Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NMF: Neurology > SPINE > Flashcards

SPINE Flashcards

1
Q

Where are motor neurons found in the spinal cord?

A

the ventral (anterior) horn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is somatosensory information received in the spinal cord?

A

the dorsal (posterior) horn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which vertebral levels have a lateral horn containing the autonomic neurons?

A

T1-L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which spinal tract controls fine touch, pressure and vibration?

A

Dorsal column-medial leminiscus (DCML)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which spinal tract controls pain and temperature?

A

Lateral Spinothalamic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which spinal tract controls crude touch?

A

anterior spinothalamic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do the spinocerebellar pathways do?

A

provide unconscious proprioceptive information to the cerebellum in order to coordinate posture and the movement of the lower limb and upper limb musculature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which spinocerebellar pathways provide info from the upper limbs?

A

cuneocerebellar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which spinocerebellar pathways provide information for the lower limbs?

A

dorsal and ventral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name the two pyramidal descending tracts

A

corticospinal and corticobulbar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What type of movement does the corticospinal tract control?

A

voluntary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the function of the corticobulbar tract?

A

it contains UMN of the CN to innervate face head and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is the forehead unaffected in an UMN or LMN lesion of the facial nerve?

A

unaffected if UMN –> facial palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name the extrapyramidal tracts

A

vestibulospinal, reticulospinal, rubrospinal, tectospinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do the extrapyramidal tracts originate from?

A

the brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does the vestibulospinal tract control?

A

balance and posture by innervating the anti-gravity muscles (extensors for legs and flexors for arms).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two parts of the reticulospinal tract?

A

pontine and medullary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which part of the reticulospinal tract facilitates movement?

A

the pontine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which spinal tract excites flexor muscles and inhibits extensor muscles of the upper body?

A

Rubrospinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which spinal tract co-ordinates movements of head and neck to vision stimuli?

A

tectospinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Reflex pneumonic

A

1,2 buckle my shoe: ankle reflex S1,2

3,4 kick the door: patellar reflex L3,4

5,6 pick up sticks: biceps reflex C5,6

7,8 shut the gate: triceps reflex C7,8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe C1

A

THE ATLAS no body or spinous process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What part of the vertebrae is only present in c2?

A

dens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name the 2 parts of the intervertebral disc

A

annulus fibrosis (outer fibrocartilage)

Nucleus pulpsosis (water, dehydrates with age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Ligaments spine

A

Anterior longitudinal ligament:

Connects the anterolateral aspects of vertebral bodies and IV discs.

Posterior longitudinal ligament:

It runs within the vertebral canal posterior to the vertebral bodies.

Ligamentum flavum:

It is so called because it is rich in elastin and therefore appears yellow. It runs vertically connecting the lamina of adjacent vertebrae. It helps maintain an upright posture and assist straightening the spine after flexion.

Supraspinous ligament:

Runs along the tips of the spinous processes.

Interspinous ligament:

Runs between the spinous processes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Layers lumbar puncture goes through starting from the skin

A
  • Skin
  • Fascia
  • Supraspinous ligament
  • Interspinous ligament
  • Ligamentum flavum
  • Epidural space
  • Dura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Signs that back pain is mechanical

A

Morning stiffness that resolves with movement, pain worse on sitting and when rising from a seated position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the most common locations for lumbar disc herniation?

A

L4/5 level and L5/S1

29
Q

When do herniated discs occur in a) young and b) elderly patients?

A

young - sprain on the spine eg carrying a heavy load

old - degeneration of the vertebrae or spondylosis

30
Q

Which nerve root is damaged in a a paramedian (posterolateral) herniation?

A

the transversing nerve ie. the nerve root that exists below the level of prolapsed disc

31
Q

Which nerve root is damaged when a far lateral (extraforaminal) herniation occurs?

A

the exiting nerve (the nerve root that exists at that level)

32
Q

Name two consequences of a central disc herniation

A

Lumbar stenosis or cauda equina

33
Q

What is radiculopathy?

A

dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the muscle groups supplied by that nerve.

34
Q

Which nerve roots are compressed in sciatica?

A

L4-S3

35
Q

Describe the general clinical features of sciatica

A
  • shooting pain radiating from the buttocks to posterior knee
  • pain exaggerated by coughing/ sneezing
  • numbness or tingling along nerve distribution
  • weakness
  • straig leg raise +ve (leg raised to <45 causes pain)
36
Q

What features would be present if S1 root is compressed

A

Pain along the posterior thigh with radiation to the heel.

Weakness of plantar flexion (on occasion).

Sensory loss in the lateral foot.

Reduced or absent ankle jerk.

37
Q

What features would be present if L5 was compressed?

A

Pain along the posterior or posterolateral thigh with radiation to the dorsum of the foot and great toe.

Weakness of dorsiflexion of the toe or foot.

Paraesthesia and numbness of the dorsum of the foot and great toe.

Reflex changes unlikely.

38
Q

What features would be present if L4 was compressed?

A

Pain in the anterior thigh.

Wasting of the quadriceps muscle.

Weakness of the quadriceps function and dorsiflexion of foot.

Diminished sensation over anterior thigh, knee and medial aspect of lower leg.

Reduced knee jerk.

39
Q

What are the indications for discectomy?

A

Failure of conservative treatment (physiotherapy and analgesia) - First line management

Pain

Central disc prolapse: Patients with bilateral sciatica or other features indicating a central disc prolapse, such as sphincter disturbance and diminished perineal sensation, should be investigated promptly.

