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Head, Neck and Neurological Systems > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What types of neuroglia are found in the CNS?

A

Ependymal cells
Oligodendrocytes
Astrocytes
Microglia

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2
Q

What types of neuroglia are found in the PNS?

A

Satellite cells

Schwann cells

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3
Q

What cells are responsible for producing myelin sheaths in the CNS and PNS?

A

CNS - oligodendrocytes

PNS - Schwann cells

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4
Q

What is the function of microglia?

A

Macrophages

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5
Q

What could be the underlying problem in a patient with RHS hemiparesis sparing the leg and aphasia?

A

Lesion of the LHS of the brain caused by stroke affecting the left middle cerebral artery causing damage to Broca’s area

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6
Q

What part of the brain controls voluntary movement and what feature is it adjacent to?

A

Motor cortex

Central sulcus

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7
Q

What are the names of the 2 main speech areas in the brain and on which side are they located?

A

Broca’s and Wernicke’s areas

LHS

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8
Q

What nerve is affected in carpal tunnel syndrome?

A

Median nerve

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9
Q

What is a possible cause of sensory loss following a ‘stocking and glove’ distribution?

A

Vitamin B12 deficiency

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10
Q

Where do sympathetic preganglionic neurons originate from?

A

Thoracolumbar (T1-L3)

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11
Q

Where do parasympathetic preganglionic neurons originate from?

A

Brainstem (cranial nerves)

Sacral (S2-S4)

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12
Q

Where are sympathetic and parasympathetic ganglia located?

A

Sympathetic - in the sympathetic chain next to the vertebral column (far from target organ)
Parasympathetic - in the walls of the viscera which they innervate (close to target organ)

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13
Q

How is the spinal cord organised?

A

31 segments

8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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14
Q

What is the difference between passage of spinal nerves C1-7 and the rest?

A

C1-7 pass above their corresponding vertebrae

C8 onwards pass below

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15
Q

What is the upper limit of the spinal cord?

A

Junction with medulla oblongata

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16
Q

What is the lower limit of the spinal cord?

A

Newborn - L3/L4

Adult - L1/L2

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17
Q

What does the alar plate become after development?

A

Dorsal horn

Receives incoming sensory information

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18
Q

What does the alar plate become after development?

A

Ventral horn

Source of outgoing motor information

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19
Q

What are the types of spina bifida by increasing severity?

A

Occulta
Lipomeningocele
Meningocele
Myelomeningocele

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20
Q

What are the components of grey matter?

A

Dorsal horn
Intermediate horn
Ventral horn

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21
Q

What are the components of white matter?

A

Dorsal funiculus
Lateral funiculus
Ventral funiculus

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22
Q

In which spinal cord segments is the grey matter more predominant and why?

A

Cervical and lumbar

Innervation of limbs requires more fine sensory and motor innervation

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23
Q

In which spinal cord segments is the grey matter less predominant and why?

A

Thoracic and sacral

Innervation of large coarse muscle groups requires little sensory and motor innervation

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24
Q

Name the 3 layers of the meninges

A

Dura mater
Arachnoid mater
Pia mater

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25
Q

What are the main features of the dura mater?

A

Thick, inelastic membrane

Fuses with endosteum of cranium at foramen magnum

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26
Q

What separates the dura mater from the vertebrae?

A

Epidural space

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27
Q

What are the main features of the arachnoid mater?

A

Thin, fibrous membrane

Trabeculae formed across the arachnoid space

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28
Q

What is found within the arachnoid space?

A

Arachnoid trabeculae

CSF (140ml)

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29
Q

What is CSF and where is it formed and reabsorbed?

A

Filtrate of blood
Formed - choroid plexus of ventricular system (500ml/day)
Reabsorbed - venous drainage system of the head

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30
Q

What is the function of CSF?

A

Mechanical and immunological protection for the brain and spinal cord

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31
Q

What are the main features of the pia mater?

A

Unicellular membrane

Forms 21 lateral denticulate ligaments

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32
Q

What separates the pia mater from the spinal cord?

A

Very little

Subpial space

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33
Q

What venous system is found in the epidural space and what is it’s clinical significance?

A

Batson/vertebral venous plexus

Major route of cancer spread from deep pelvic regions

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34
Q

What is the blood supply to the thoracic spinal cord?

