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B5W3 > PBL 1 > Flashcards

PBL 1 Flashcards

1
Q

what are the 3 layers of protection of the spinal cord?

A

the skull and vertebral column
the meninges
subarachnoid space containing CSF (shock absorbing)

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2
Q

what forms the vertebral canal?

A

the vertebral foramina of all the vertebrae are stacked on top of each other

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3
Q

what are the 3 layers of the meninges from superficial to deep?

A

dura matter
arachnoid matter
pia matter

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4
Q

what is dura matter?

A

the most superficial layer of the meninges made up of a thick, strong layer composed of dense irregular connective tissue.

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5
Q

what is arachnoid matter?

A

the middle layer of the meninges. it is thin and avascular. it is comprised of mainly collagen and elastic fibres. it is continuous with the foramen magnum

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6
Q

what is within the subdural space?

A

interstitial fluid1

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7
Q

what is Pia matter?

A

the innermost layer of the meninges. it is a thin, connective tissue layer that adheres to the spinal cord and brain surface. it has many blood vessels. it has denticulate ligaments.

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8
Q

what are denticulate ligaments?

A

thickenings of Pia matter that project laterally and fuse with the arachnoid matter and dura matter. they protect the spinal cord against sudden displacement which could result in shock
it also anchors the spinal cord in place

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9
Q

what is within the subarachnoid space?

A

cerebrospinal fluid

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10
Q

describe the length of the spinal cord?

A

from the medulla oblongata to the superior border of L2

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11
Q

what are the 2 enlargements of the spinal cord? where are they?

A

cervical enlargement C4-T1

lumbar enlargement T9-T12

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12
Q

what is the cervical enlargement?

what is the lumbar enlargement?

A

cervical- nerves to and from upper limbs

lumbar- nerves to and from lower limbs

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13
Q

what is the conus medullaris?

A

the tapered, lower end of the spinal cord at L1/L2

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14
Q

what is the film terminale?

A

a delicate strand of fibrous tissue proceeding downward from the apex of the conus medullaris- its an extension of Pia matter

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15
Q

how do spinal nerves branch from the spinal cord?

A

they pass laterally to exit through the intervertebral foramina

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16
Q

what are the cauda equina?

A

a bundle of spinal nerves and spinal nerve rootlets,

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17
Q

what are the 2 grooves called that separate the white matter of the spinal cord into right and left?

A

anterior median fissure and posteror median sulcus

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18
Q

what is the grey commissure?

A

a thin strip of grey matter that surrounds the central canal of the spinal cord and, along with the anterior white commissure, connects the two halves of the cord

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19
Q

when do we get lateral grey horns?

A

only in thoracic and upper lumbar segments of the spinal cord. they exist between the posterior and anterior grey horns.

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20
Q

what do lateral grey horns consist of?

A

autonomic motor nuclei- regulate cardiac muscle, smooth muscle and glands

21
Q

what are the 3 ascending spinal tracts?

A

dorsal column medial lemniscus system
spinocerbellar tracts
spinothalamic

22
Q

what is the function of the dorsal column-mediated lemniscus pathway?

A

carries the sensory modalities of fine touch , vibration and proprioception

23
Q

describe the dorsal column-mediated lemniscus pathway?

A

First-order neurons extend from sensory receptors into the spinal cord and ascend to the medulla oblongata on the same side of the body. the axons enter the cuneate (above T6) or gracile fasciculus (below T6).
The axons synapse with the dendrites of the second-order neurons whose cell bodies are located in the gracile nucleus or cuneate nucleus of the medulla.
The axons of the second-order neurons cross to the opposite side of the medulla and enter the medial lemniscus. In the thalamus, the second-order neurons synapse with third-order neurons, which project their axons to the primary somatosensory area of the cerebral cortex.

24
Q

what is the function of the spinothalamic tract?

A

transmission of pain and temperature (lateral)

crude touch and pressure (anterior)

25
Q

describe the spinothalamic tract?

A

First order neurones arise from the sensory receptors and enter the spinal cord, ascend 1-2 vertebral levels, and synapse at the tip of the dorsal horn – an area known as the substantia gelatinosa.
first order neurones synapse and decussate and the second order neurones carry the sensory information from the substantia gelatinosa to the thalamus via the anterior or lateral spinothalamic tract (depending on stimulus)
These tracts run alongside each other, and they can be considered as a single pathway. They travel superiorly within the spinal cord, synapsing in the thalamus.
The third order neurones carry the sensory signals from the thalamus to the ipsilateral primary sensory cortex of the brain. They ascend from the ventral posterolateral nucleus of the thalamus, travel through the internal capsule and terminate at the sensory cortex

26
Q

what is the function of the spinocerebellar tracts?

