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SUM'20 - Anatomy & Physiology > week 1 neuroanatomy 2 of 4 > Flashcards

week 1 neuroanatomy 2 of 4 Flashcards

1
Q

ventral rami form interlacing nerve networks called plexus- which section of the spine does not have a nerve plexus

A

T2-T12

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2
Q

Therefore- plexuses are found where along the spine?

A

cervical brachial lumbar sacral

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3
Q

fibers travel to the periphery via several different routes- each muscle receives a nerve supply from … why do the muscles receive nerves from more than one spinal nerve

A

more than one spinal nerve Damage to one spinal segment cannot completely paralyze a muscle

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4
Q

the brachial plexus is formed by

A

c5, c6, c7, c8, t1

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5
Q

what are the four major branches of this plexus

A

roots (5 ventral rami) Trunks (upper middle lower) divisions ( anterior and posterior) cords (lateral medial and posterior ) branches

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6
Q

what nerve lies between clock position 12-3

A

median

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7
Q

what nerves lies between 3-6

A

ulner

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8
Q

what nerve lies between 6-9

A

radial

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9
Q

what nerve lies between 9-12

A

muscultaneous

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10
Q

Second most common postop peripheral neuropathy

A

brachial plexus

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11
Q

how is the brachial plexus damaged

A

Injured when arm abduction > 90 or improperly placed shoulder brace

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12
Q

innervates the deltoid and teres minor

A

Axillary

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13
Q

injury to this nerve realist in inability to abduct arm

A

axillary

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14
Q

injury to this nerve result in the inability to flex forearm

A

musculocutaneous

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15
Q

sends fibers to the biceps brachii and brachialis

A

musculocutaneous

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16
Q

injury can occur from blood draws or carpel tunnel

A

median nerve

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17
Q

branches to most of the flexor muscles of wrist and fingers (also opponens pollicis)

A

median nerve

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18
Q

what does the injury to the median nerve appear as

A

ape hand unable to oppose thumb

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19
Q

median nerve movements

A

Pronation of forearm Flexion of wrist Opposition of thumb Flexion of lateral three fingers

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20
Q

is supplied by the flexor carpi ulnaris and flexor digitorum profundus

A

ulnar nerve

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21
Q

injury to ulnar nerve manifest as

A

claw hand

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22
Q

ulnar nerve abilities

A

Flexion of wrist Adduction of fingers Flexion of medial two fingers (4,5)

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23
Q

Most common postop peripheral neuropathy

A

ulnar nerve damage

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24
Q

innervates essentially ALL extensor muscles of arm and forearm

A

radial

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25
Q

injury to the radial nerve result in

A

wrist drop

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26
Q

this nerve can be blocked to reduce pain from tourniquet inflation during IV regional neural anesthesia

A

intercostobrachial nerve

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27
Q

radial nerve is responsible for

A

Extension at elbow Supination of forearm Extension of wrist and fingers

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28
Q

what is klumpske paralysis

A

injury to superior trunk c5, c6

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29
Q

what is the limp hand position with klumpke paralysis

A

“ Waiter’s tip position” (limb hand by the side in medial rotation)

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30
Q

Excessive stretch in angle between neck and shoulder ( fall landing on shoulder) - tear of the roots

A

klumpke paralysis

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31
Q

Erb Duchenne palsy

A

injury to superior trunk c5, c6 during delivery

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32
Q

presentation of era-duchenne palsy

A

Limb hangs by the side with adducted shoulder (paralysis of abductors: deltoid and supraspinatus) Medially rotated arm (paralysis of lateral rotators: Deltoid, infraspinatus and teres minor) Forearm is pronated (loss of biceps )

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33
Q

injury to these nerves occur when the upper limb is suddenly pulled superiorly- if someone grasp something to break a fall or excessive pulling of a limb during delivery

A

inferior trunk c8 t1

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34
Q

injury of inferior trunk c8-t1 results in what nerve damage

A

ulnar nerve - claw hand- loss of sensation over medial palm, ring and pinky finger

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35
Q

claw hand-

A

inability to abduct or oppose 5th finger (pinky). Loss of sensation over medial palm, ring and pinky finger. Most common post op nerve injury due to compression

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36
Q

damage to radial nerve “saturday night palsy”

A

wrist drop- loss of sensation over posterior surface of lateral three and half fingers- caused from compression or humerus fracture at shaft.

