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A&P I > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Factors that determine effects of muscle contraction:

A
  1. Anatomical arrangement of muscle fibers

2. The way the muscle attaches to bone

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2
Q

One can classify muscles by which 3 factors?

A
  1. Shape
  2. Action (movement)
  3. Size and range of motion
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3
Q

Based on the arrangement of a fascicle:

A

All muscle fibers are parallel in a single fascicle.

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4
Q

List the 4 different shapes of muscles:

A
  1. Parallel
  2. Pennate
  3. Convergent
  4. Circular or Sphincter
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5
Q

Muscle shape in which the axes of fascicles run parallel to axes of the muscle:

A

parallel muscles

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6
Q

Muscle shape: spindle shaped or strap-like, will have a central body (belly or gaster)

A

parallel muscles

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7
Q

Muscle shape: contraction–gets smaller and larger in diameter, especially at the belly

A

parallel muscles

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8
Q

Give examples of parallel muscles:

A

biceps and sartorius

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9
Q

Muscle shape: feather-like, fascicles are short and oblique attached to a central tendon–produces more tension

A

pennate muscles

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10
Q

List the 3 different types of pennate muscles:

A
  1. Unipennate
  2. Bipennate
  3. Multipennate
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11
Q

Shape: fascicles insert into only one side of the tendon, also give example

A

Unipennate muscles; ex. extensor digitorum (extends fingers)

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12
Q

Muscle shape: fascicles insert on both sides of tendon, also give example

A

bipennate muscles; ex. rectus femoris (extends knee)

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13
Q

Muscle shape: many fascicles are inserted into a tendon that typically branches, also give example

A

multipennate muscles; ex. deltoid muscle

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14
Q

Muscle shape: fan-shaped, force directed to a point (raphe), can pull in different directions since each section can change direction, also give example

A

convergent muscles; ex. pectoralis major

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15
Q

point where tendon, aponeurosis, and collagen fibers converge

A

raphe

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16
Q

Muscle shape: contraction acts to close; fascicles are arranged in a circular pattern, also give example

A

circular/sphincter muscle; ex. obicularis oris, obicularis oculi

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17
Q

immovable end of muscle to bone

A

origin

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18
Q

moveable end of muscle to bone attachment

A

insertion

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19
Q

Movement can be named for what two factors?

A

Bone involved or joint involved (ex., flexion of forearm, flexion of elbow)

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20
Q

What are the 3 functional groups of muscles based on size and range of motion?

A
  1. Agonist
  2. Antagonist
  3. Synergists
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21
Q

prime mover, muscle is chiefly responsible for movement; give example

A

agonist; ex. prime mover of elbow is biceps brachii–origin is the humerus and the insertion is the radius

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22
Q

oppose or reverse a movement–located on opposite side of joint; give example

A

antagonist; ex. triceps brachii vs. biceps brachii

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23
Q

help prime movers; list 3 different functions

A

synergists; 1. adds extra force to the movement

  1. reduces undesirable or unnecessary movement
  2. it is a fixator–immobilises a bone of muscle origin
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24
Q

Give an example of the synergist function of adding extra force to a movement:

A

ex. external intercostals aiding with respiration

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25
Q

Give an example of the synergist function of reducing undesirable or unncessary movement:

A

ex. brachioradialis for forearm flexion

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26
Q

Give an example of the synergist function of immobilising a bone of muscle origin

A

ex. scapula to the axial skeleton, muscle maintaining upright posture

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27
Q

A muscle may act as a prime mover in one movement, an antagonist in another movement, and a synergist for a third movement: true or false?

A

true

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28
Q

Give an example of a muscle that may act as a prime mover in one movement, an antagonist in another movement, and a synergist in a third movement:

A

deltoid muscle

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29
Q

List the 3 different example functions of a deltoid muscle performing all three muscle functions in three different movements:

A
  1. prime mover of arm abduction when all fibers contract simultaneously
  2. antagonist of pectoralis major and latissimus dorsi which adduct the arm
  3. synergist of pectoralis major, which is the prime mover of arm flexion
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30
Q

Operation of most skeletal muscles involves the use of levers—these can change what?

A
  1. Direction of applied force
  2. Distance and speed of movement
  3. Effective in strength of applied force
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31
Q

rigid bar that moves on a fixed point; give example

A

lever; ex. bones

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32
Q

fixed point; give example

A

fulcrum; ex. joints

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33
Q

effort used to move a resistance; give example

A

applied force; ex. muscle contraction

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34
Q

the load; give example

A

resistance; ex. bone, tissue, etc.

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35
Q

Mechanical advantage—power lever; give example

A
  1. needs less work
  2. effort is farther than the load from the fulcrum
  3. resistance is close to the fulcrum
  4. applied force is applied far from the fulcrum
  5. slower, more stable, strength

small effort over long distance moves a large load over small distance; ex. jacking a car

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36
Q

Mechanical disadvantage—speed lever; give example

A
  1. more work
  2. effort (resistance) is nearer to the load than to the fulcrum
  3. applied force is far from the fulcrum
  4. the resistance is applied near the fulcrum
  5. good speed and range of motion

force exerted by muscle must be greater than the load moved or supported; ex. shoveling

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37
Q

List the 3 classes of levers:

A
  1. First class
  2. Second class
  3. Third class
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38
Q

Resistance – Fulcrum – Applied Force; which lever is this? Also give example.

A

first class lever; ex. scissors or seesaws

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39
Q

What is a mechanical advantage of a first class lever?

A

lifting a head off of a chest

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40
Q

What is a mechanical disadvantage of a first class lever?

A

triceps extending the forearm

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41
Q

Fulcrum – Resistance – Applied Force; which lever is this? Also give an example.

A

second class lever; ex. wheelbarrow, or standing on toes

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42
Q

List the 3 different aspects of second class levers:

A
  1. Lift the greatest weight with the least applied force–moves slowly and covers short distance
  2. uncommon in the body
  3. sacrifices speed and range of motion
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43
Q

Resistance – Applied Force – Fulcrum; which lever is this? Also give example.

A

third class lever; ex. forceps, tweezers biceps

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44
Q

List the 4 different aspects of third class levers:

A
  1. speed and distance increase
  2. always at mechanical disadvantage
  3. most common in the body
  4. these muscles tend to be thicker and more powerful
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45
Q

What are the 8 factors for naming skeletal muscles?

A
  1. Location of the muscle
  2. Shape of the muscle
  3. Position
  4. Relative size of the muscle
  5. Number of origins
  6. Location of attachments
  7. Direction of muscle fibers/fascicles
  8. Action of the muscle
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46
Q

location of the muscle ex.

A

fibularis, tibialis, sternocleidomastoid

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47
Q

shape of muscle ex.

A

deltoid, trapezius

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48
Q

position of muscle ex.

A

extremus or superficialis, interns, extrinsic (stabilise organ), intrinsic (within organ)

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49
Q

relative size of muscle ex.

A

maximus, minimus, longus, brevis

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50
Q

number of origins ex.

A

biceps, triceps, quadriceps

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51
Q

location of attachments ex. (origin is listed first and then insertion)

A

sternocleidomastoid

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52
Q

direction of muscle fibers/fascicles ex.

A

rectus, oblique, transverse

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53
Q

action of muscle ex.

A

flexor, extensor, adductor, abductor, etc.

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54
Q

List the 4 different effects of aging on the muscular system:

A
  1. skeletal muscle fibers become smaller in diameter because of a decrease in myofibrils, resulting in decreased function–fatigue rapidly
  2. muscles become less elastic as a result of fibrosis (increase of fibrous CT)
  3. lower tolerance for exercise resulting in difficulty with fatigue and thermoregulation
  4. muscle repair after injury decreases–fewer myoblasts and satellite cells
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55
Q

List the 4 disorders of the muscular system:

A
  1. Charley horse
  2. Calcaneal tendon rupture
  3. Shin splints
  4. Hernia
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56
Q

tearing of the muscle with bleeding into the tissue; severe, prolonged pain

A

Charley horse

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57
Q

plantar flexion not possible, dorsiflexion is exaggerated

A

Achilles (calcaneal) tendon rupture

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58
Q

irritation of the anterior compartment of the leg caused by irritation of the anterior tibialis muscle; may be used loosely to indicate stress fracture of the tibia, inflammation of fascia or muscle tears

A

Shin splints

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59
Q

organ protrudes through a muscle–more common in obese and elderly

A

hernia

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60
Q

Hernia results more easily in which two types of people?

A
  1. those whose lifestyles result in a lack of the use of the abdominal muscles
  2. those whose livelihood requires heavy lifting
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61
Q

List the 5 different types of hernias:

A
  1. inguinal hernia
  2. femoral hernia
  3. umbilical hernia
  4. hiatus hernia
  5. incisional hernia
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62
Q

80% of all hernias are of this type–these individuals have a defect which carries the spermatic cord from the scrotum or the round ligament of the uterus to the labia majora

A

inguinal hernia

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63
Q

this type of hernia occurs when there is an enlargment of the ring that normally passes the blood vessels to and from the thigh

A

femoral hernia

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64
Q

type type of hernia is more common in infants

A

umbilical hernia

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65
Q

in this type of hernia there is a protrusion of the stomach into the thoracic cavity as a reult of a weakness in the opening passing the esophagus through the diaphragm

A

hiatus hernia

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66
Q

this type of hernia is due to surgery–there is a weakness at the cut site and the viscera will protrude—additional surgery will be required

A

incisional hernia

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67
Q

List the 5 functions of neural tissue:

A
  1. Control and communication
  2. Control homeostasis
  3. Monitor
  4. Integration
  5. Motor output
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68
Q

changes in stimuli and information–sensory input

A

monitor

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69
Q

evaluate sensory input and fashion a response

A

integration

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70
Q

respond to stimuli via an effector organ

A

motor output

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71
Q

What are the two parts of the nervous system?

A
  1. Central nervous system (CNS)

2. Peripheral nervous system (PNS)

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72
Q

brain & spinal cord

A

central nervous system

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73
Q

List the two aspects of the central nervous system:

A
  1. Responsible for integration

2. Responses may be based on reflexes, experience, or current conditions

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74
Q

spinal and cranial nerves

A

peripheral nervous system

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75
Q

The peripheral nervous system is responsible for what?

A

monitoring & motor output

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76
Q

What are the two different parts of the peripheral nervous system?

A
  1. Afferent system

2. Efferent system

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77
Q

sensory information from receptors to the CNS

A

afferent system

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78
Q

motor information from the CNS to effector organs (muscles, glands, etc.)

A

efferent system

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79
Q

What are the two parts of the efferent system?

A
  1. Somatic nervous system

2. Autonomic nervous system

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80
Q

supplies voluntary information to skin and skeletal muscles, any automatic action like reflexes

A

somatic nervous system (somatic motor division)

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81
Q

supplies involuntary information to smooth muscles, heart, and glands

A

autonomic nervous system (visceral motor division)

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82
Q

List the 2 parts of the autonomic nervous system (ANS):

A
  1. Sympathetic

2. Parasympathetic

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83
Q

causes changes in response to stress

A

sympathetic

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84
Q

maintains normal functions

A

parasympathetic

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85
Q

structural and functional unit of the nervous system

A

neuron

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86
Q

List the 4 aspects of neurons:

A
  1. extreme longevity–100 years
  2. high metabolic rate–high oxygen and glucose usage
  3. contains no structures associated with cell division, stem cells still active in the nose (olfactory) and hippocampus (memory storage)
  4. mitosis ceases between 6 months and 4 years
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87
Q

List the 10 parts of the neuron:

A
  1. dendrites
  2. axon
  3. neurofibrils
  4. nissl bodies
  5. myelin sheath
  6. nodes of ranvier
  7. neurolemma (sheath of Schwann)
  8. cell body
  9. golgi apparatus
  10. plasma membrane
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88
Q

branch-like extensions of the cytoplasm each with spines forming 80-90% of neuron total surface

A

dendrites

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89
Q

What are the 3 aspects of dendrites?

A
  1. carry impulses toward the cell body
  2. their distal ends form receptors
  3. dendrite length will vary from micro to over 3 feet
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90
Q

single, long process

A

axon

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91
Q

What are the 4 aspects of axons?

A
  1. carries impulse away from the cell
  2. terminates with with branches called teliodendria at the synaptic terminal
    3 may have side branches called collaterals
  3. axon length will vary from micro to 3 feet
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92
Q

cytoplasm of the axon

A

axoplasm

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93
Q

special portion of the axon cell membrane

A

axolemma

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94
Q

provide internal support

A

neurofibrils

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95
Q

List one aspect of neurofibrils:

A

they spread nutrients and depolarisation waves through the cell

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96
Q

most active and well-developed rough endoplasmic reticulum in the body; protein synthesis–gives gray colour to gray matter

A

nissl bodies

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97
Q

a segmented, whitish, phospholipid covering that will act to insulate the fiber and spread the condution of nerve impulses

A

myelin sheath

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98
Q

What is the myelin sheath formed by in the peripheral nervous system (PNS)?