A

carry unconscious proprioceptive information gleaned from muscle spindles, Golgi tendon organs, and joint capsules to the cerebellum.

27
Q

what are the 4 individual pathways in the spinocerebellar tracts?

A

posterior, anterior, rostral and cuneocerebellar tracts.

28
Q

what are the 2 types of descending spinal tracts?

A

pyramidal - voluntary control of musculature of body and face
extrapyramidal - involuntary and automatic control of all musculature.

29
Q

what are the 2 pyramidal spinal tracts?

A

corticospinal and corticobulbar.

30
Q

what is the function of the corticospinal tract?

A

controls primary motor activity for the somatic motor system from the neck to the feet.

31
Q

describe the corticospinal tract?

A

After originating from the cortex, the neurones converge, and descend through the internal capsule
After the internal capsule, the neurones pass through the crus cerebri of the midbrain, the pons and into the medulla.
In the most inferior (caudal) part of the medulla, the tract divides into two:
The fibres within the lateral corticospinal tract decussate (cross over to the other side of the CNS). They then descend into the spinal cord, terminating in the ventral horn (at all segmental levels). From the ventral horn, the lower motor neurones go on to supply the muscles of the body.
The anterior corticospinal tract remains ipsilateral, descending into the spinal cord. They t terminate in the ventral horn of the cervical and upper thoracic segmental levels.

32
Q

where does the corticospinal and corticobulbar tract receive input from?

A

the primary motor cortex
the premotor cortex
the supplementary motor area
the somatosensory area

33
Q

where do we find the internal capsule?

A

between the thalamus and basal ganglia

34
Q

why is it clinically important that we know the neurones descend through the internal capsule in the corticospinal tract?

A

internal capsule is particularly susceptible to compression from haemorrhagic bleeds. Such an event could cause a lesion of the descending tracts.

35
Q

what is the function of the corticobulbar tract?

A

carries upper motor neuron input to motor nuclei of trigeminal, facial, glossopharyngeal, vagus, accessory, and hypoglossal nerves.

36
Q

describe the corticobulbar tract?

A

They receive the same inputs as the corticospinal tracts. The fibres converge and pass through the internal capsule to the brainstem.
The neurones terminate on the motor nuclei of the cranial nerves. Here, they synapse with lower motor neurones, which carry the motor signals to the muscles of the face, head and neck.
many neurones innervate fibres bilaterally.

37
Q

what are the 4 extrapyramidal tracts? which of these are ipsilateral?

A

vestibulospinal (ipsilateral)
reticulospinal (ipsilateral)
rubrospinal (contralateral)
tectospinal (contralateral)

38
Q

what is the function of the vestibulospinal tract?

A

positioning of the head, neck, balance and postural changes by innervating ‘anti-gravity’ muscles via LMN

39
Q

describe the vestibulospinal tract?

A

the medial and lateral pathways both arise from the vestibular nuclei, which receive input from the organs of balance. The tracts convey this balance information to the spinal cord, where it remains ipsilateral.

40
Q

what is the function of the reticulospinal tract?

A

posture, gait, sensory modulation

41
Q

describe the reticulospinal tract?

A

The medial reticulospinal tract arises from the pons. It facilitates voluntary movements and increases muscle tone.
The lateral reticulospinal tract arises from the medulla. It inhibits voluntary movements and reduces muscle tone.

42
Q

what is the function of the rubrospinal tract?

A

control of muscle tone in flexor muscle groups of upper limbs and helps to coordinate movement

43
Q

describe the rubrospinal tract?

A

The rubrospinal tract originates from the red nucleus, a midbrain structure. As the fibres emerge, they decussate (cross over to the other side of the CNS), and descend into the spinal cord. Thus, they have a contralateral innervation.

44
Q

what is the function of the tectospinal tract?

A

mediates reflex postural movements of the head in recponse to visual and auditory stimuli

45
Q

describe the tectospinal tract pathway?

A

This pathway begins at the superior colliculus of the midbrain. The superior colliculus is a structure that receives input from the optic nerves. The neurones then quickly decussate and enter the spinal cord. They terminate at the cervical levels of the spinal cord.

46
Q

what are multi-disciplinary teams?

A

provisions of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their care givers, to the extend preferred by each patient, to accomplish shared goals within and across settings to achieve coordinated, high-quality care

47
Q

what are the basic 5 principles of MDTs?

A

shared goals, clear roles/expectations, mutual trust, effective communication and measurable processes and outcomes,

48
Q

what are the 7 best practice factors for effective MDT work?

A

Patient-centred care
Physician integration Shared goals and objectives
Shared information technology and access to patient data
Culture, collaboration and shared decision-making processes
Co-location / geographical integration
Targeting high risk populations

B5W3 (9 decks)

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