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37
Q

injury to long thoracic nerve

A

serratus anterior- winged scapula

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38
Q

injury to tibial nerve

A

foot drop

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39
Q

injury to common peroneal fibular nerve

A

foot drop

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40
Q

injury to femoral nerve by self retaining retractor

A

absent knee reflex

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41
Q

where does the sciatic nerve originate from

A

lumbosacral trunk (L4-L5 and S1-S3)

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42
Q

sciatic nerve two branches

A

common peroneal nerve and tibial nerve

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43
Q

two ways sciatic nerve can be damaged

A

compression under piriformis improper lithotomy position

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44
Q

superior rectus

A

cranial nerve 3 adduction medial rotation elevation

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45
Q

inferior rectus

A

cranial nerve 3 adduction lateral rotation depression

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46
Q

medial rectus

A

cranial nerve 3 adduction

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47
Q

lateral rectus

A

cranial nerve 6 abduction

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48
Q

superior oblique

A

cranial nerve 4 depression abduction medial rotation

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49
Q

inferior oblique

A

cranial nerve 3 elevation abduction lateral rotation

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50
Q

levator palpebrae superioris

A

cranial nerve 3 elevation of the eyelid

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51
Q

where do the arteries of the brain come from

A

they begin at the bifurcation of the common carotid artery

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52
Q

the common carotid artery supplies which part of the head

A

right side and left side right and left internal carotid artery

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53
Q

the common carotid artery divides into

A

anterior cerebral artery

middle cerebral artery

54
Q

what forms the basilar artery

A

formed by the union of two vertebral arteries.

55
Q

the basilar artery branch is the

A

posterior cerebral artery

56
Q

internal carotid and basilar arteries are connected with

A

circle of willis

57
Q

what are the main feeders of the brain

A

internal carotid and vertebral arteries

58
Q

what does a good stump pressure indicate

A

adequate perfusion of the brain

59
Q

the circle of willis permits blood distribution to any part of cerebral hemisphere termed

A

collateral blood flow

60
Q

the circle of willis is a vascular hub that ensure blood supply in what event

A

event of blockade

61
Q

the major vessels of the circle of willis

A

right and left internal carotids

basilar artery

anterior and posterior communicating arteries

anterior cerebral artery

middle cerebral artery

posterior cerebral artery

62
Q

the anterior cerebral artery supplies-

A

supply medical surface of the brain

63
Q

middle cerebral artery supplies

A

lateral surface of the brain

64
Q

posterior cerebral artery supplies

A

posterior surface of brain

65
Q

blood from basal portion of brain empties into

A

internal jugular vein

66
Q

blood from cerebral and cerebellar cortex flows through…

A

dural venous sinuses

67
Q

blood supply of spinal cord

A

anterior spinal artery (75%) posterior spinal artery(25%) small segmental arteries

68
Q

what is the artery of adamkiewicz

A

a single segmental branch of aorta

69
Q

why is the artery of adamkiewicz important

A

its the major source of blood to the lower 2/3 of the spinal cord. interruption of flow through this vessel can lead to paraplegia

70
Q

aortic cross clamping can disrupt flow through which artery leading to paraplegia.

A

artery of adamkiewicz **bomb**

71
Q

occlusion of posterior spinal artery will affect _____tract

A

is it dorsal column tract??? answer not in PPT

72
Q

dermatomes slide 96- dear god do we have to know these???

A

…

73
Q

c2

A

posterior half of skull cap

74
Q

c3

A

high turtle neck

75
Q

c4

A

low collar shirt clavicle

76
Q

t4

A

nipple

77
Q

t7

A

xiphoid process

78
Q

t10

A

umbilicus

79
Q

L1

A

inguinal region

80
Q

L4 L5

A

tibia

81
Q

S2S3S4

A

get your penis off the floor erection and sensation of penile and anal area

82
Q

c1

A

purely motor- no sensory component

83
Q

what is nocicpetion

A

the detection and perception of noxious stimuli

84
Q

the receptor for pain are ______ in the skin muscle and viscera

A

free nerve endings

85
Q

fast sharp pain is carried by

A

a delta fibers

86
Q

this type of pain is rapid onset and offset and is well localized

A

fast sharp pain- a delta fibers

87
Q

this pain is characterized as aching, burning or throbbing that is poorly localized

