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KLowe-Advanced Anes 2 (Rachel's Class) > Spinal Anatomy > Flashcards

Spinal Anatomy Flashcards

1
Q

How many spinal vertebrae are there?

A

33

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2
Q

Spinal vertebrae are separated by intervertebral ___

A

Spinal vertebrae are separated by intervertebral DISCS

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3
Q

Vertebral ___ allows for passage and protection of the spinal cord

A

Vertebral FORAMEN allows for passage and protection of the spinal cord

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4
Q

___ process is on each side of the vertebra (laterally)

A

TRANSVERSE process is on each side of the vertebra (laterally)

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5
Q

___ process is located posteriorly

A

SPINOUS process is located posteriorly

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6
Q

What do we hope to feel when doing a spinal or epidural?

A

Spinous process

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7
Q

Spinous processes overlap to protect the spinal cord–T/F?

A

True

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8
Q

Lateral notches are known as intervertebral ___ and allow for the passage of ___

A

Lateral notches are known as intervertebral FORAMINA and allow for the passage of nerves

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9
Q

If intervertebral foramina or discs become damaged, pressure is exerted on nerves which can cause pain and parasthesias–T/F?

A

True

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10
Q

Pedicles have superior and inferior articular surfaces and lateral notches; when vertebrae are stacked, the notches and surfaces form the ___ joint

A

Pedicles have superior and inferior articular surfaces and lateral notches; when vertebrae are stacked, the notches and surfaces form the FACET joint

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11
Q

Regional variation of vertebrae–cervical and thoracic spinous processes are more ___; require more ___ (caudal/cephalad) angle for needle

A

Regional variation of vertebra–cervical and thoracic spinous processes are more ANGLED; require more CEPHALAD angle for needle

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12
Q

Regional variation of vertebrae–lumbar vertebrae are ___ (smaller/larger); there is ___ (more/less) overlap, making ___ (smaller/larger) gaps; ___ (easier/harder) placement of needles

A

Regional variation of vertebra–lumbar vertebrae are LARGER; there is LESS overlap, making LARGER gaps; EASIER placement of needles

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13
Q

Regional variation of vertebrae–sacral vertebrae are ___; lamina of last sacral vertebra is ___ (complete/incomplete) and bridged only by ___, known as sacral ___

A

Regional variation of vertebrae–sacral vertebrae are FUSED; lamina of last sacral vertebra is INCOMPLETE and bridged only by LIGAMENTS, known as SACRAL HIATUS

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14
Q

What is the bony process used to identify the sacral hiatus? What is this good for?

A

SACRAL CORNU is the bony process used to identify the sacral hiatus; this is good for CAUDAL BLOCKS

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15
Q

Scoliosis = ___ (anterior/posterior/lateral) curvature

A

Scoliosis = LATERAL curvature

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16
Q

Kyphosis = ___ (anterior/posterior/lateral) curvature

A

Kyphosis = POSTERIOR curvature

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17
Q

Lordosis = ___ (anterior/posterior/lateral) curvature

A

Lordosis = ANTERIOR curvature

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18
Q

Abnormal curvatures of the spine may interfere with the interlaminar ___–don’t always expect it to be directly anterior to the spinous process

A

Abnormal curvatures of the spine may interfere with the interlaminar FORAMEN–don’t always expect it to be directly anterior to the spinous process

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19
Q

The intervertebral disc between each vertebral body contains (3) ligaments–what are they?

A
  • Supraspinous
  • Intraspinous
  • Ligamentum flavum
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20
Q

Supraspinous ligaments are ___ (weak/strong) cord like ligament; connect apices of spinous processes; major ligament of ___ and upper ___ regions

A

Supraspinous ligaments are STRONG cord like ligament; connect apices of spinous processes; major ligament of CERVICAL and upper THORACIC regions

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21
Q

Intraspinous ligaments are ___ (thick/thin); run between adjacent spinous processes; absent or poor quality in ___ region; can be extremely thin in ___ region

A

Intraspinous ligaments are THIN; run between adjacent spinous processes; absent or poor quality in CERVICAL region; can be extremely thin in LUMBAR region

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22
Q

Ligamentum flavum is ___ (thick/thin) on lateral edge, ___ (thick/thin) midline, like a V

A

Ligamentum flavum is THIN on lateral edge, THICK midline, like a V

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23
Q

What spinous ligament is the strongest?

A

Ligamentum flavum

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24
Q

Ligamentum flavum can be 3-5 mm thick at L__-__

A

Ligamentum flavum can be 3-5 mm thick at L2-3

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25
Q

Anterior and posterior longitudinal ligaments cover anterior and posterior portions of vertebrae–T/F?