A

Aorta → intercostal arteries → anterior spinal artery and 2 posterior spinal arteries

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35
Q

What is the artery of Adamkiewicz and what is it’s clinical significance?

A

Arises from left posterior intercostal artery (70%) and supplies lower 1/3 of the spinal cord
Affected in anterior spinal artery syndrome - loss of continence and impaired leg function; complication of aortic aneurysm surgery

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36
Q

What is the tip of the end of the spinal cord called?

A

Conus medullaris

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37
Q

What are the loose strands at the end of the spinal cord called?

A

Cauda equina

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38
Q

What are filum terminale?

A

Filaments which anchor the end of the spinal cord in place

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39
Q

What is the lumbar cistern?

A

Site for epidural injections and lumbar puncture

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40
Q

How is an epidural injection performed?

A

L3/L4 or L4/L5 vertebral level

Needle pushed into the epidural space

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41
Q

How is a lumbar puncture performed?

A

L3/L4 or L4/L5 vertebral level

Needle pushed into spinal canal

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42
Q

What are lumbar punctures used for?

A

Withdraw CSF or measure pressure

Administer antibiotics or chemotherapy

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43
Q

In which area of the spinal cord does the sensory aspect of the pain pathway terminate?

A

Superficial dorsal horn

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44
Q

In which area of the spinal cord does the sensory aspect of the gentle touch pathway terminate?

A

Deep dorsal horn

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45
Q

What is the diameter, speed and sensory receptor associated with Aα axons?

A

Diameter - 13-20 μm
Speed - 80-120 m/sec
Receptor - skeletal muscle proprioceptors

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46
Q

What is the diameter, speed and sensory receptor associated with Aβ axons?

A

Diameter - 6-12 μm
Speed - 35-75 m/sec
Receptor - skin mechanoreceptors

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47
Q

What is the diameter, speed and sensory receptor associated with Aδ axons?

A

Diameter - 1-5 μm
Speed - 5-30 m/sec
Receptor - pain, temperature

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48
Q

What is the diameter, speed and sensory receptor associated with C axons?

A

Diameter - 0.2-1/5 μm
Speed - 0.5-2 m/sec
Receptor - pain, temperature, itch

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49
Q

What ascending sensory pathways are there?

A

Discriminative touch - dorsal column medial lemniscus pathway
Pain - spinothalamic pathway

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50
Q

What descending activity modulating pathways are there?

A

Motor/voluntary - corticospinal and corticobulbar tracts

Motor/muscle tone - reticulospinal, tectospinal, vestibulospinal

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51
Q

At what level do axons in the dorsal column medial lemniscus pathway cross over?

A

Secondary to tertiary neuron

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52
Q

At what level do axons in the spinothalamic pathway cross over?

A

Primary to secondary neuron

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53
Q

What is the typical resting membrane potential of a neuron?

A

-70mV

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54
Q

What is the distribution of Na, K and Cl across the membrane of a neuron?

A

Na - extra 145mM, intra 12mM
K - extra 5mM, intra 150mM
Cl - extra 110mM, intra 10mM

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55
Q

What is the equilibrium potential?

A

The membrane potential at which there is no net gain or loss of ions - electrical and chemical gradients are balanced

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56
Q

What is responsible for depolarisation and re/hyperpolarisation?

A

Depolarisation - fast opening of voltage gated Na channels

Re/hyperpolarisation - slow opening of voltage gated K channels

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57
Q

How can voltage gated Na channels be used in medicine?

A 
Lidocaine (local anaesthetic)
Nociceptive nerves (pain)
Epilepsy
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58
Q

What factors contribute to the passage of an electrical current through an axon?

A

Axon diameter

Number of open channels

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59
Q

What is saltatory conduction?

A

The way action potentials jump from one node of Ranvier to the next in a myelinated axon

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60
Q

What disorders are associated with defective myelination of the CNS and PNS?

A

CNS - MS

PNS - Guillain-Barre

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61
Q

What are the pathophysiology and symptoms of MS?

A

Antibodies attack myelin causing scar formation which delays/blocks action potentials
Symptoms - blurred vision, muscle pain, paralysis, fatigue, lack of co-ordination

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62
Q

What are the pathophysiology and symptoms of Guillain-Barre?

A

Inflammatory disease causing destruction of myelin

Symtoms - progressive motor weakness, sensory and motor loss

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63
Q

What occurs at the postsynaptic terminal during neurotransmission?

