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Apex > Spine > Flashcards

Spine Flashcards

1
Q

Sensory peripheral nerves enter the spinal cord via what?

A

Dorsal nerve root

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2
Q

Motor and autonomic neurons exit the spinal cord via what?

A

Ventral nerve root

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3
Q

What is a ganglion?

A

Collection of cell bodies OUTSIDE of the CNS

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4
Q

What is Grey matter?

A

Contains neuronal cell bodies
Processing center for afferent signals that arrive from periphery

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5
Q

What is white matter?

A

Contains the axons of the ascending and descending tracts

(Divided into the dorsal, lateral, and central columns)

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6
Q

What are the 4 sensory tracts?

A

Dorsal column: ci eat us and gracilis

Tract of Lissauer: pain and temperature

Lateral spinothalamic tract: pain and temp

Ventral spinothalamic tract: crude touch and pressure

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7
Q

What are the two motor tracts?

A

Lateral corticospinal tract: limb motor

Ventral corticospinal Tract: posture motor

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8
Q

What are some traits about the dorsal column?

A

Mechanoreceptive sensations (fine touch, vibration, pressure)

Capable of two-point discrimination

Contains LARGE MYELINATED fibers

Transmits faster than anterolateral system

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9
Q

Which mechanoreceptor can discriminate between two points?

A

Meissner’s corpuscles

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10
Q

Which mechanoreceptor is related to continuous touch?

A

Merkel’s discs

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11
Q

Which mechanoreceptor relates to proprioception, prolonged touch and pressure?

A

Ruffini’s endings

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12
Q

Which mechanoreceptor is related to vibration?

A

Pacinian corpuscles

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13
Q

What is the order of transmission in the dorsal column?

A

Usually an a-beta neuron

First order: enters spinal cord via dorsal root > ascends in same side > synapses with second order neuron in the medulla (cuneate and gracile nuclei)

Second order: cross side in medulla > thalamus > synapses with 3rd order in the thalamus relay station

Third order: advance towards somatosensory cortex in post central gyrus

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14
Q

What is the pathway via the spinothalamic tract?

A

Mostly A-delta or C-fibers

1st order neuron: cell body is in dorsal root ganglion > may ascend 1-3 levels before synapsing with second order

Second order: crosses sides in the spinal cord and ascends via two paths > anterior spinothalamic or lateral spinothalamic > synapse with 3rd in the RAS and thalamus

3rd order: pass through thalamus and advance to somatosensory cortex

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15
Q

With the corticospinal tract, if an injury happens above the decussation (crossing) what will result?

A

Spastic paralysis on the CONTRALATERAL side

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16
Q

With the corticospinal tract, if an injury happens below the decussation (crossing) what will result?

A

Flaccid paralysis on the IPSILATERAL side

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17
Q

What is the corticospinal tract also called?

A

Pyramidal tract

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18
Q

What is the path of transmission in the corticospinal tract?

A

Motor neurons begin in cerebral cortex and synapse with lower motor neurons in the ventral horn

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19
Q

Injury to an upper motor neuron results in what?

A

Contralateral spastic paralysis and hyperreflexia

(Cerebral palsy and ALS)

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20
Q

What does the babinski sign test?

A

Corticospinal integrity

21
Q

What does a negative babinski test say?

A

Corticospinal tract is INTACT ~ GOOD sign

Produces a downward motion of the toes (toes curl)

22
Q

What does a positive babinski test determine?

A

Damage to corticospinal tract ~ BAD sign

Upward extension of the big toe with fanning of the other toes

23
Q

Where does lower motor neurons begin?

A

Ventral horn and end at the neuromuscular junction

24
Q

What will result in a LOWER motor neuron injury?

A

Ipsilateral flaccid paralysis

(Impaired reflexes and flaccid paralysis)

**babinski sign is absent in a lower motor injury

25
Q

What does SSEPs monitor?

A

Dorsal column (posterior blood flow)

26
Q

What do MEPs monitor?

A

Monitor the integrity of the corticospinal tract (anterior perfusion)

27
Q

What is the triad to spinal cord injury? Aka neurogenic shock?

A

Hypotension
Bradycardia
Hypothermia

(This lasts 1-3 weeks)

28
Q

What does impairment to the cardioaccelerator fibers cause?

A

Unopposed vagal tone ~ resulting in bradycardia and reduced inotropy

29
Q

What is hypothermia the results of in neurogenic shock?

A

Impairment of the sympathetic pathways ~ inability of cutaneous vasculature to vasoconstrict, cause a redistribution of blood flow towards the periphery and allowing more heat to escape

30
Q

What is the difference b/t neurogenic shock and hypovolemic shock?

A

Neurogenic: hypotension, bradycardia, warm, pink extremities

Hypovolemic: hypotension, tachycardia, cool clammy extremities

31
Q

What is the vasopressors of choice in neurogenic shock?

A

LEVO

and volume expansion

32
Q

What is the major cause of morbidity and mortality in patients with cervical and upper thoracic lesions?

A

Ineffective alveolar ventilation and the inability to clear secretions.

33
Q

What is autonomic hyperflexia?

A

Following a spinal cord injury (and spinal shock) the body begins to mend itself in a pathological and disorganized way. reflexes returns but are not inhibited in any way ~ results in an overactive state.

34
Q

What % of patients (with an injury above T6) will develop autonomic hyperreflexia?

A

85%

35
Q

What are some common events that cause autonomic hyperreflexia?

A

Stimulation of the hollow organs (bladder, bowel, uterus)

Bladder catherization

Surgery (cysto)

Bowel mov.

Childbirth

36
Q

What is the classic presentation of autonomic hyperreflexia?

A

Hypertension and bradycardia

37
Q

Where does vasoconstriction occur in autonomic hyperreflexia?

A

Below the level of injury

38
Q

Where does vasodilation occur in autonomic hyperreflexia?

A

Above the level of injury

39
Q

What are some other S&S of spinal cord injury?

A

Nasal stuffiness
Hypertension (headache and blurred vision)
Severe HTN: stroke, seizure, LV failure, pulmonary edema

40
Q

What is the best management for autonomic hyperreflexia?

A

Prevention!!!

(Then either a GA or Spinal)

41
Q

How is hypertension best treated with? In AH following SCI

A

Removal of the stimulus
Deepening of the anesthetic
Rapid-vasodilator

42
Q

How is bradycardia best treated in AH following SCI?

A

Atropine or Glyco

43
Q

What is amyotrophic lateral sclerosis (ALS)?

A

Progressive degeneration of motor neurons in the corticospinal tract. Both upper and lower neurons are affected.

44
Q

S&S of ALS?

A

Upper neurons involvement: spasticity, hyperreflexia, loss of coordination

Lower neuron involvement: musc weakness, fasciculations, atrophy

45
Q

Where does ALS typically begin?

A

Hands

46
Q

What is the only drug that reduces mortality in ALS?

A

Riluzole (NMDA antagonist)

47
Q

What is the most common cause of death in ALS?

A

Resp failure

48
Q

How should an anesthetic provider approach paralysis for a patient with ALS?

A

NO SUX
Increased sensitivity to NMB

Apex (47 decks)

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