Tumour

Neurological deficits

40
Q

What are the clinical features of cauda equina?

A
  • urinary retention
  • saddle paraesthesia
  • incontinence (both internal and external anal sphincters)
  • low back pain
  • bilateral sciatic leg pain
41
Q

Why do some patients with cauda equina syndrome have bladder incontinence?

A

Their bladder problems will be intermittent. Severe exacerbation of lower back pain can cause bladder spasm and incontinence.

Look for absent ankle reflexes to confirm cauda equina syndrome.

42
Q

How do you investigate cauda equina?

A

MRI lumbrosacral spine and PR exam (lack of anal sphincter tone and perianal numbness)

43
Q

Treatment of cauda equina

A

If it was due to a herniated disc –> discectomy

If it was due to a fracture –> decompression +- fixation

If it was due to a hematoma –> evacuation

44
Q

What is the risk of permanent incontinence and/or impotence even if there is prompt surgery for cauda equina?

A

10%

45
Q

What is spinal stenosis?

A

narrowing of the spinal canal which compresses the lowest most spinal cord, conus medullaris, nerve roots, the latest will lead to symptoms of neurogenic claudication. Symptomatic lumbar stenosis occurs most commonly at the L4/5 level followed by L3/4. Occurs mainly in older patients >50 years old.

46
Q

What are the clinical features of lumbar spinal stenosis?

A
  • insidious and progressive unilateral or bilateral hip/buttocks/lower extremity pain or burning - precipitated by standing or back extension - relieved by sitting, lumbar flexion or walking uphill
  • neurogenic claudication: leg weakness, tingling, numbness and paraesthesia
47
Q

Treatment of lumbar spinal stenosis

A

conservative: physio and analgesia

surgery once symptoms untolerable and pain uncontrolled by analgesia: lumbar surgical decompression by laminectomy

48
Q

What is cervical spondylosis?

A

A degenerative arthritic process involving the cervical spine

Affects the intervertebral disc and zygapophyyseal joints

Most patients are over 50

Degeneration causes stress on the articular cartilage causing osteophytic spurs to develop around the margins that can grow posteriorly into the spinal canal and arteriorly into the prevertebral space

49
Q

How do patients with cervical spondylosis present?

A

either present as degenerative cervical myelopathy (UMN signs) or radiculopathy (LMN signs).

50
Q

What are the clinical features of cervical spondylosis?

A

Radiculopathy: LMN signs in the upper and lower limbs, neck pain

Myelopathy

51
Q

What are the radiographic findings of cervical spondylosis?

A

Narrowed disc space (C5/6 and C6/7)

Osteophyte formation

52
Q

Treatment of cervical spondylosis

A
  • Multi-level pathologies/posterior compression due to osteophyte or ligamentum flavum hypertrophy –> decompressive cervical laminectomy
  • Predominant anterior compression due to disc –> anterior cervical discectomy
  • Unilateral nerve root compression can be approached through a posterior cervical foraminotomy
53
Q

What is degenerative cervical myelopathy?

A

Spinal cord compression causing UMN signs (Especially in the lower limbs)

Older patients

54
Q

Clinical features of degenerative cervical myelopathy

A
  • imbalance and disturbance in gait –> falls
  • clumsy hands
  • urinary or faecal incontinence (Rare)
  • pain (non-dermatomal)
  • legs jump at night (hyperreflexia)
55
Q

Why does degenerative cervical myelopathy cause falls?

A

due to hypertonia causing spasticity and decreased proprioception

56
Q

What is found on examination of degenerative cervical myelopathy?

A
  • weakness, hyperreflexia and spasticity
  • positive babinksi and hoffman’s signs
  • loss of dexterity using fingers
57
Q

How do you investigate degenerative Cervical myelopathy?

A

MRI of the cervical spine is the gold standard: may reveal disc degeneration and ligament hypertrophy +/- spinal cord signal change.

58
Q

How is degenerative cervical myelopathy treated?

A

Decompressive spinal surgery to prevent deterioration

59
Q

What is anterior cord syndrome?

A

anterior spinal artery infarction

paralysis and loss of pain and temperature below

preserved proprioception and vibration

60
Q

Describe presentation of a complete cord transection

A

INITIAL: flaccid, arreflexic

then UMN signs

61
Q

What is Brown-Sequard syndrome?

A

cord hemisection

ipsilateral UMN paralysis and loss of proprioception below

contralateral loss of pain and temperature 1 or 2 segments below

62
Q

What is central cord syndrome?

A

bilateral uper limb weakness > lower limb

cape like loss of pain and temperature

dorsal column preserved

63
Q

Name 3 potential causes of central cord syndrome

A

acute extension injury to a stenotic neck

syringomyelia

tumour

64
Q

Burning down back of legs that is not as bad uphill

A

Spinal stenosis

65
Q

A 66 year old has several falls over a few months. He has symetrical weakness of his legs and mild weakness of his hand. He had an abnormal gait. His reflexes were extremely brisk in his legs with upgoing plantars bilaterally.

A

Degenerative cervical myelopathy due to cervical spondylosis

66
Q

Stab wound to the back causing R weakness at T5 and left sided loss of pinprick and temperature at T7.

A

Brown-sequard syndrome

67
Q

A 39-year-old woman presented with severe headaches whenever she sneezed. She also had decreased sensation to pinprick over her upper back, shoulders, and upper arms. Her power in her arms was 2/5 but her lower body power was 5/5.

A

syringomelia

68
Q

Which cervical nerve root comes out below the verebrae?

A

C8

NMF: Neurology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions