QUIZ 1 Flashcards

1
Q

atlantoaxial subluxation

A

-incomplete dislocation of the median atlantoaxial joint
-rupture of transverse ligament
-complete dislocation -> dens may be driven into:
-upper cervical region of spinal cord -> quadriplegia
-medulla of the brainstem -> death

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1
Q

injury and disease of zygapophysial joints treatment

A

-denervation of lumbar zygapophysial joints
-nerves destroyed by radiofrequency percutaneous rhizolysis (root dissolution)
-denervation directed at articular branches of 2 adjacent posterior rami bc each joint receives innervation from both the nerve exiting and the superjacent nerve

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2
Q

back pain

A

-5 categories of structures receive innervation in back and can be sources of pain:
-1. meninges- coverings of the spinal cord
-2. synovial joints- capsules of the zygapophysial joints
-3. muscles- intrinsic muscles of the back
-4. nervous tissue- spinal nerves or nerve roots exiting the IV foramina
-1&2 innervated by meningeal branches
-3&4 innervated by posterior rami
-pain from nervous tissue (compression or irritation of nerves)- referred pain- perceived as coming from skin (dermatome) suppled by that nerve

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3
Q

lower supply to spinal cord

A

-great anterior segmental medullary artery
-drop in BP, fracture, dislocation, clamping of aorta in artery, occlusion, aneurysm
-paraplegia
-only major arterial supply to the lower thoracic, lumbar, and sacral segments of the spinal cord

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4
Q

labor epidural

A

-caudal epidural block
-in the sacral canal
-causal epidural anesthesia- through sacral hiatus
-trans-sacral epidural anesthesia- through posterior sacral foramina

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5
Q

straight leg test

A

lasegue test/sign

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6
Q

local vs chronic back pain

A

-local- ligamentous
-chronic- spinal nerve roots

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7
Q

spondylolisthesis

A

-forward displacement of (commonly L5) vertebral body relative to sacrum
-reduced pelvic inlet diameter
-pressure cauda equina as they pass into superior part of sacrum

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8
Q

heterotopic bone

A

-bone forms in soft tissue not normally present
-due to chronic muscle strain -> small hemorrhagic areas undergo calcification and ossification

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9
Q

6 types of synovial joints

A

-pivot- uniaxial, rounded process fits into bony ligamentous socket -> rotation- ex. median atlantoaxial joint
-ball and socket- multiaxial, rounded head fits into concavity- ex. hip joint
-condyloid- biaxial, permit flexion, extension, abduction, adduction, circumduction- ex. metacarpophalangeal joint
-saddle- biaxial- ex. carpometacarpal joint
-hinge- uniaxial, permit flexion and extension- ex. elbow
-plane- usually uniaxial, gliding or sliding- ex. acromioclavicular joint

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10
Q

anastomoses, collateral, circulation, and terminal (end) arteries

A

-smaller channels increase in size -> provide collateral circulation -> ensures blood supply to structures distal to blockage
-collateral circulation takes time -> insufficient for sudden occlusion or ligation
-terminal (end) arteries- do not anastomose with adjacent arteries
-occlusion of terminal artery cuts off supply to organ or structure completely
-functional terminal arteries- arteries with ineffectual anastomoses supply segments of brain, liver, kidney, spleen, intestines

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11
Q

lymphangitis, lymphadenitis, lymphedema

A

-lymphangeittis and lymphandenitis- secondary inflammation of lymphatic vessels and lymph nodes
-may occur when the lymphatic system is involved in the metastasis of cancer -> lymphogenous dissemination of cancer cells
-lymphedema - the accumulation of interstitial fluid that occurs when lymph is not drained from an area
-when cancerous lymph nodes are removed from axilla -> lymphedema of upper lime may result

