement of the head in response to auditory and visual stimuli.

84
Q

whats the function of the rubrospinal tract?

A

regulation of flexion and extension tone of large group muscles, as well as fine motor control.

85
Q

x

A

x

86
Q

why are they called extrapyramidal tracts?

A

they use interneurones between upper and lower motor neurones

87
Q

outline the structure of the vestibulospinal tract?

A

UMN descend from lateral vestibular nuclei in medulla to spinal cord where it synapses with interneurones which activates LMN in ventral horn
medial tract stops in cervical region
lateral tract travels through all spinal segments

88
Q

outline the structure of the reticulospinal tract?

A

UMN descend from reticular formation
medial tract descends to ipsilateral spinal tract
lateral tract descends to give off ipsilateral and contralateral branches

89
Q

outline the tectospinal tract?

A

UMN descend from superior colliculi and decends to contralateral cervical spinal cord where it synapses with a LMN in the ventral horn

90
Q

outline the rubrospinal tract?

A

UMN descend from red nucleus, decussate and enter contralateral spinal cord in cervical region where it synapses with internerons which activate LMN in ventral horn

91
Q

what would happen if we had a unilateral lesion in a ventromedial pathway?

A

no obvious defects as other side of body can control both sides

92
Q

what would happen if we had a bilateral lesion in a ventromedial pathway?

A

loss of posture correction, navigational control, trunk immobility, affecting proximal muscles of trunk and shoulder

93
Q

what would a lesion above the point of decusation in dorsolateral pathways cause?

A

contralateral spastic paresis, positive babinski

symptoms on contralateral side

94
Q

what would a lesion below the point of decusation in dorsolateral pathways cause?

A

ipsilateral spastic paresis and psoitive babibnski

symptoms on ipsilateral side

95
Q

what would a lesion in a dorsolateral pathway do?

A

normal walking and posture correction but arms hang limply and to reach out you would have to use shoulder circumduction as you have no fine movement control

96
Q

what are the symptoms of upper motor neuron lesions?

A

minimal muscle atrophy
muscle weakness
hyper-reflexic deep tendon reflexes but diminished/absent superficial reflexes
positive babinski sign

97
Q

what ar the symptoms of a lower motor neuron lesion?

A 
muscle atrophy
flacid paresis
normal or no plantar response
absent tendon reflexes
fasciculations of affected muscle
98
Q

outline the mechanism for locking and unlocking the knee?

A

to lock the knee, the Quadriceps muscle medially rotates the femur to pull the ligaments taught
To unlock the knee, the popliteus muscle laterally rotates the femur.

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