A

Schwann cell

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99
Q

What is the myelin sheath formed by in the central nervous system (CNS)?

A

oligodendrocytes

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100
Q

large areas of axon that are myelinated

A

internodes

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101
Q

unmyelinated gaps in the myelin sheath from which axon collaterals can emerge

A

nodes of ranvier

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102
Q

thin living nucleated membrane around the fiber or its myelin sheath of the PNS

A

neurolemma (Sheath of Schwann)

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103
Q

List the 3 aspects of the neurolemma (Sheath of Schwann):

A
  1. brain and spinal cord do not have a neurolemma
  2. essential along with a cell body for regeneration of a nerve fiber
  3. is formed by the Schwann cell
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104
Q

biosynthetic center

A

cell body (perikaryon, soma)

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105
Q

well developed in the neuron

A

Golgi apparatus

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106
Q

3 structural components of the neuron:

A
  1. dendrite
  2. axon
  3. axonal terminal
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107
Q

receptive or input region of a neuron

A

dendrite

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108
Q

conducting component of a neuron

A

axon

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109
Q

secretory or output component of a neuron

A

axonal terminal

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110
Q

clusters of cell bodies in the CNS are called:

A

nuclei

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111
Q

clusters of cell bodies that lie along the nerves in the PNS are called:

A

ganglia

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112
Q

functional connection between neuron and cell

A

synapse

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113
Q

List 2 aspects of synapses:

A
  1. must have neurotransmitter–acetylcholine, norepinephrine, serotonin, dopamine, etc.
  2. if the neurotransmitter substance remains in contact with the postsynaptic neuron, the impulse will continue indefinitely; to stop the impulse an enzyme is necessary
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114
Q

neuron conducting impulses toward the synapse; information sender

A

presynaptic neuron

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115
Q

neuron that transmits the electrical signal away from the synapse; information receiver

A

postsynaptic neuron

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116
Q

where neurotransmitters are released

A

presynaptic membrane

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117
Q

these have receptors for the neurotransmitters

A

postsynaptic membrane

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118
Q

Explain neuron functions:

A

In the body periphery, postsynaptic cells may be either neuron or effector cell (muscle, gland)

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119
Q

List 3 aspects of neuron functions:

A
  1. neuromuscular junction
  2. neuroglandular junction
  3. synaptic knob
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120
Q

nerve to muscle junction

A

neuromuscular junction

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121
Q

neuron to gland junction

A

neuroglandular junction

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122
Q

postsynaptic cell is another neuron

A

synaptic knob

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123
Q

movement of materials between synaptic knobs and the cell body

A

axoplasmic transport

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124
Q

movement from cell body to synaptic knobs

A

anterograde flow

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125
Q

movement from synaptic knob to cell body

A

retrograde flow

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126
Q

Give an example of retrograde flow:

A

rabies enters nerve cells by way of retrograde actions

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127
Q

List the 4 structural classifications of neurons:

A
  1. multipolar
  2. bipolar
  3. unipolar or pseudounipolar
  4. anaxonic
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128
Q

What are the 3 aspects of multipolar neurons?

A
  1. they consist of one axon and several dendrites
  2. they are found in the brain and spinal cord
  3. they are the most common type in humans and a major type in the CNS and in skeletal muscle
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129
Q

What are the 2 aspects of bipolar neurons?

A
  1. they have one axon, one dendrite, and a cell body between

2. they are rare: found in the retina, inner ear, and olfactory area

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130
Q

What are the 3 aspects of unipolar neurons?

A
  1. axon and dendrite are continuous, cell body to one side
  2. sensory neurons of the PNS
  3. some of the longest are from the toes to the spinal cord
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131
Q

What are the 2 aspects of anaxonic neurons?

A
  1. small and no anatomical clues to distinguish dendrites from axons
  2. located in the brain and special sense organs
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132
Q

List the 3 functional classifications of neurons:

A
  1. Sensory (Afferent)
  2. Motor (Efferent)
  3. Association Neurons (connector, interneurons)
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133
Q

What are the 3 aspects of sensory neurons?

A
  1. carry information from receptors to the spinal cord and brain
  2. unipolar with processes called afferent fibers
  3. cell bodies in the sensory ganglia outside CNS
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134
Q

What are the sensory receptor categories?

A
  1. exteroreceptors
  2. proprioceptors
  3. interoceptors
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135
Q

external environment receptors

A

exteroceptors

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136
Q

body position and movement receptors

A

proprioceptors

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137
Q

internal organ system receptors–taste, deep pressure, pain

A

interoceptors

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138
Q

List the 3 aspects of motor neurons:

A
  1. carry impulses from the brain and spinal cord to effector organs
  2. multipolar and axons have efferent fibers
  3. most cell bodies are in the CNS
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139
Q

What are the 4 aspects of association neurons?

A
  1. conduct impulses from sensory to motor neurons
  2. most are multipolar, ex. Purkinje & pyramidal cells
  3. found only in the brain and spinal cord–memory, learning, and planning
  4. outnumber all other types combined
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140
Q

small and more numerous than neurons; branching processes and a cell body

A

neuroglia (glial cells)

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141
Q

List the functions of neuroglia:

A
  1. supports the neurons and anchors them to blood vessels
  2. protection or defense through phagocytosis
  3. plays a part in the formation of the myelin sheath in the CNS
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142
Q

What are the neuroglia of the central nervous system?

A
  1. astrocytes
  2. microglia
  3. oligodendrocytes
  4. ependymal cells
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143
Q

List the aspects of astrocytes:

A
  1. most abundant and most versatile
  2. star shaped cells; many processes
  3. provide structural framework for neurons in the CNS
  4. can assist in repair of injury by stabilising the tissue and preventing further injury
  5. direct neuron development in the embryonic brain
  6. astrocyte end feet provide signals that stimulate endothelial cells of the brain capillaries to form tight junctions to maintain the blood-brain barrier
  7. controls chemical environment around neurons–absorb and recycle excess neurotransmitters; regulate concentration of Na+, K+, and CO2.
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144
Q

List the aspects of microglia:

A
  1. smallest and least numerous
  2. migrate through neural tissue, many fine processes
  3. move around and carry on phagocytosis–important because cells of the immune system are denied access to the CNS
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145
Q

List the aspects of oligodendrocytes:

A
  1. fewer and shorter processes than astrocytes
  2. support and connect neurons to blood vessels
  3. function in formation of the myelin sheath around axons of neurons of the CNS (white matter because of lipids)
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146
Q

List the aspects of ependymal cells:

A
  1. single layer of epithelial cells, may be ciliated
  2. form the continuous lining of the ventricles of the brain and central canal of the spinal cord, filled with CSF
  3. cilia may contribute to the circulation of CSF
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147
Q

What are the neuroglia cells of the peripheral nervous system?