A

c fibers

88
Q

referred pain

A

pain of visceral origin is referred to sites on the skin and follows the dermatome rule These sites are innervated by nerve that arise from the same segment of spinal cord

89
Q

what are the 5 classifications of pain

A

somatic superficial (skin) deep (muscle tendon joint fascia) visceral (partial peritoneum or viscera) a delta (fast) vs c fibers (slow)

90
Q

Pain sensations from genital organs are carried by _____________

A

autonomic nervous system

91
Q

What sensations are blocked in the lateral column by epidural or spinal anesthesia?

A

pain and temperature

92
Q

If the right lateral spinothalamic trace is severed at C3 what sensations are lost where?

A

pain and temperature left side

93
Q

a delta fibers

A

Free (naked) nerve endings Myelinated Diameter = 1-4 u m Transmit fast/sharp pain (stinging, pricking) Well localize , can point to pain

94
Q

C fibers

A

Free (naked) nerve endings Unmyelinated Diameter = 0.4-1.2 u m Transmit slow/chronic pain Diffuse , burning ,aching , throbbing sensation

95
Q

cell bodies of a delta and c fibers lie in the

A

DRG dorsal root ganglia

96
Q

fibers ascend or descend 1-3 segments in

A

track of lissauer *BOMB*

97
Q

Pathway for fast sharp pain:

A

After leaving tract of Lissauer, A-delta fibers terminated Lamina I and V of dorsal horn and cross to the contralateral lateral spinothalamic tract and ascend to the brain.

98
Q

Pathway for slow chronic pain

A

C fibers terminates in Lamina II and Lamina III (Substantia Gelatinosa ). Interneuron transmit C fibers impulses to Lamina V from Lamina II and III. Neurons leaving Lamina V cross immediately to the contralateral lateral spinothalamic tract and ascend to brain.

99
Q

a delta fibers neurotransmitter is

A

glutamate

100
Q

glutamate binds to

A

AMPA and NMDA receptors on the postsynaptic membrane

101
Q

c fibers neurotransmitter is

A

substance P

102
Q

what does substance P bind to

A

NK-1(neurokinin-1) receptor on the postsynaptic membrane. NK-1 receptors increase the synthesis of prostaglandins, kinins, thromboxane etc.

103
Q

Pain and temperature from the genitalia are mediated by what system

A

autonomic nervous system.

104
Q

Site where pains are attenuated (weaken)

A

substantial gelatinosa

105
Q

terminates in the substantia gelatinosa( Lamina II & III), synapse with interneuron and secrete substance P -PAIN

A

c fibers

106
Q

Interneurons release

A

enkephalin

107
Q

enkephalin acts on opioid receptors _____ causing decrease ca entry increase K outflux (hyperpolarization) as a result of this transmission of pain is

A

MU, KAPPA, DELTA reduced- no pain

108
Q

morphine does the same way as ___ to result in no pain

A

enkephalin

109
Q

Analgesia system of the brainstem and spinal cord

A

Interneuron connects descending (pain modulating and ascending (pain) pathways

110
Q

Mechanism of action of _________ or endorphin ‘red dots’ and morphine in the transmission of pain impulses from the periphery to the CNS. Spinal interneurons containing enkephalin synapse with the terminals of pain fibers and inhibit the release of the ________. As a result, the receptor neuron in the dorsal horn receives less excitatory (pain) impulses and transmits fewer pain impulses to the brain. Morphine binds to unoccupied enkephalin receptors, mimicking the pain-suppressing effects of the endogenous opiate enkephalin.

A

Mechanism of action of enkephalin or endorphin ‘red dots’ and morphine in the transmission of pain impulses from the periphery to the CNS. Spinal interneurons containing enkephalin synapse with the terminals of pain fibers and inhibit the release of the substance P. As a result, the receptor neuron in the dorsal horn receives less excitatory (pain) impulses and transmits fewer pain impulses to the brain. Morphine binds to unoccupied enkephalin receptors, mimicking the pain-suppressing effects of the endogenous opiate enkephalin.