A

True

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26
Q

Epidural space lies between ___ and ___ mater

A

Epidural space lies between LIGAMENTUM FLAVUM and DURA mater

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27
Q

Epidural space originates in the base of the ___ and ends in the sacral ___

A

Epidural space originates in the base of the CRANIUM and ends in the sacral SULCUS

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28
Q

Distance of epidural space from the skin varies with level and is loosely correlated with weight–T/F?

A

True

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29
Q

If using a midline lumbar approach, distance of epidural space from the skin is ___-___ cm, average ___ cm

A

If using a midline lumbar approach, distance of epidural space from the skin is 2.5-8 cm, average 5 cm

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30
Q

Spinal cord extends from ___ to ___ in adults, ___ in peds

A

Spinal cord extends from MEDULLA OBLONGATA to L2 in adults, L3 in peds

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31
Q

Layers of the spinal cord are known as ___

A

Layers of the spinal cord are known as MENINGES

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32
Q

What are the (3) layers of the meninges?

A
  • Dura mater
  • Arachnoid mater
  • Pia mater
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33
Q

Which meninges layer holds the CSF?

A

Arachnoid mater

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34
Q

There are ___ pairs of spinal nerves

A

There are 31 pairs of spinal nerves

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35
Q

How many cervical spinal nerves are there?

A

8 cervical

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36
Q

How many thoracic spinal nerves are there?

A

12 thoracic

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37
Q

How many lumbar spinal nerves are there?

A

5 lumbar

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38
Q

How many sacral spinal nerves are there?

A

5 sacral

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39
Q

How many coccygeal spinal nerves are there?

A

1 coccygeal

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40
Q

Thoracic spinal nerves run along the ___ (superior/inferior) margin of the rib; where would you put a chest tube?

A

Thoracic spinal nerves run along the INFERIOR margin of the rib

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41
Q

Where would you put a chest tube? In the superior or inferior aspect of the rib?

A

You would put a chest tube in the SUPERIOR aspect of the rib (so you don’t damage thoracic spinal nerves)

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42
Q

Spinal nerve level always correlates with vertebrae–T/F?

A

FALSE–does NOT always correlate with vertebrae

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43
Q

C1 exits between base of ___ and ___

A

C1 exits between base of SKULL and ATLAS

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44
Q

C8 exits between C__-T__

A

C8 exits between C7-T1

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45
Q

Cervical spinal nerves correlate with vertebrae ___ (above/below); after T1, spinal nerves correlate with vertebrae ___ (above/below)

A

Cervical spinal nerves correlate with vertebrae BELOW; after T1, spinal nerves correlate with vertebrae ABOVE

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46
Q

Spinal cord is approximately 25 cm ___ (shorter/longer) than vertebral canal

A

Spinal cord is approximately 25 cm SHORTER than vertebral canal

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47
Q

Spinal cord is enlarged at C__-C__ and L__-S__

A

Spinal cord is enlarged at C5-C7 and L2-S3

because C4-T1 = brachial plexus
L2-S3 = lumbar and sacral plexus

48
Q

Brachial plexus = ___ (what spinal levels?)

A

Brachial plexus = C4-T1

49
Q

Lumbar and sacral plexus = ___ (what spinal levels?)

A

Lumbar and sacral plexus = L2-S3

50
Q

Cauda equina = long roots of ___ and ___ nerves; extends from L__-S__

A

Cauda equina = long roots of lumbar and sacral nerves; extends from L1-S5

51
Q

Spinal cord is divided into ___, ___, and ___ regions

A

Spinal cord is divided into DORSAL, LATERAL, AND VENTRAL regions

52
Q

Dorsal region = entering ___ (sensory/motor) root

A

Dorsal region = entering SENSORY root

53
Q

Ventral region = outgoing ___ (sensory/motor) root

A

Ventral region = outgoing MOTOR root

54
Q

H-shaped central gray region contains neuronal cell ___ and ___ (myelinated/unmyelinated) fibers; it is surrounded by ___ (gray/white) matter containing fiber tracts

A

H-shaped central gray region contains neuronal cell BODIES and UNMYELINATED fibers; it is surrounded by WHITE matter containing fiber tracts

55
Q

Grey matter is subdivided into ___ laminae of ___

A

Grey matter is subdivided into 12 laminae of Rexed

56
Q

Grey matter AFFERENT tracts = __-__

A

Grey matter AFFERENT tracts = I-VI

57
Q

Grey matter VENTRAL tracts = __-__

A

Grey matter VENTRAL tracts = VII-IX

58
Q

Grey matter AFFERENT tracts receive ___ (sensory/motor) information from the periphery