A
  1. Schwann cells

2. satellite cells

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148
Q

List the aspects of Schwann cells:

A
  1. they are also called neurilemmal cells
  2. they form a sheath around every peripheral axon, myelinated or not
  3. peripheral nerve fibers regeneration
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149
Q

List the aspects of satellite cells:

A
  1. also called amphicytes
  2. surround cell bodies in ganglia
  3. work like astrocytes
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150
Q

If damage is severe or near the cell body of a neuron:

A

the entire neuron may die and other neurons stimulated by that axon may die

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151
Q

if cell body of a neuron remains intact, cut, or compressed:

A

axons on peripheral nerves can regenerate

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152
Q

the greater the distance between the severed nerve ending:

A

the less likely regeneration will occur

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153
Q

List the steps of neural repais in the peripheral nervous system:

A
  1. Wallerian degeneration spreads distally from the site until the axon is fragmented
  2. Macrophages move to the injury site and phagocytise debris
  3. Neurolemma remains intact within the endoneurium
  4. Neuron cell body undergoes changes in response to axonal injury by dispersing genetic material to the cell periphery, where it can direct synthesis of proteins to support regeneration
  5. Macrophages release chemicals that cause Schwann cells to proliferate and move to injury site
  6. Schwann cells then release growth factor to encourage axon growth forming a regeneration tube; then remyelinating the regeneration tube
154
Q

within a few hours of injury, the axon and myelin sheath distal to the injury start to disintegrate from lack of nutrients

A

Wallerian degeneration

155
Q

Neural changes are produced by:

A
  1. anything that changes membrane permeability to any type of ion
  2. anything that alters ion concentration on the two sides of the membrane
156
Q

Two types of signals are produced by change in membrane potential:

A
  1. graded potentials

2. action potentials

157
Q

temporary localised change, decrease in strength over distance

A

graded potentials

158
Q

signal over long distance and brief reversal of membrane potential: only axons can generate these

A

action potential

159
Q

electric potential across a nerve fiber membrane resulting from concentration differences of certain ions between the two sides of the membrane (Na+, K+, and protein ions), passive (gradients) and active (sodium-potassium pump) forces act across membrane

A

transmembrane potential

160
Q

when the membrane is positively charged on the outside and negatively charged on the inside; cell is polarised

A

resting membrane potential

161
Q

List the 3 aspects of resting membrane potential:

A
  1. Na+ concentration is greater outside the resting fiber than inside
  2. K+ concentration is greater inside the resting fiber than outside
  3. Sodium-potassium pump transports 3 Na+ out of the cell for every 2 K+ into the cell—ATP driven
162
Q

no energy required to move ions

A

passive forces

163
Q

concentration gradient; sodium and potassium

A

chemical gradients

164
Q

results from differences in speed of movement of Na+ and K+ ions and polarity; can reinforce or oppose chemical gradient (positive is attracted to negative so K+ slowly leaves and Na+ wants to come in more)

A

electrical gradient

165
Q

sum of the chemical and electrical gradients acting on an ion across the cell membrane

A

electrochemical gradient

166
Q

requires energy

A

active forces

167
Q

List the 2 aspects of active forces:

A
  1. sodium-potassium pump requires ATP to work
  2. DDT and other chlorinated hydrocarbons (pesticides) interfere with the sodium-potassium pump so it can effect nerve impulses, and helps to cause deaths
168
Q

List the 2 membrane channels:

A
  1. (Passive) leak channels

2. (Active) gated channels

169
Q

always open but can change permeability from moment to moment

A

leak channels

170
Q

open and close in response to a stimuli

A

gated channels

171
Q

changes relative to resting membrane potential–spreads in a wave or nerve impulse or action potential

A

depolarisation

172
Q

What are the 3 graded potentials?

A
  1. depolarisation
  2. repolarisation
  3. hyperpolarisation
173
Q

inside of the membrane becomes less negative resulting in a decrease in membrane potential; influx of Na+; local current, can’t go very far

A

depolarisation

174
Q

restoration of resting membrane potential, but not in the original ionic distributions (sodium-potassium pump restores original distribution), starts at the same point in the fiber where depolarisation began

A

repolarisation

175
Q

inside of membrane becomes more negative resulting in an increase in membrane potential

A

hyperpolarisation

176
Q

A neuron receives info via graded potential at the dendrites and cell body but is unable to transmit info for long distances so:

A

an action potential links graded potential to the synaptic terminals which in turn causes a graded potential in the presynaptic membrane which may trigger release of a neurotransmitter

177
Q

changes in the membrane potential that affect an entire excitable membrane

A

action potentials

178
Q

What is an aspect of action potentials?

A

Not all local depolarisations produce action potentials. The depolarisation must reach threshold values.

179
Q

minimal stimulus strong enough to decrease the receptor potential and initiate an impulse

A

threshold stimulus

180
Q

any stimulus not capable of initiating an impulse unless a second or several stimuli are applied quickly to a neuron, at which time these additional stimuli are summed

A

subthreshold stimulus

181
Q

a stimulus is either strong enough to trigger an action potential or does not produce one at all

A

all-or-none law

182
Q

Period from opening of activation gates of Na+ channels to the closing of the inactivation gates; membrane can’t respond to further stimulus ensuring each action potential is separate; ensures one way propagation of the action potential

A

absolute refractory period

183
Q

Na+ gates closed and K+ gates open; return to resting state (repolarisation)

A

relative refractory period

184
Q

What are the 2 aspects of propagation of action potentials?

A
  1. continuous

2. saltatory

185
Q

action potential moves across the membrane in small steps; unmyelinated fiber, always away from the site of generation

A

continuous

186
Q

myelinated fiber; myelin sheath acts as an insulator and the action potential jumps from node to node, faster and takes less energy

A

saltatory

187
Q

rate of impulse propagation depends on:

A
  1. axon diameter

2. degree of myelination

188
Q

List the 3 axon diameters:

A
  1. Type A fibers
  2. Type B fibers
  3. Type C fibers
189
Q

What are the 5 aspects of Type A fibers?

A
  1. largest
  2. all myelinated
  3. carry sensory information to the CNS concerning position balance, and fine touch and pressure sensations from the skin surface
  4. carry commands from motor neurons to skeletal muscles
  5. 300 mph
190
Q

What are the 5 aspects of Type B fibers?

A
  1. mid-sized
  2. all myelinated
  3. carry less urgent information such as pain, temperature, general touch, and pressure sensations to the CNS
  4. carry motor commands to smooth muscle, cardiac muscle, glands, and periphery effectors
  5. 40 mph
191
Q

What are the 5 aspects of Type C fibers?

A
  1. smallest in diameter
  2. unmyelinated
  3. carry less urgent information as type B
  4. incapable of saltatory propagation
  5. 2 mph
192
Q

List the 3 aspects of degree of myelination:

A
  1. myelin sheath decreases time between reception of stimulus and response
  2. myelination is not complete until adolescence
  3. myelination improves coordination and control
193
Q

The two types of synapses:

A
  1. electrical

2. chemical

194
Q

List the 3 aspects of electrical synapses:

A
  1. rare, in the CNS and PNS
  2. presynaptic and postsynaptic membranes held together at gap junctions
  3. action potentials move rapidly from cell to cell
195
Q

specialised for release and reception of chemical neurotransmitters

A

chemical synapses

196
Q

in presynaptic neuron, contains synaptic vesicles containing neurotransmitters

A

axonal terminal

197
Q

on the membrane of a dendrite or cell body of a postsynaptic neuron that has neurotransmitter receptors

A

receptor region

198
Q

What are the 2 parts of a chemical synapse and what is between them?

A
  1. axonal terminal
  2. receptor region

synaptic cleft

199
Q

these result in depolarisation and propagation of an action potential

A

excitatory neurotransmitter

200
Q

these result in hyperpolarisation and suppress propagation of action potential

A

inhibitory neurotransmitter

201
Q

release acetylcholine

A

cholinergic synapse

202
Q

Other neurotransmitters:

A
  1. norepinephrine
  2. dopamine
  3. serotonin
  4. gammaaminobutyric acid
203
Q

brain and ANS; usually excitatory effects

A

norepinephrine

204
Q

brain; may be either excitatory or inhibitory; regulates motor function; Parkinson’s

A

dopamine

205
Q

CNS; role in emotional behaviour; low levels may contribute to chronic depression

A

serotonin

206
Q

generally inhibitory effect; may reduce anxiety

A

GABA (gammaaminobutyric acid)

207
Q

regulate the rate of neurotransmitter release by the presynaptic neuron or alter the response by the postsynaptic cells to the neurotransmitter; neuropeptides

A

neuromodulators

208
Q

natural opiates

A

endorphins

209
Q

neurotransmitter and neuromodulator functions:

A
  1. direct effect
  2. indirect effect
  3. lipid-soluble gases
210
Q

gated channels; acetylcholine

A

direct effect

211
Q

G proteins serve as a link between the first messenger and second messenger

A

indirect effect

212
Q

CO and NO; bind to enzymes on the inside of the cell which then form second messengers that affect cellular activity

A

lipid-soluble gases

213
Q

graded potentials in postsynaptic membranes in response to a neurotransmitter; may be excitatory (EPSP) or inhibitory (IPSP)

A

postsynaptic potentials

214
Q

neurotransmitter binding causes graded depolarisation of the postsynaptic membrane which may trigger an action potential at the axon hillock; opening of chemically regulated gates

A

excitatory postsynaptic potential (EPSP)

215
Q

neurotransmitter binding causes graded hyperpolarisation of the postsynaptic membrane; reduces ability to propagate an action potential

A

inhibitory postsynaptic potential (IPSP)

216
Q

a single EPSP or TPSP may not initiate an action potential, combining them may initiate the action potential

A

summation

217
Q

rapidly reoccurring stimuli at a single synapse

A

temporal summation

218
Q

simultaneous stimuli at multiple synapses

A

spatial summation

219
Q

a neuron close to reaching threshold; it will be easier for the next stimulus to initiate the action potential

A

facilitation

220
Q

Give an example of facilitation:

A

caffeine and other chemicals cause this; it lowers the threshold so you become jumpy because your reflexes are primed

221
Q

6 neural conditions:

A
  1. demyelination
  2. rabies
  3. tay-sachs disease
  4. hyperkalemia
  5. tumors
  6. neurotoxins
222
Q

progressive destruction of myelin sheaths in both CNS and PNS, result in loss of sensation and motor control, many diseases may cause this

A

demyelination

223
Q

retrograde flow carries the virus from bitten/infected tissues to the cell bodies, results in cell death and once many are lost animal dies

A

rabies

224
Q

genetic abnormality involving metabolism of gangliosides, gradual deterioration of neurons because of by-product build up

A

tay-sachs disease

225
Q

abnormally high extracellular concentration of K+

A

hyperkalemia

226
Q

result from division of abnormal neuroglia

A

tumors

227
Q

compound that disrupts normal nerve functions

A

neurotoxins

228
Q

Example of neurotoxins:

A

TTX tetrodotoxin, some snake, spider, scorpion, mammale (rare) venoms

229
Q

Peripheral nervous system terms:

A
  1. ganglia
  2. nerves
  3. spinal nerves
  4. cranial nerves
230
Q

collection of neuron cell bodies in the PNS

A

ganglia

231
Q

bundles of axons, usually myelinated

A

nerves

232
Q

connected to the spinal cord

A

spinal nerves

233
Q

connected to the brain

A

cranial nerves

234
Q

Central nervous system terms:

A
  1. center
  2. nucleus
  3. neural cortex
  4. higher centers
  5. tracts
  6. columns
  7. sensory (ascending) pathway
  8. motor pathway
  9. horns
  10. gray matter
  11. white matter
235
Q

collection of neuron cell bodies in the CNS with common function

A

center

236
Q

collection of neuron cell bodies in the interior of the CNS

A

nucleus

237
Q

outer surface of the brain composed of gray matter

A

neural cortex

238
Q

complex centers of the brain

A

higher centers

239
Q

bundles of axons in the CNS, usually myelinated

A

tracts

240
Q

large bundles of axons in the spinal cord that are divided into tracts

A

columns

241
Q

carry information from peripheral receptors to the brain

A

sensory (ascending) pathway

242
Q

CNS to effectors

A

motor pathway

243
Q

masses of neuron cell bodies located in the gray matter of the spinal cord

A

horns

244
Q

mainly neuron cell bodies and dendrites or bundles of unmyelinated axons and neuroglia

A

gray matter

245
Q

myelinated nerve bundles

A

white matter

246
Q

Spinal cord continues to grow to enlarge and elongate with the spinal column until:

A

age 4

247
Q

The quantity of gray matter increases in areas involved with:

A

sensory and motor control of limbs

248
Q

from C4 to T1 and supplies nerves to the shoulder girdle and upper limbs

A

cervical enlargement

249
Q

from T9 to T12 and supplies nerves to the pelvis and lower limbs

A

lumbar enlargement

250
Q

below lumbar enlargement, spinal cord tapers into a conical portion

A

conus medullaris

251
Q

nerve roots at the inferior end of the vertebral column arising from the conus medullaris

A

cauda equina

252
Q

fibrous extension of the pia mater that anchors the spinal cord in place

A

filum terminale

253
Q

deep, wide groove on the anterior surface

A

anterior median fissure

254
Q

shallower, narrow groove on the posterior surface

A

posterior median sulcus

255
Q

31 pairs; contain both sensory and motor fibers, mixed nerves

A

spinal nerves

256
Q

contains cell bodies of sensory neurons

A

dorsal root ganglia

257
Q

contains axons of sensory neurons

A

dorsal root

258
Q

axons of motor neurons

A

ventral root

259
Q

collective term for the 3 membranes that cover the brain and spinal cord

A

meninges

260
Q

Spinal meninges:

A
  1. pia mater
  2. arachnoid mater
  3. dura mater
  4. epidural space
  5. subdural space
  6. subarachnoid space
  7. denticulate ligaments
261
Q

tender mother, inner vascular, carries blood to brain and spinal cord

A

pia mater

262
Q

spider form, middle layer, web like and thin enclosing the subarachnoid space

A

arachnoid mater

263
Q

hard mother, outer, tough layer, major protective layer; anchors spinal cord at the foramen magnum and coccygeal ligament, prevents longitudinal movement of spinal cord

A

dura mater

264
Q

loose CT, adipose, blood vessels; fuses to periosteum of occipital bone at the foramen magnum and becomes continuous with the cranial dura mater; blends with filum terminale to become coccygeal ligament

A

epidural space

265
Q

below the dura mater

A

subdural space

266
Q

filled with CSF

A

subarachnoid space

267
Q

extends from pia mater through arachnoid mater and attaches at the dura mater; prevent lateral movement of spinal cord

A

denticulate ligaments

268
Q

unmyelinated nerve fibers, in the inside of the spinal cord

A

grey matter

269
Q

List the parts of grey matter:

A
  1. posterior gray horn
  2. anterior gray horn
  3. lateral gray horn
  4. gray commissure
270
Q

contain somatic and visceral sensory nuclei

A

posterior gray horn

271
Q

contain somatic motor nuclei

A

anterior gray horn

272
Q

contains visceral motor nuclei; located in thoracic and lumbar segments

A

lateral gray horn

273
Q

contains axons that cross over

A

gray commissure

274
Q

myelinated nerve fibers, outside of spinal cord

A

white matter

275
Q

List the parts of white matter:

A
  1. posterior white column
  2. anterior white column
  3. lateral white column
  4. white commissure
  5. posterior median sulcus
  6. anterior median fissure
276
Q

sensory tracts

A

ascending tracts

277
Q

motor tracts

A

descending tracts

278
Q

List the parts of the ascending tracts:

A
  1. lateral spinothalamic tract
  2. ventral spinothalamic tract
  3. dorsal and ventral spinothalamic tract
  4. gracilis and cuneate tracts
279
Q

pain and temperature

A

lateral spinothalamic tract

280
Q

crude touch

A

ventral spinothalamic tract

281
Q

unconscious muscle sense for controlling muscle tone and posture

A

dorsal and ventral spinothalamic tract

282
Q

touch, pressure, two-point discrimination, conscious muscle sense concerned with appreciation of body position. The impulses come from the skin, muscles, tendons, and joints.

A

gracilis and cuneate tracts

283
Q

List the parts of the descending tracts:

A
  1. lateral and ventral corticospinal tracts
  2. rubrospinal tract
  3. reticulaspinal tract
  4. vestibulospinal tract
284
Q

carry voluntary impulses to the skeletal muscles

A

lateral and ventral corticospinal tracts

285
Q

carries involuntary impulses to skeletal muscles concerned with tone and posture

A

rubrospinal tract

286
Q

increases skeletal muscle tone and motor neuron activity

A

reticulaspinal tract

287
Q

regulates muscle tone to maintain balance and equilibrium

A

vestibulospinal tract

288
Q

a clear, colourless protective fluid in the subarachnoid space of the brain and spinal cord

A

cerebrospinal fluid

289
Q

List the aspects of cerebrospinal fluid:

A
  1. the composition is similar to blood plasma–water, proteins, glucose, urea, lactic acid, cations (Na+, K+, Ca+, Mg+), anions (Cl-, HCO3-), and some lymphocytes
  2. Volume: 80 to 150 ml
  3. pH: 7.35-7.4
290
Q

List the functions of cerebrospinal fluid:

A
  1. Mechanical protection–the fluid serves as a shock-absorbing medium to protect the brain and spinal cord from hitting against the cranial and vertebra cavities
  2. Chemical protection–provides an optimal chemical environment for accurate neuronal signaling. Even slight changes in ionic composition of CSF within the brain could disrupt action potentials
  3. Circulation–the fluid delivers nutritive substances filtered from the blood to the brain and spinal cord, and removes wastes and toxic substances produced by brain and spinal cells
291
Q

Lumbar puncture or spinal tap:

A
  1. Fluid is removed from between the 3rd and 4th lumbar vertebrae or between the 4th and 5th lumbar vertebrae. A lumbar puncture is made at this point because it is below the spinal cord and thus poses little danger to it. In addition, the subarachnoid space is slightly larger at this point.
  2. Lumbar punctures are used to withdraw fluid for diagnostic purposes, to introduce antibiotics and contrast media, or to introduce an anesthetic to create spinal anesthesia, to administer chemotherapy, or to measure CSF pressure
  3. A line drawn across the highest points of the iliac crests passes through the spinous process of the 4th lumbar vertebra
292
Q

Spinal nerves terms:

A
  1. epineurium
  2. perineurium
  3. endoneurium
  4. fascicle
293
Q

outer layer, dense CT

A

epineurium

294
Q

middle layer, encloses a fascicle

A

perineurium

295
Q

surround an axon

A

endoneurium

296
Q

bundle of axons, 31 pairs

A

fascicle

297
Q

How many cervical spinal nerve bundles are there?

