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
2
Q
Therefore- plexuses are found where along the spine?
A
cervical brachial lumbar sacral
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
4
Q
the brachial plexus is formed by
A
c5, c6, c7, c8, t1
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
6
Q
what nerve lies between clock position 12-3
A
median
7
Q
what nerves lies between 3-6
A
ulner
8
Q
what nerve lies between 6-9
A
radial
9
Q
what nerve lies between 9-12
A
muscultaneous
10
Q
Second most common postop peripheral neuropathy
A
brachial plexus
11
Q
how is the brachial plexus damaged
A
Injured when arm abduction > 90 or improperly placed shoulder brace
12
Q
innervates the deltoid and teres minor
A
Axillary
13
Q
injury to this nerve realist in inability to abduct arm
A
axillary
14
Q
injury to this nerve result in the inability to flex forearm
A
musculocutaneous
15
Q
sends fibers to the biceps brachii and brachialis
A
musculocutaneous
16
Q
injury can occur from blood draws or carpel tunnel
A
median nerve
17
Q
branches to most of the flexor muscles of wrist and fingers (also opponens pollicis)
A
median nerve
18
Q
what does the injury to the median nerve appear as
A
ape hand unable to oppose thumb
19
Q
median nerve movements
A
Pronation of forearm Flexion of wrist Opposition of thumb Flexion of lateral three fingers
20
Q
is supplied by the flexor carpi ulnaris and flexor digitorum profundus
A
ulnar nerve
21
Q
injury to ulnar nerve manifest as
A
claw hand
22
Q
ulnar nerve abilities
A
Flexion of wrist Adduction of fingers Flexion of medial two fingers (4,5)
23
Q
Most common postop peripheral neuropathy
A
ulnar nerve damage
24
Q
innervates essentially ALL extensor muscles of arm and forearm
A
radial
25
injury to the radial nerve result in
wrist drop
26
this nerve can be blocked to reduce pain from tourniquet inflation during IV regional neural anesthesia
intercostobrachial nerve
27
radial nerve is responsible for
Extension at elbow Supination of forearm Extension of wrist and fingers
28
what is klumpske paralysis
injury to superior trunk c5, c6
29
what is the limp hand position with klumpke paralysis
“ Waiter’s tip position” (limb hand by the side in medial rotation)
30
Excessive stretch in angle between neck and shoulder ( fall landing on shoulder) - tear of the roots
klumpke paralysis
31
Erb Duchenne palsy
injury to superior trunk c5, c6 during delivery
32
presentation of era-duchenne palsy
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 )
33
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
inferior trunk c8 t1
34
injury of inferior trunk c8-t1 results in what nerve damage
ulnar nerve - claw hand- loss of sensation over medial palm, ring and pinky finger
35
claw hand-
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
36
damage to radial nerve "saturday night palsy"
wrist drop- loss of sensation over posterior surface of lateral three and half fingers- caused from compression or humerus fracture at shaft.
37
injury to long thoracic nerve
serratus anterior- winged scapula
38
injury to tibial nerve
foot drop
39
injury to common peroneal fibular nerve
foot drop
40
injury to femoral nerve by self retaining retractor
absent knee reflex
41
where does the sciatic nerve originate from
lumbosacral trunk (L4-L5 and S1-S3)
42
sciatic nerve two branches
common peroneal nerve and tibial nerve
43
two ways sciatic nerve can be damaged
compression under piriformis improper lithotomy position
44
superior rectus
cranial nerve 3 adduction medial rotation elevation
45
inferior rectus
cranial nerve 3 adduction lateral rotation depression
46
medial rectus
cranial nerve 3 adduction
47
lateral rectus
cranial nerve 6 abduction
48
superior oblique
cranial nerve 4 depression abduction medial rotation
49
inferior oblique
cranial nerve 3 elevation abduction lateral rotation
50
levator palpebrae superioris
cranial nerve 3 elevation of the eyelid
51
where do the arteries of the brain come from
they begin at the bifurcation of the common carotid artery
52
the common carotid artery supplies which part of the head
right side and left side right and left internal carotid artery
53
the common carotid artery divides into
anterior cerebral artery
middle cerebral artery
54
what forms the basilar artery
formed by the union of two vertebral arteries.