A

Neurotransmitter causes channels to open to allow Na and Cl to enter
Ions cause depolarisation (excitation) or hyperpolarisation (inhibition)

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64
Q

What is an IPSP?

A

Inhibitory postsynaptic potential
Moves the post-synaptic membrane further away from threshold (hyperpolarised) to reduce the probability of the postsynaptic cell producing an action potential

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65
Q

What are temporal and spatial summation?

A

Temporal - multiple action potentials fired by the same axon (frequency)
Spatial - multiple action potentials fired by multiple axons

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66
Q

In what 2 ways can cholinergic synaptic transmission be disrupted?

A

Botulism - botulinum toxin from clostridium bacteria prevents ACh release leading to skeletal muscle weakness and diaphragm paralysis
Myasthenia gravis - antibodies bind to ACh receptors in postsynaptic membrane leading to muscle weakness

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67
Q

In what 2 patterns can information be spread within the nervous system?

A

Divergence

Convergence

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68
Q

What methods are available for investigating cerebral function?

A

EEG
PET
fMRI
TMS

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69
Q

What is EEG and how is it used for cerebral function?

A

Electroencephalography
Records the electrical activity of
the brain
Investigate cognitive processes in response to a stimulus

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70
Q

What is PET?

A

Positron emission tomography
Measures blood flow, via a small dose of radioactive material injected into bloodstream
Locate brain activity while performing a task

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71
Q

What is fMRI?

A 
Functional magnetic
resonance imaging
Measures blood
flow
Locate brain activity while performing a task
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72
Q

What is TMS?

A

Transcranial
magnetic
stimulation
Uses electromagnet to stimulate brain activity, causing depolarisation or interrupted firing
Interrupt brain activity while performing a task

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73
Q

Where are the 1st, 2nd and 3rd neurons usually located in a sensory pathway?

A

1st - periphery
2nd - CNS
3rd - thalamus

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74
Q

Briefly describe the route of the 1st neuron in the dorsal column medial lemniscal pathway

A

Aβ fibre
From periphery to lumbar spinal cord
Bifurcates into central and ascending branches (dorsal funiculus/column)
Projects upwards and terminates at gracile nucleus of the medulla

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75
Q

Briefly describe the route of the 2nd neuron in the dorsal column medial lemniscal pathway

A

Decussation at level of the brainstem
Continues as internal arcuate fibres
Projects upwards through medial lemniscus
Terminates at the VPL of the thalamus

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76
Q

Briefly describe the route of the 3rd neuron in the dorsal column medial lemniscal pathway

A

Travels via the internal capsule

Projects to and terminates at the sensory cortex

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77
Q

What is the dorsal column medial lemniscal pathway responsible for?

A

Discriminitive tactile sensation

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78
Q

What is the spinothalamic pathway responsible for?

A

Pain, temperature, itch sensation

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79
Q

Briefly describe the route of the 1st neuron in the spinothalamic pathway

A

Aδ or C fibres

Travels to and terminates at dorsal horn of lumbar spinal cord

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80
Q

Briefly describe the route of the 2nd neuron in the spinothalamic pathway

A

Decussation at level of the spinal cord

Projects upwards in antero-lateral funiculus to the thalamus (branches given off at various points)

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81
Q

Briefly describe the route of the 3rd neuron in the spinothalamic pathway

A

Travels via the internal capsule

Terminates at the sensory cortex

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82
Q

What is the difference between the corticospinal and corticobulbar pathways?

A

Corticospinal - axons from primary motor cortex project to motor nuclei in spinal cord
Corticobulbar - axons from primary motor cortex project to cranial nerve nuclei in the brainstem

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83
Q

What percentage of axons project in the lateral corticospinal tract compared to the anterior?

A

Lateral - 85%

Anterior - 15%

84
Q

What name is often given to the descending corticospinal/corticobulbar tracts?

A

Pyramidal tracts

85
Q

Where does decussation occur in the corticospinal/corticobulbar tracts?

A

At the pyramids of the medulla

86
Q

What are the lobes of the brain/bones of the skull?

A

Frontal
Parietal
Occipital
Temporal

87
Q

What is the weight of an average brain?

A

1.3-1.4kg

88
Q

Where are the cell bodies of axons in the corticospinal/corticobulbar tracts found?

A

Primary motor cortex

89
Q

What are sulci and gyri?