A

8

298
Q

How many thoracic spinal nerve bundles are there?

A

12

299
Q

How many lumbar spinal nerve bundles are there?

A

5

300
Q

How many sacral spinal nerve bundles are there?

A

5

301
Q

How many coccygeal spinal nerve bundles are there?

A

1

302
Q

Each spinal nerve connects to the spinal cord by two roots:

A
  1. dorsal root

2. ventral root

303
Q

sensory or afferent; arise from sensory neurons in the spinal ganglia that conduct impulses from peripherally located receptors

A

dorsal root

304
Q

motor or efferent; arise from anterior horn motor neurons that extend to the skeletal muscles

A

ventral root

305
Q

The motor and sensory fibers mingle together in the spinal nerve. The spinal nerves are short because:

A

almost immediately after leaving the foramen they branch into small dorsal rami or larger ventral rami

306
Q

supply the posterior body trunk

A

dorsal rami

307
Q

supply the rest of the body trunk and limbs

A

ventral rami

308
Q

Roots:

A

lie medial to and form the spinal nerves; each root is strictly motor or sensory

309
Q

Rami:

A

lie distal to and are lateral branches of the spinal nerve and carry both sensory and motor fibers

310
Q

each region of the skin is served by a single pair of spinal nerves, parts that “fall asleep” have nerves that are pinched or compressed and the nerve loses contact with that area. Except for T2-T12, all ventral rami join one another lateral to the vertebral column in nerve plexuses or groups.

A

dermatomes

311
Q

What are the aspects of the cervical plexus?

A
  1. Cervical nerves (C1-C5) combine to form the cervical plexus lying in the upper part of the neck under the sternocleidomastoid muscle
  2. Nerves from the plexus pass to the muscles and skin of the scalp and neck, and to the diaphragm by way of the phrenic nerve, controls breathing and is the most important nerve here.
  3. A broken neck may result in respiratory paralysis through injury to the phrenic nerve.
  4. Hiccups result from irritation of this nerve and if severed must be put on mechanical respirator.
  5. Contains ventral rami only.
312
Q

What are the aspects of the brachial plexus?

A
  1. The anterior roots of spinal nerves from the lower cervical and upper thoracic (C6-T1) combine to form this plexus, which lies in the anterior base of the neck just superior to the clavicle.
  2. It sends nerves to the skin and muscles of the upper appendages.
  3. The nerves are superficial at the axilla so injury may result in paralysis.
  4. There are five major nerves that exit from this plexus.
313
Q

What are the 5 major nerves that exit the brachial plexus?

A
  1. Axillary nerve
  2. Musculocutaneous nerve
  3. Median nerve
  4. Ulnar nerve
  5. Radial nerve
314
Q

supplies shoulder joint and deltoid

A

axillary nerve

315
Q

supplies structures of the anterior upper arm

A

musculocutaneous nerve

316
Q

supplies anterior forearm, injury makes it hard to use the pincer grasp; wrist slashing

A

median nerve

317
Q

supplies anterior forearm, injury prevents ability to make a fist or grip; stimulates the “funny bone”

A

ulnar nerve

318
Q

supplies the posterior upper arm, forearm, and hand; injury causes wrist drop, may be caused by improper use of crutch

A

radial nerve

319
Q

What are the aspects of the lumbar plexus?

A
  1. Lumbar nerves (L1-L4) combine to form the lumbar plexus lying within the posterior part of the psoas muscle.
  2. Three main nerves exit from the plexus.
320
Q

What are the 3 major nerves that exit the lumbar plexus?

A
  1. Femoral nerve
  2. Lateral cutaneous nerve
  3. Obturator nerve
321
Q

supplies the skin and muscles of the anterior thigh

A

femoral nerve

322
Q

supplies the skin and muscle of the upper lateral thigh

A

lateral cutaneous nerve

323
Q

supplies the skin and muscles of the medial thigh

A

obturator nerve

324
Q

What are the aspects of the sacral plexus?

A
  1. The lower lumbar and upper sacral (L4-S4) combine to form the sacral plexus lying in the middle portion of the greater (false) pelvis.
  2. The major nerve of the sacral plexus is the sciatic nerve. There are 3 important branches of the sciatic nerve.
325
Q

What are the 3 important branches of the sciatic nerve in the sacral plexus?

A
  1. hamstring nerve
  2. tibial nerve
  3. common peroneal nerve
326
Q

rises from the sciatic nerve in the thigh and supplies the skin and muscles of the posterior thigh. This nerve is a part of the tibial nerve.

A

hamstring nerve

327
Q

rises from the sciatic nerve just above the knee and supplies the skin and muscles of the knee joint and posterior leg

A

tibial nerve

328
Q

also rises just above the knee. It continues down the leg, giving branches that supply the skin and muscles of the knee, anterior and lateral leg, and foot

A

common peroneal nerve

329
Q

What are the aspects of intercostal nerves?

A
  1. Not arranged in plexus.
  2. Arise from the thorax (T2-T11) and form the intercostal nerves supplying the intercostal muscles and abdominal muscles
330
Q

Nerve fibers crisscross and redistribute so:

A
  1. each branch contains fibers from different spinal nerves
  2. each muscle receives nerve supply from more than one spinal nerve

Damage to one spinal segment or limb cannot paralyse an entire limb

331
Q

functional groups of neurons that integrate incoming information received from other sources and then forward the processed information to other destinations–connection neurons

A

neuronal pools

332
Q

patterns of synaptic connections in neuronal pools, which determine functional capabilities of the pool

A

neural circuits

333
Q

What are the 5 aspects of neural circuits?

A
  1. Divergence
  2. Convergence
  3. Reverberation
  4. Serial processing
  5. Parallel
334
Q

one incoming fiber triggers responses in ever-increasing numbers of neurons farther and farther along the circuit

A

divergence

335
Q

What are the 2 aspects of divergence and an example?