A

Grey matter AFFERENT tracts receive SENSORY information from the periphery

59
Q

Grey matter VENTRAL tracts are ___ (sensory/motor) neurons

A

Grey matter VENTRAL tracts are MOTOR neurons

60
Q

Laminae ___ is very important to anesthesia; it is called ___

A

Laminae II is very important to anesthesia; it is called SUBSTANTIA GELATINOSA

61
Q

Why is the substantia gelatinosa (laminae 2) very important to anesthesia?–because it receives input from ___ and ___ receptors

A

Because it receives input from pain and thermoreceptors

62
Q

(2) classes of white matter–___ white and ___/___ white

A

Dorsal white and lateral/ventral white

63
Q

White matter is highly ___

A

White matter is highly organized

64
Q

Dorsal white matter is almost exclusively ___ (ascending/descending) ___ (sensory/motor) fiber tracts

A

Dorsal white matter is almost exclusively ASCENDING SENSORY fiber tracts

65
Q

Lateral/ventral white matter is ___ (ascending/descending) ___ (sensory/motor) tracts

A

Lateral/ventral white matter is DESCENDING MOTOR tracts

66
Q

Most lateral/ventral white matter cross over at some point–T/F?

A

True

67
Q

Lateral/ventral white matter can do one of two things–1) ascend to the ___; 2) originate and terminate entirely within the ___

A

Lateral/ventral white matter can do one of two things–1) ascend to the BRAIN; 2) originate and terminate entirely within the SPINAL CORD [i.e: spinal reflexes]

68
Q

What type of motor function involves an association tract that originates and terminates entirely within the spinal cord?

A

Reflexes

69
Q

Sensory pathways = ___ (afferent/efferent); ___ (ascend/descend)

A

Sensory pathways = AFFERENT; ASCEND

70
Q

Sensory pathways transmit (6) things?

A
  • Pain
  • Temperature
  • Pressure
  • Touch
  • Vibratory sense
  • Proprioception
71
Q

Sensory receptors location–pain and temp receptors are located in the ___ and ___

A

Sensory receptors location–pain and temp receptors are located in the EPIDERMIS AND DERMIS

72
Q

Sensory receptors location–pressure, touch, vibration, and proprioception are located in the ___

A

Sensory receptors location–pressure, touch, vibration, and proprioception are located in the DERMIS

73
Q

(2) classifications of sensory receptors–___ceptors, ___ceptors

A

(2) classifications of sensory receptors–EXTRORECEPTORS and PROPRIOCEPTORS

74
Q

Extroreceptors are located near surface of ___ and ___ mucosa

A

Extroreceptors are located near surface of SKIN and ORAL mucosa

75
Q

Proprioceptors are located in ___ (superficial/deeper) skin layers, joint ___, ligaments, tendons, muscles, and periosteum

A

Proprioceptors are located in DEEPER skin layers, joint capsules, ligaments, tendons, muscles, and periosteum

76
Q

What are the (2) main sensory tracts in the dorsal column?

A
  • Medial lemniscal pathway

- Anterolateral pathway

77
Q

Medial lemniscal pathway–carries signals upwards towards ___ in dorsal column tract; cross over at ___; carried through brainstem to ___ in medial lemniscus tract; to area of brain to interpret

A

Medial lemniscal pathway–carries signals upwards towards MEDULLA in dorsal column tract; cross over at MEDULLA; carried through brainstem to THALAMUS in medial lemniscus tract; to area of brain to interpret

78
Q

Medial lemniscal pathway [review]–sensory signal enters through ___ (dorsal/ventral) root; ascends through dorsal column on ___ (same/opposite) side; arrives at ___ and crosses over (1st order to 2nd order synapse); ascends via medial lemniscus tract through ___ (2nd order neuron); arrives at ___ (2nd to 3rd order synapse) and then to area of brain to interpret (3rd order neuron)

A

Medial lemniscal pathway–sensory signal enters through DORSAL root; ascends through dorsal column on SAME side; arrives at MEDULLA and crosses over (1st order to 2nd order synapse); ascends via medial lemniscus tract through BRAINSTEM (2nd order neuron); arrives at THALAMUS (2nd to 3rd order synapse) and then to area of brain to interpret (3rd order neuron)

79
Q

Anterolateral pathway originates in ___ (dorsal/ventral) horn to what (4) laminae?

A

Anterolateral pathway originates in DORSAL horn to laminae I, IV, V, VI [1,4,5,6]

80
Q

Anterolateral pathway–immediately cross over in anterior ___ to ___ and ___ white columns

A

Anterolateral pathway–immediately cross over in anterior COMMISSURE to ANTERIOR AND LATERAL white columns

81
Q

Anterolateral pathway–signals ascend to brain through associated tract–___ spinothalamic or ___ spinothalamic; go to ___ or ___, to area of brain to interpret

A

Anterolateral pathway–signals ascend to brain through associated tract–ANTERIOR spinothalamic or LATERAL spinothalamic; go to BRAINSTEM or THALAMUS, to area of brain to interpret

82
Q

Anterolateral pathway [review]–sensory signal enters through ___ (dorsal/ventral) horn [1st order neuron]; immediately synapses in the ___ (dorsal/ventral) horn of ___ (grey/white) matter [Rexed laminae, 1st to 2nd order synapse]; crosses over at ___ level; ascends to ___ or ___ [2nd order neuron]; synapse in ___ or ___ [2nd to 3rd order synapse]; carried to area of brain for interpretation [3rd order neuron]

A

Anterolateral pathway [review]–sensory signal enters through DORSAL horn [1st order neuron]; immediately synapses in the DORSAL horn of GREY matter [Rexed laminae, 1st to 2nd order synapse]; crosses over at ENTRY level; ascends to BRAINSTEM or THALAMUS [2nd order neuron]; synapse in BRAINSTEM OR THALAMUS [2nd to 3rd order synapse]; carried to area of brain for interpretation [3rd order neuron]

83
Q

Dorsal column medial lemniscus–fibers are ___ (small/large), ___ (myelinated/unmyelinated); conduction speed is __-__ m/sec; spatial orientation is ___ (low/high) with respect to origin; ___ (discrete/broad) types of mechanoreceptive sensations

A

Dorsal column medial lemniscus–fibers are LARGE, MYELINATED; conduction speed is 30-110 m/sec; spatial orientation is HIGH with respect to origin; DISCRETE types of mechanoreceptive sensations

84
Q

Dorsal column anterolateral system–fibers are ___ (small/large), ___ (myelinated/unmyelinated); conduction speed is ___-___ m/sec; spatial orientation is ___ (low/high) with respect to origin; ___ (discrete/broad) spectrum of sensory modalities

A

Dorsal column anterolateral system–fibers are SMALL, MYELINATED; conduction speed is few-40 m/sec; spatial orientation is LOW with respect to origin; BROAD spectrum of sensory modalities (i.e.: pain, warmth, cold, crude, touch)

85
Q

SNS preganglionic neurons are ___ fibers, ___ (small/large)

A

SNS preganglionic neurons are B fibers, SMALL

86
Q

SNS preganglionic neurons originate in the intermediolateral grey horn between T__-L__/__

A

SNS preganglionic neurons originate in the intermediolateral grey horn between T1-L2/L3

87
Q

SNS preganglionic neurons exit the spinal cord via the ___ (dorsal/ventral) nerve root

A

SNS preganglionic neurons exit the spinal cord via the VENTRAL nerve root white rami communicans

88
Q

Series of paired segmental paravertebral ganglia form ___

A

Series of paired segmental paravertebral ganglia form SYMPATHETIC TRUNKS

89
Q

Cervical ganglia are divided into ___, ___, and ___ ganglia

A

Cervical ganglia are divided into SUPERIOR, MEDIAL, AND INFERIOR ganglia

90
Q

Stimulation of SNS fiber in the superior cervical ganglia causes ___iasis [contraction of the radial muscle of the iris], ___ (contraction/relaxation) of the ciliary muscle of the eye, ___ (constriction/dilation) of the blood vessels of the head

A

Stimulation of SNS fiber in the superior cervical ganglia causes MYDRIASIS [contraction of the radial muscle of the iris], RELAXATION of the ciliary muscle of the eye, CONSTRICTION of the blood vessels of the head

91
Q

Damage to the superior cervical ganglia, central SNS damage, or injury to other cervical paravertebral ganglia causes ___osis, ___osis, ___osis…what is this known as?

A

Damage to the superior cervical ganglia, central SNS damage, or injury to other cervical paravertebral ganglia causes MIOSIS, PTOSIS, ANHYDROSIS…this is known as HORNER’S SYNDROME

92
Q

The inferior cervical ganglia fuses with the first thoracic ganglia to form the ___ ganglia at C__-C__

A

The inferior cervical ganglia fuses with the first thoracic ganglia to form the STELLATE ganglia at C5-C6

93
Q

What are the (4) stages of pain transmission?