A

Sulci - grooves

Gyri - folds

90
Q

What is the function of the precentral and postcentral gyri?

A

Pre - motor

Post - sensory

91
Q

How many temporal gyri are there and what are they called?

A

3

Superior, middle, inferior

92
Q

What does the central sulcus divide?

A

Frontal and parietal lobes

93
Q

What important brain areas are located on the LHS?

A

Visual cortex
Auditory cortex - Wernicke’s area
Motor speech - Broca’s area

94
Q

What is Broca’s area and what is the consequence of damage to it?

A

Responsible for motor aspect of speech

Damage - expressive aphasia, non-fluent, slow speech

95
Q

What is Wernicke’s area and what is the consequence of damage to it?

A

Sensory language area for lexical processing/understanding of speech
Damage - receptive aphasia, poor comprehension

96
Q

What components make up the basal ganglia?

A

Caudate nucleus
Leniform nucleus - putamen and globus pallidus
Thalamus
Substantia nigra

97
Q

What are the 3 main action selection centres of the brain which influence motor control?

A

Corpus striatum
Sub-thalamic nuclei
Substantia nigra

98
Q

What basal ganglia comprise the corpus striatum?

A

Caudate nucleus

Lentiform nucleus - putamen and globus pallidus

99
Q

What disease results from damage to the substantia nigra?

A

Parkinson’s disease

100
Q

What disease results from damage to the corpus striatum?

A

Huntington’s disease

101
Q

What brain areas are affected in Parkinson’s and Huntington’s diseases?

A

Parkinson’s - substantia nigra

Huntington’s - corpus striatum

102
Q

What components make up the ventricular system of the brain?

A 
Lateral ventricles (2)
Cerebral aqueduct 
Third ventrical 
Interventricular foramen 
Fourth ventricle
103
Q

What are the 4 areas of the corpus callosum called?

A

Rostrum
Genu
Body
Splenium

104
Q

What group of cells produce CSF?

A

Choroid plexus

105
Q

How is the internal capsule somatotopic?

A

Corticobulbar axons concentrated at the genu

Corticospinal axons concentrated at the Posterior limb

106
Q

What are the boundaries of the lentiform nucleus?

A

Claustrum
Posterior limb
Genu
Anterior limb

107
Q

How many cranial nerves are there?

A

12

108
Q

What are the cranial nerves?

A 
Olfactory
Optic
Occulomotor
Trochlear
Trigeminal
Abducens 
Facial
Vestibulocochlear 
Glossopharyngeal
Vagus
Accessory 
Hypoglossal
109
Q

What is the basic anatomical layout of the circle of Willis?

A

2 vertebral arteries join to form the basilar artery

Basilar artery joins several arteries to form a ring - posterior, middle and anterior cerebral arteries

110
Q

What is the definition of pain?

A

An unpleasant sensory and emotional experience associated with actual or potential tissue damage

111
Q

What is involved in the acute catabolic stress response?

A

CNS - anxiety, depression, sleep deprivation
CVS - increased BP/HR/IHD
Respiration - inhibits cough, hyperventilation
GI - ileus, nausea, vomiting
GUS - urinary retention, uterine inhibition
Muscle - restless, immobility
Metabolic - increased cortisol/glucagon/GH/catecholamines, decreased insulin/testosterone/plasminogen (DVT)

112
Q

What is nociception?

A

The neural mechanism by which an individual dectects the presence of a potentially tissue-harming stimulus

113
Q

What are the processes involve in the nociception pathway?

A

Transduction, transmission, modulation, perception

114
Q

How is pain/temperature sensed in the skin?

A

Free nerve endings - mechanical, thermal and chemical stimuli

115
Q

What do Merkel’s discs relay?

A

Touch

116
Q

What do Meissner’s corpuscles relay?

A

Touch

117
Q

What do Pacinian corpuscles relay?

A

Vibration

118
Q

What do Ruffini’s endings relay?

A

Stretch

119
Q

Where are nociceptors located?

A

Skin, bone, muscle, organs, blood vessels

Not the brain

120
Q

Outline the characteristics of Aδ fibres involved in pain

A 
Fast 
Physiological
High threshold 
Thermo/mechanoreceptors
Sharp, short, localised pain 
Reflex withdrawal 
Not abolished by morphine
Useful for survival
121
Q

Outline the characteristics of C fibres involved in pain

A 
Slow 
Pathophysiology
High threshold
Polymodal 
Dull, diffuse, prolonged pain 
Spasms and guarding 
Abolished by morphine 
Not useful
122
Q

In what level of the dorsal horn do Aδ and C fibres enter?