A
  1. amplifying circuit
  2. common in sensory and motor systems

ex. eye sense–goes to conscious to process, also balance and posture sites

336
Q

a motor neuron can be controlled by both conscious and subconscious, breathing

A

convergence

337
Q

oscillating circuits; works like positive feedback mechanisms; maintains consciousness, coordination, and normal breathing

A

reverberation

338
Q

relay system passing on info

A

serial processing

339
Q

multiple neurons or pools process information at the same time allowing many responses to occur simultaneously; in response to pain–feel it, pull away, make response

A

parallel

340
Q

Reflex arcs:

A
  1. simplest functional unit of the nervous system
  2. reflex–quick involuntary response to a stimulus transmitted over a reflex arc
  3. negative feedback
  4. ex. respiration, urination, defecation, heart rate, digestion
341
Q

Parts of a reflex arc:

A
  1. receptor
  2. sensory (afferent) neuron
  3. center
  4. motor (efferent) neuron
  5. effector
342
Q

to detect a change

A

receptor

343
Q

to conduct the impulse from stimulation of the receptor to the CNS

A

sensory (afferent) neuron

344
Q

where a synapse is made between neurons. This will be within the CNS and may contain a connector neuron.

A

center

345
Q

to conduct an impulse to the organ of the body that will respond

A

motor (efferent) neuron

346
Q

an organ, either a muscle or gland, that does something to maintain homeostasis

A

effector

347
Q

Classification of reflexes:

A
  1. Development
  2. Processing site
  3. Response
  4. Complexity of circuit
  5. Control
348
Q

Development:

A
  1. Innate

2. Acquired

349
Q

Processing site:

A
  1. spinal

2. cranial

350
Q

Response:

A
  1. Somatic

2. Visceral

351
Q

voluntary control of muscle system, skin, tendons

A

somatic

352
Q

other systems autonomic reflexes

A

visceral

353
Q

Complexity of circuit:

A
  1. monsynaptic

2. polysynaptic

354
Q

sensory neuron synapses directly on a motor neuron

A

monsynaptic

355
Q

at least 1 interneuron between the sensory and motor, more delay

A

polysynaptic

356
Q

Control:

A
  1. ipsilateral

2. contralateral

357
Q

same side affected–left hand moves when left is stimulated

A

ipsilateral

358
Q

opposing sides–right hand moves when left is stimulated

A

contralateral

359
Q

Monosynaptic reflexes:

A

Intrafusal muscle fibers; stretch reflex

360
Q

What are the aspects of intrafusal muscle fibers?

A
  1. lack myofilaments
  2. noncontractile
  3. receptor surface of the spindle
  4. primary sensory endings
  5. secondary sensory endings
  6. innervated by gamma efferent fibers which maintain sensitivity of the spindle at the distal ends of intrafusal fibers
361
Q

stimulated by rate and amount of stretch

A

primary sensory endings

362
Q

monitor degree of stretch

A

secondary sensory endings

363
Q

Stretch reflex example:

A

knee jerk reflex (patellar reflex), some postural reflexes

364
Q

What are the aspects of stretch reflex?

A
  1. external stretch
  2. internal stretch
  3. stretch –> action potential down afferent –> spinal cord, stimulate interneurons –> afferent pathway down motor neuron to muscle fiber, ESPS, contraction
  4. the opposite muscle = interneurons send afferent pathway down motor neurons to antagonistic muscle, causes an ISPS on that muscle to lead to relaxation
  5. ipsilateral and monosynaptic (all stretch reflexes single synapse); reflex arcs that inhibit the antagonistic muscles are polysynaptic
  6. stretch reflex is necessary for normal muscle tone and activity but never acts alone; accompanied by gamma motor neuron reflex arc
  7. as muscle shortens, the spindle’s rate of firing declines –> reduces impulse generation by alpha motor neurons
365
Q

lengthening entire muscle–give example

A

external stretch; ex. carry heavy weight or antagonistic muscle contract

366
Q

stretching the middle of the muscle by activating gamma motor neurons

A

internal stretch

367
Q

List the polysynaptic reflexes:

A
  1. tendon reflex
  2. withdrawal reflex
  3. crossed extension reflex
  4. superficial reflex
368
Q

What are the aspects of the tendon reflex?

A
  1. has the opposite effect of the stretch reflex, muscle relaxes in response to stretching; protects the muscle from over-stretching and tearing tendons
  2. golgi tendon organs ensure smooth onset and termination of muscle contractions
369
Q

What are the aspects of withdrawal reflex?

A
  1. flexor reflex
  2. ex. moving hand off hot stove; pricking your finger
  3. response to painful stimuli, where stimulus causes automatic withdrawal
  4. polysynaptic and ipsilateral
370
Q

What are the aspects of crossed extension reflex?

A
  1. important in maintaining balance

2. combination of ipsilateral withdrawal and contralateral (opposite) extensor reflexes

371
Q

What are the aspects of superficial reflex?

A
  1. cutaneous stimulation
  2. plantar reflex
  3. plantar reflex is replaced by Babinski sign if the primary motor cortex or coricospinal tract is damaged
  4. abdominal reflex
372
Q

downward flexion of toes when sole is stroked

A

plantar reflex

373
Q

found in infants and abnormal in adults; with the same stimulation, the toes flare and move laterally; normal for infants because the nervous system is incompletely myelinated

A

Babinski’s sign

374
Q

light stroking of the abs will cause twitch

A

abdominal reflex

375
Q

Clinical conditions of the spine:

A
  1. ALS (amyotropic lateral sclerosis)
  2. Poliomyelitis
  3. Shingles/chicken pox/herpes
  4. Meningitis
  5. Epidural block
376
Q

Lou Gehrig’s Disease; progressive destruction of anterior horn and pyramidal tracts; results in loss of speech, swallowing, and breathing

A

amyotropic lateral sclerosis

377
Q

destruction of anterior horn motor neurons by virus, produces paralysis

A

poliomyelitis

378
Q

invades dorsal root of the spinal nerves, forming blister-like lesions on the skin along the dermatome; reactivated virus migrates along sensory nerve associated with the infected dorsal root ganglion

A

shingles/chicken pox/herpes

379
Q

inflammation of the meninges

A

meningitis

380
Q

meningitis affecting only the dura mater

A

pachymeningitis

381
Q

meningitis affecting the arachnoid and pia mater. This form is most common.

A

leptomeningitis

382
Q

affects the area immediately around the site of injection

A

epidural block

A&P I (6 decks)

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