A
  • Transduction
  • Transmission
  • Modulation
  • Perception
94
Q

Some fibers in the dorsal horn give off branches that synapse with ___ neurons; these synapse with ___ (sensory/motor) neurons in the ___ (dorsal/ventral) horn; can cross over and travel up or down before synapsing; part of the reflex response to pain

A

Some fibers in the dorsal horn give off branches that synapse with INTERNUNCIAL [messenger] neurons; these synapse with MOTOR neurons in the VENTRAL horn; can cross over and travel up or down before synapsing; part of the reflex response to pain

95
Q

Afferent nerves come from relatively limited areas of the skin, and there is some overlap–T/F?

A

True

96
Q

T4 dermatome = ___

A

T4 dermatome = NIPPLE LINE

97
Q

T6-7 dermatome = ___

A

T6-7 dermatome = XIPHOID PROCESS

98
Q

T10 dermatome = ___

A

T10 dermatome = BELLY BUTTON

99
Q

Nipple line = ___

A

Nipple line = T4

100
Q

Xiphoid process = ___

A

Xiphoid process = T6-7

101
Q

Belly button = ___

A

Belly button = T10

102
Q

Motor pathways = ___ (afferent/efferent), ___ (enter/exit)

A

Motor pathways = efferent, exit

103
Q

Motor pathways = info from brain to ___ (voluntary/involuntary) muscles, ___ and ___ muscles, and some ___

A

Info from brain to voluntary muscles, smooth and cardiac muscles, and some glands

104
Q

___ tract supplies the voluntary muscles of the trunk and extremities

A

Corticospinal tract supplies the voluntary muscles of the trunk and extremities

105
Q

Corticospinal tract originates in ___ (small/large), ___ (upper/lower) ___ (sensory/motor) neurons located in the ___

A

Corticospinal tract originates in large, upper motor neurons located in the precentral gyrus

106
Q

Corticospinal tract travels from ___ through the internal capsule (anterior limb) through the midbrain to the ___

A

Corticospinal tract travels from precentral gyrus through the internal capsule (anterior limb) through the midbrain to the medulla

107
Q

90% of corticospinal tracts cross in medulla, forming ___ of medulla

A

90% of corticospinal tracts cross in medulla, forming pyramids of medulla

108
Q

Corticospinal tract is sometimes referred to as ___ tract

A

Corticospinal tract is sometimes referred to as pyramidal tract

109
Q

After crossing from the lateral corticospinal tract, the nerves ___ (ascend/descend) the spinal cord and leave at the designated level; they enter the ___ (dorsal/ventral) gray horn and synapse with ___ (upper/lower) motor neurons

A

After crossing from the lateral corticospinal tract, the nerves DESCEND the spinal cord and leave at the designated level; they enter the VENTRAL gray horn and synapse with LOWER motor neurons

110
Q

10% of corticospinal tracts that don’t cross continue down as the ___ (dorsal/ventral) corticospinal tract; then cross over before synapsing with lower motor neurons in the gray matter; travel in spinal nerves to innervate ___ (involuntary/voluntary) muscle

A

10% of corticospinal tracts that don’t cross continue down as the VENTRAL corticospinal tract; then cross over before synapsing with lower motor neurons in the gray matter; travel in spinal nerves to innervate INVOLUNTARY muscle

111
Q

A few corticospinal tract neurons are located anterior to the precentral gyrus–T/F?

A

True

112
Q

Corticospinal tract neurons located anterior to the precentral gyrus have ___ (stimulatory/inhibitory) effect on the lower motor neurons to prevent them from discharging excessively

A

Corticospinal tract neurons located anterior to the precentral gyrus have INHIBITORY effect on the lower motor neurons to prevent them from discharging excessively

113
Q

Damage to corticospinal tract neurons located anterior to the precentral gyrus can cause lower motor neurons to ___ fire or fire ___

A

Damage to corticospinal tract neurons located anterior to the precentral gyrus can cause lower motor neurons to OVER fire (hyperreflexia) or fire SIMULTANEOUSLY (spasticity)

114
Q

With upper motor neuron paralysis, reflexes are ___ (intact/damaged), suppressor fibers are ___ (stimulated/impeded), and ___(hyper/hypo) reflexia occurs

A

With upper motor neuron paralysis, reflexes are intact, suppressor fibers are impeded, and hyperreflexia occurs

115
Q

Damage to lower motor neurons produces ___ type paralysis

A

Damage to lower motor neurons produces flaccid type paralysis

116
Q

What (2) diseases affect the corticospinal tract?

A
  • Cerebral palsy

- ALS

KLowe-Advanced Anes 2 (Rachel's Class) (16 decks)

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