A

Superficial laminae - I and II

123
Q

In what level of the dorsal horn do Aβ fibres enter?

A

Deep laminae - III and VI

Also feed into lamina II

124
Q

What additional neurons are present in lamina II?

A

Interneurons - excitatory (glutamine) and inhibitory (GABA)

125
Q

At what 2 levels is pain modulated?

A

Spinal - gate control theory (ascending)

Supraspinal - conditioned pain modulation (descending)

126
Q

Outline the gate control theory?

A

C fibre input absent - inhibitory interneurons block pain pathway
C fibre input - inhibitory interneurons blocked, painful stimulus sent to brain
C fibre and Aβ fibre input - inhibitory interneurons activated, painful stimulus to brain dereased (modulation)

127
Q

What machine is used to block pain and also proves the gate control theory?

A

TENS - transcutaneous electrical nerve stimulation

128
Q

Where do the fibres involved in descening modulation (supraspinal) arise?

A

Midbrain - periaqueductal grey matter (endogenous opioid receptors)

129
Q

What neurotransmitters are involved in conditioned pain modulation and which is most useful in blocking pain?

A

Noradrenaline - most useful

5-HT

130
Q

What is the core network of the supraspinal pain neuromatrix?

A

Sensory discriminative (site, severity, duration of pain) - thalamus, SS1, SS2, post insula
Affective-motivational - anterior insula cortex, anterior mid cingulate cortex
Cognitive activation - lateral prefrontal cortex

131
Q

Define hyperalgesia

A

Abnormally high levels of pain from noxious stimuli (e.g. blunt pin-prick)

132
Q

Define allodynia

A

Pain from a stimulus which is not normally painful (e.g. cotton wool)

133
Q

Outline chronic pain hypersensitivity

A

Peripheral sensitisation - primary hyperalgesia

Central sensitisation - secondary hyperalgesia and allodynia

134
Q

What substances can activate nociceptors?

A 
K+
5-HT
Bradykinin
H+
Histamine 
ATP
Adenosine
135
Q

What substances can sensitise nociceptors?

A 
Prostaglandins 
Leukotrienes
Substance P 
Noradrenaline 
Neurokinin A 
CGRP 
NO
ROS
136
Q

What is the basic mechanism of peripheral sensitisation?

A

Nociceptors change from high threshold to low threshold due to influx of inflammatory cells

137
Q

What is the basic mechanism of central sensitisation?

A

Loss of interneuron brake leads to hypo-active CPM

138
Q

How can pain be classified?

A

Acute vs chronic (>3 months)
Cancer vs non-cancer
Nociceptive vs neuropathic

139
Q

What is the difference between neuropathic and nociceptive pain?

A

Neuro - nerve damage (e.g. peripheral diabetic neuropathy)
Noci - tissue damage (e.g. RA)
Trauma/surgery constitutes a combination of both

140
Q

How can nociceptive pain be divided?

A

Somatic - skin/muscle/bone

Visceral - internal organs

141
Q

What are the characteristics of somatic pain?

A 
Well localised 
Dermatomal 
Sharp, aching, gnawing 
Constant
Rarely associated
142
Q

What are the characteristics of visceral pain?

A 
Vague distribution 
Diffuse 
Dull, cramp, dragging 
Periodic 
Associated with nausea, sweating, HR and BP
143
Q

What descriptors are associated with neuropathic pain?

A 
Shooting 
Electric-shock
Burning 
Tingling 
Numbness
144
Q

How might a herniated intervertebral disc cause lower back pain?

A

Nucleus pulposus bulges out
Nociceptive pain - activation of local nociceptors (constant ache/throbbing of back)
Neuropathic pain - compression an inflammation of nerve root (shooting/burning of foot)

145
Q

What are the 2 components of intervertebral discs?

A

Inner nucleus pulposus

Outer annulus fibrosis

146
Q

What is sciatica?

A

Herniated disc with lumbar radicular pain travelling all down the leg in a narrow band

147
Q

What must sciatic pain be distinguished from?

A

Somatic referred pain due to noxious stimulation of interspinous ligaments at L3-S1 (particularly L5)

148
Q

How are sciatic pain and somatic referred pain distinguished clinically?

A

Below the knee
Character of pain
Associated sensory/motor deficits
Aggravation by straight leg raise

149
Q

How can severity of pain be assessed?

A

Numerical rating, verbal rating, visual analogue
Assess physical and mental impact and quality of life
30% improvement is good - manage expectations

150
Q

What are the main associations of functional impairment?

A

Sleep disturbance, pain, anxiety and depression

151
Q

What factors are important in pain?

A

Biomedical
Psychosocial
Affective-cognitive
Ethno-cultural

152
Q

What is a brief pain inventory (BPI)?

A

Tool for assessing pain
Pain severity - 0-10, average/worst/least/now
Functional impairment - walking, work, sleep, mood, life, social
Can also be used to assess response to pain relief - increased function with decreased pain

153
Q

What are the 6 P’s of pain treatment?

A 
Prevention 
Pathology 
Physical therapy 
Pharmacotherapy 
Procedures 
Psychology
154
Q

Outline the WHO analgesic ladder

A

Step 1 - non-opioids; paracetamol, NSAIDs
Step 2 - mild opioids; codeine, dextropropoxyhene
Intermediate - tramadol
Step 3 - opioids; morphine, oxycodone, fentanyl, methadone, pethidine

155
Q

How is codeine metabolised in the body?

A

Pro-drug is metabolised to morphine by CP450 CYP 2D (significant genetic variation)

156
Q

How is opioid prescribing decided on?

A

Pain - ensure type of pain is opioid-responsive
Patient - screen for dependency risk and monitor for abuse, define and agree on outcome
Prescription - drug, dose, duration

157
Q

What pharmacologic therapies are used in neuropathic pain?

A

Anti-depressants - amitriptyline
Anti-convulsants - gabapentin, pregabalin
Anti-arrythmics - lidocaine
Others - ketamine, capsaicin, clonidine, cannabinoids

158
Q

What are the 4 P’s of harmful beliefs patients have with pain?

A

Progressive pathology
Passive - sickness behaviour, lack of support
DePression
Problems - social, work, financial, legal

159
Q

What is the role of psychology in pain management?

A 
Clinical explanation 
Education class
Support groups
Pain management programme 
1:1 psychology (or psychiatry)
160
Q

What are the anatomical boundaries of lower back pain?

A

Tension, pain and/or stiffness posteriorly between ribs and inferior buttocks

161
Q

What are the red flags associated with lower back pain?

A 
Weight loss/past malignancy 
Fever
Systemic inflammation 
Anatomical change 
History of trauma 
Cauda equina syndrome
Neurological signs
162
Q

What procedures may be used in lower back pain?

A

Epidural injection of steroid to reduce pain - temporary, expensive
Facet joint nerve denervation - medial branch of dorsal primary ramus, no associated problems

163
Q

What is the STarT back screening tool?

A

9 questions to find out what the patient thinks of their pain, how they behave and what their expectations are
Low score = low risk chronicity, 2 days bed rest with paracetamol and some physiotherapy advice
High score = proactive, intense psychology and physiotherapy

164
Q

What important structures are located at the root of the neck?

A 
Apex of the lung 
Stellate ganglion 
Ventral rami of C8 and T1
Inferior trunk of the brachial plexus 
Sublavian artery and vein
165
Q

What are the roots of the brachial plexus?

A

C5, C6, C7, C8, T1

166
Q

What are the trunks of the brachial plexus?

A

Superior, middle, inferior

167
Q

What are the divisions of the brachial plexus?

A

Anterior, posterior

168
Q

What are the cords of the brachial plexus?

A

Lateral, posterior, medial

169
Q

What are the branches of the brachial plexus?

A 
Musculocutaneous
Axillary 
Median 
Radial 
Ulnar
170
Q

Which dermatome relates to the inner aspect of the arm?

A

T1

171
Q

What is Horner’s syndrome?

A

Interruption of the sympathetic nerve supply to the eye, characterised by the classic triad of miosis (constricted pupil), partial ptosis (drooping upper eyelid), and loss of hemifacial sweating (anhidrosis)

172
Q

Outline the 3 neuron arc involved in sympathetic innervation to the eye

A
  1. Hypothalamus → spinal cord (C8-T2)
  2. T1 → sympathetic chain → superior cervical ganglion → alongside internal carotid
  3. Cavernous sinus → join abducens nerve → enter orbit with trigeminal nerve as long ciliary nerves → innervation of iris dilator and eyelid muscle contractor
173
Q

Which neuron is most likely to be damaged by a Pancoast tumour to cause Horner’s syndrome?