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12
Q

Nerve damage

A

-CNS- proximal stumps begin to regenerate -> send sprouts into area -> however -> growth blocked by astrocyte proliferation -> permanent disability
-PNS:
-axons degenerate distal to lesion bc they depend on cell bodies
-crushing- cell bodies survive -> connective tissue of the nerve guide growing axons to their destinations -> no surgical intervention
-cut nerves require surgery -> apposition of the cut ends by suture through the epineurium -> individual fascicles are realigned
-compression of vasa nervorum-> ischemia -> nerve degeneration
-prolonged ischemia -> severe damage similar to crushing or cutting nerve

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13
Q

layers in peripheral nerve

A

-endoneurium and neurolemma surround the axons -> fascicle bundled by perineurium -> multiple fascicles bundled by epineurium

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14
Q

spinal cord end

A

-spans from foramen magnum to L1-L2
-conus medullaris- tapered region at the end of the cord
-filum terminale- filament extending inferiorly from the end of spinal cord in the dural sac and attaches to dorsum of coccyx -> anchors the inferior end of the spinal cord

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15
Q

posterior vs anterior ramus supply

A

-posterior- intrinsic back muscles, head, neck, zygapophysial joints, skin, trunk
-anterior- muscles, joints, skin of LIMBS, anterolateral trunk

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16
Q

arterial supply to spinal cord

A

-anterior and posterior spinal artery supply only the short superior part of spinal cord
-run longitudinally from medulla of brain stem to conis medularis

17
Q

enteric

A

-autonomic nervous system
-independent
-2 ganglionated plexuses- myenteric and submucosal
-myenteric- longitudinal and circular smooth muscle of GI tract
-submucosal- submucosa
-receive from postganglionic sympathetic or preganglionic parasympathetic

18
Q

sympathetic and parasympathetic innervations

A

-sympathetic- T1-L2
-parasympathetic- CN 3, 7, 9, 10 and S 2, 3, 4
-short preganglionic, long postganglionic- sympathetic
-long preganglionic, short postganglionic- parasympathetic

19
Q

ganglia

A

-3 cervical- superior, middle, inferior
-12 thoracic
-4 lumbar
-5 sacral

20
Q

splenic nerves

A

-afferent and efferent
-abdominopelvic splenic
-greater, lesser, least, and lumbar splenic nerves
-synapse in prevertebral ganglia
-surround the branches of aorta -> celiac aortic or renal, superior and inferior mesenteric ganglion
-celiac ganglion receive input from superior greater splenic nerve -> innervate foregut, distal esophagus, stomach, proximal duodenum, pancreas, liver, biliary system, spleen, adrenal glands
-aortic or renal from the lesser splenic nerve
-superior and inferior mesenteric ganglion from the least and lumbar splenic nerves

21
Q

intervertebral venous plexus

A

-in the epidural space
-Batson’s plexus
-drains the entire length of the vertebral column
-This plexus and the external vertebral venous plexus provides a route for metastasis to the vertebrae, spinal cord, or brain from an abdominal (kidney), thoracic (breast and lung), or pelvic (prostate) tumor
-occurs bc lack valves

22
Q

epidural abcess

A

-pus between dura mater/spinal cord and bones of spine/skull
-more common in spine bc it is a real space

23
Q

spinal block

A

-injected into subarachnoid space into CSF
-below L1/L2

24
denticulate ligaments
-thickened extensions of pia mater -traverse the subarachnoid space -attach to dura mater -21 pairs -stabilize spinal cord to prevent side to side motion
25
disc hernation
-cervical posterolateral herniation- nerve impinged = lower vertebra (C5 is impinged at C4-C5) -> bc cervical nerves exit superiorly -thoracic posterolateral herniation- nerve impinged = upper vertebrae (T3 is impinged at T3-T4) -lumbar posterolateral herniation- nerve impinged = lower vertebrae -> because nerve extending to the level below the herniation is impinged in the lateral recess of the vertebral canal
26
intrinsic back muscles
-maintain posture and move head and vertebral column -innervated by dorsal rami -superficial- splenius capitis and splenius cervicis -intermediate- erector spinae: iliocostalis, longissimus, spinalis -deep- transversospinalis group (semispinalis)
27
splenius capitis and cervicis
-superficial layer -directed superolaterally -distal attachments are distinct -capitis- inferior- nuchal ligament and spinous processes of C7-T6 -capitis- superior- mastoid process and superior nuchal line -cervicis- inferior- SP T3-T6 -cervicis- superior- transverse processes C1-C3/C4 -innervated by dorsal rami of spinal nerves -action- bilaterally extends head and neck unilaterally laterally flexes and rotates head
28
erector spinae: iliocostalis, longissimus, spinalis
-intermediate layer -from lateral to medial -> iliocostalis, longissimus, spinalis (I Love Spines) -originates on posterior aspects of iliac crests and sacrum, sacroiliac ligaments and spinous processes of sacral and inferior lumbar vertebrae -inserts on spinous and transverse processes of vertebrae, ribs, skull -innervated by dorsal rami -supplied by dorsal branches of posterior intercostal and lumbar arteries -action- erect posture, bilateral contraction to extend vertebral column, unilateral contraction for rotation
29
transversospinalis group
-form transverse processes (inferiorly) to spinous processes (superiorly) -between spinous process and transverse process -rotation and lateral bending movement -stabilize vertebral column -semispinalis is the only visible
30
semispinalis
-most superficial of transversospinalis -semispinalis capitis- attaches to occipital bone -fibers are longitudinal and parallel to vertebral column -thoracic, cervicis, capitis -originate on transverse processes of C4-T12 -insert on occipital bone and spinous processes of thoracic and cervical region -innervated by dorsal rami of spinal nerves -action- maintain lordosis and balance head on the neck, bilateral contraction- extension of head and neck, unilateral contraction to rotate head and neck
31
greater occipital nerve
-dorsal ramus of the C2 spinal nerve -nerve passes through semispinalis muscle and trapezius -entirely sensory supplying skin on the back of the head
32
triangle of auscultation
-allows for optimal auscultating lung sounds -approx at intercostal space 6 -borders: -laterally- medial border of the scapula (border of rhomboid major) -medially- ascending fibers of trapezius -inferiorly- superior border of the latissimus dorsi
33
suboccipital triangle
-contents- vertebral artery and (C1) suboccipital nerve -muscles: -rectus capitis posterior major- medially -rectus capitis posterior minor -obliquus capitis inferior- below -obliquus capitis superior- above -innervated- suboccipital nerve C1 -greater occipital nerve C2- sensory -avoid during surgery
34
atlanto-occipital joints
-most superior joints of the spine -synovial -between occipital condyles and superior facets of the atlas (C1)
35
antlanto-axial joints
-synovial -between inferior facets of the atlas (C1) and the superior facets of the axis (C2) as well as a synovial pivot joint with the dens (odontoid process of C2 forming the axis of pivot
36
inferior to atlanto-axial joints: 3 types of joints*
-all vertebrae have 3 types of joints -1. anteriorly, a symphysis (a midline, cartilaginous joint) including the body of superior vertebrae, an intervertebral disc, and body of the inferior vertebrae -2&3. posteriorly, 2 synovial facet joints
37
parts of a vertebrae*
-anulus fibrosus- outer layer, consists of collagen and fibrocartilage and surrounds the nucleus pulposus -nucleus pulposus- inner layer, a remnant of the notochord -the inferior- most intervertebral disc sits between the body of L5 and the articular surface of the sacrum at the lumbosacral junction
38
difference between cervical, thoracic, and lumbar vertebrae
-transverse foramina only present in cervical -facets/hemifacets for ribs are only present for thoracic -transverse processes are only bifid for cervical -spinous process is small and often bifid for cervical -spinous process if inferior sloping for thoracic -spinous process if robust, posteriorly projecting for lumbar
39
Lumbar triangle
latissimus dorsi medially, external oblique muscle laterally, iliac crest inferiorly- site of lumbar hernia
40
agonist
-prime mover