111
Q

Brain Control of Substantia gelatinosa

1.Descending neurons form ________ and _________ _____ _____terminates on enkephalin-releasing interneuron in __________

A

Brain Control of Substantia gelatinosa

1.Descending neurons form periventricular and periaqueductal gray matter terminates on enkephalin-releasing interneuron in substantia gelatinosa

112
Q

1.The interneuron release _______

A

1.The interneuron release enkephalin

113
Q

1.Enkephalin inhibits release of ________

A

1.Enkephalin inhibits release of substance P

114
Q

Decrease number of pain impulses in the ascending lateral spinothalamic tract –> ?

A

Decrease number of pain impulses in the ascending lateral spinothalamic tract –> spinal analgesia

115
Q

Dorsolateral tract modulates pain by hyperpolarizing what?

A

1.Dorsolateral tract modulates pain by hyperpolarizing second order neurons

116
Q

________________ releases endorphins

A

1.Acupuncture releases endorphins

117
Q

What are the

1.Neurotransmitters in descending pain modulation pathway

A

a. Enkephalin
b. GABA
c. Nor epi
d. Serotonin (5-HT

118
Q

Substance P mediates what?

A

•Substance P mediates lower back pain, arthritis, fibromyalgia.

119
Q

Over-the-counter creams containing ______ (made from chili peppers) can deplete _______ (by causing its release) from local nerve endings and hence relieve pain.

A

Over-the-counter creams containing capsaicin (made from chili peppers) can deplete Substance P (by causing its release) from local nerve endings and hence relieve pain.

120
Q

•Capsaicin selectively binds to _______, that resides on membranes of pain and heat sensing neurons.

A

•Capsaicin selectively binds to capsaicin receptor, that resides on membranes of pain and heat sensing neurons.

121
Q

The capsaicin receptor is a _____________, which normally opens between 37 ° and 45 °C; hence, when capsaicin binds to its receptor, a sensation of heat is felt.

A

The capsaicin receptor is a heat activated calcium channel, which normally opens between 37 ° and 45 °C; hence, when capsaicin binds to its receptor, a sensation of heat is felt.

122
Q

•Prolonged activation of neurons by ________________________, one of the body’s neurotransmitters for pain and heat –> No pain

A

•Prolonged activation of neurons by capsaicin depletes presynaptic substance P, one of the body’s neurotransmitters for pain and heat –> No pain

123
Q

Mechanism of Analgesia Produced by Neuraxial Opioids: (5 points)

A

Mechanism of Analgesia Produced by Neuraxial Opioids

  1. Opioids (morphine, fentanyl, sufentanil,alfentanil) interacts with special opioid receptors ( mu-1, mu-2, kappa and delta) in substantia gelatinosa
  2. Release of substance P is inhibited
  3. Transmission of pain impulses through substantia gelatinosa is inhibited
  4. Spinal analgesia (relief of pain without loss of consciousness ) - Mainly m-2 receptor
124
Q

What is this?

A

Spinal sites of opioid action: m k and d agonists reduce release of substance-P

125
Q

What is the pic on left?

What is pic on right?

A

Left –> Injection sites for spinal and epidural anesthesia

Right –> Cross section of injection sites for peripheral nerve, epidural and spinal blocks

126
Q
A
127
Q
A
128
Q

Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane _____

A

Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane slowly

129
Q

Name 3 things regarding spinal placement of hydrophillic opioids:

A

Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane slowly

  1. Intrathecal (Spinal) Placement
    a. Slow onset and long duration of analgesia
    b. No early depression of ventilation because uptake by systemic circulation is minimal
    c. Late (6-12 hrs) depression of ventilation occur due to rostral (towards head) spread of morphine in CSF
130
Q

Name 3 things regarding epidural placement and hyrdophillic opioids:

A

Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane slowly

  1. Epidural Placement
    a. Slow onset and long duration of analgesia
    b. Early depression of ventilation (within 2 hrs) due to á uptake by systemic circulation (rapid transportation)
    c. Late depression of ventilation occur due to rostral spread in CSF
131
Q
A

SUM'20 - Anatomy & Physiology (11 decks)

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