A

Second order neuron

174
Q

What is a Pancoast tumour?

A

Cancer that form at the extreme apex of either lung in the superior sulcus and invade surrounding structures

175
Q

What structures are at risk of invasion by a Pancoast tumour?

A 
Lymphatics 
Brachial plexus (inferior branch)
Intercostal nerves 
Stellate ganglion 
Sympathetic chain 
Ribs 
Vertebrae
176
Q

What type of tumour are Pancoast tumours most likely to be?

A

Non-small cell lung cancer

Squamous cell carcinoma

177
Q

What are the risk factors for Pancoast tumours?

A

Smoking
Asbestos
Radon
Gold, nickel

178
Q

What symptoms are associated with Pancoast tumours?

A

Radiating shoulder pain
Weakening/paraesthesia/atrophy of hand/arm muscles
Oedema
Horner’s syndrome

179
Q

How are Pancoast tumours diagnosed?

A

Chest x-ray
CT/MRI
Biopsy

180
Q

How are Pancoast tumours treated?

A

Steroids
Pain management
Chemotherapy and radiation
Surgical resection

181
Q

Which vertebra is the axis?

A

C2

182
Q

Which vertebra is the atlas?

A

C1

183
Q

What does C1 articulate with superiorly?

A

Occipital condyles of the skull

184
Q

Why might osteoarthritis of facet joints in the cervical spine present as upper limb pain?

A

Nerve compression

185
Q

Where is an emergency airway placed?

A

Cricothyroidotomy - between the thyroid and cricoid cartilages

186
Q

How many cervical vertebrae are there?

A

7

187
Q

How many cervical spinal nerves are there?

A

8

188
Q

Why would laxity of the alar and dens transverse ligament be dangerous?

A

Dens may tilt back and crush the spinal cord

189
Q

How are the external and internal carotid arteries distinguished anatomically?

A

Cannot depend on their relative location
External - larger, lots of branches
Internal - presence of sinus (bulge), no branches

190
Q

At what vertebral level does the trachea start and end?

A

C6-T4

191
Q

Explain the innervation of the eyelid

A

Smooth muscle - sympathetic

Skeletal muscle - 3rd cranial nerve (occulomotor)

192
Q

What conditions may cause distension of the external jugular vein?

A

Heart failure

Mass/tumour pressing on the subclavian

193
Q

How far might infection of the retropharyngeal space travel?

A

Peritoneum and diaphragm

194
Q

Where does the thoracic duct terminate?

A

Joins the subclavian and jugular veins where they form the inominate (brachiocephalic) vein

195
Q

What is the function of the sternohyoid and omohyoid muscles?

A

Depress the hyoid bone

196
Q

Which vein lies behind the clavicle lateral to the sternocleidomastoid?

A

Subclavian vein

197
Q

Why can numbness of the inner arm correspond with weaknes of hand grip?

A

Myotome and dermatome of T1 - root injury

198
Q

Which spinal tract carries information about pain and temperature?

A

Spinothalamic

199
Q

Which artery supplies blood to the lower third of the spinal cord?

A

Major anterior medullary (segmental) artery

200
Q

Which nerve sensitising/stimulating agent is relevant to the analgesic action of aspirin?

A

Prostaglandins

201
Q

Between which vertebrae is the inferior end of the adult human spinal cord typically located?

A

L1-L2

202
Q

From which early embryonic tissue is the adult cerebellum derived?

A

Metencephalon

203
Q

Damage to which specific part of the brain results in Broca’s (expressive) aphasia in most patients?

A

Left inferior frontal gyrus

204
Q

What are arachnoid granulations?

A

Villous projections of the arachnoid membrane into the dural sinuses that allow CSF to move from the subarachnoid space into the venous system

205
Q

What are arachnoid trabeculae?

A

Delicate strands of connective tissue that loosely connect the arachnoid mater and the pia mater

206
Q

What are the denticulate ligaments and how many of them are there?

A

Bilateral triangular lateral extensions of pia mater that anchor the spinal cord to the dura mater; 21 in total

Head, Neck and Neurological Systems (6 decks)

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