55
the basilar artery branch is the
posterior cerebral artery
56
internal carotid and basilar arteries are connected with
circle of willis
57
what are the main feeders of the brain
internal carotid and vertebral arteries
58
what does a good stump pressure indicate
adequate perfusion of the brain
59
the circle of willis permits blood distribution to any part of cerebral hemisphere termed
collateral blood flow
60
the circle of willis is a vascular hub that ensure blood supply in what event
event of blockade
61
the major vessels of the circle of willis
right and left internal carotids
basilar artery
anterior and posterior communicating arteries
anterior cerebral artery
middle cerebral artery
posterior cerebral artery
62
the anterior cerebral artery supplies-
supply medical surface of the brain
63
middle cerebral artery supplies
lateral surface of the brain
64
posterior cerebral artery supplies
posterior surface of brain
65
blood from basal portion of brain empties into
internal jugular vein
66
blood from cerebral and cerebellar cortex flows through...
dural venous sinuses
67
blood supply of spinal cord
anterior spinal artery (75%) posterior spinal artery(25%) small segmental arteries
68
what is the artery of adamkiewicz
a single segmental branch of aorta
69
why is the artery of adamkiewicz important
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
aortic cross clamping can disrupt flow through which artery leading to paraplegia.
artery of adamkiewicz \*\*bomb\*\*
71
occlusion of posterior spinal artery will affect \_\_\_\_\_tract
is it dorsal column tract??? answer not in PPT
72
dermatomes slide 96- dear god do we have to know these???
...
73
c2
posterior half of skull cap
74
c3
high turtle neck
75
c4
low collar shirt clavicle
76
t4
nipple
77
t7
xiphoid process
78
t10
umbilicus
79
L1
inguinal region
80
L4 L5
tibia
81
S2S3S4
get your penis off the floor erection and sensation of penile and anal area
82
c1
purely motor- no sensory component
83
what is nocicpetion
the detection and perception of noxious stimuli
84
the receptor for pain are ______ in the skin muscle and viscera
free nerve endings
85
fast sharp pain is carried by
a delta fibers
86
this type of pain is rapid onset and offset and is well localized
fast sharp pain- a delta fibers
87
this pain is characterized as aching, burning or throbbing that is poorly localized
c fibers
88
referred pain
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
what are the 5 classifications of pain
somatic superficial (skin) deep (muscle tendon joint fascia) visceral (partial peritoneum or viscera) a delta (fast) vs c fibers (slow)
90
Pain sensations from genital organs are carried by \_\_\_\_\_\_\_\_\_\_\_\_\_
autonomic nervous system
91
What sensations are blocked in the lateral column by epidural or spinal anesthesia?
pain and temperature
92
If the right lateral spinothalamic trace is severed at C3 what sensations are lost where?
pain and temperature left side
93
a delta fibers
Free (naked) nerve endings Myelinated Diameter = 1-4 u m Transmit fast/sharp pain (stinging, pricking) Well localize , can point to pain
94
C fibers
Free (naked) nerve endings Unmyelinated Diameter = 0.4-1.2 u m Transmit slow/chronic pain Diffuse , burning ,aching , throbbing sensation
95
cell bodies of a delta and c fibers lie in the
DRG dorsal root ganglia
96
fibers ascend or descend 1-3 segments in
track of lissauer \*BOMB\*
97
Pathway for fast sharp pain:
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
Pathway for slow chronic pain
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
a delta fibers neurotransmitter is
glutamate
100
glutamate binds to
AMPA and NMDA receptors on the postsynaptic membrane
101
c fibers neurotransmitter is
substance P
102
what does substance P bind to
NK-1(neurokinin-1) receptor on the postsynaptic membrane. NK-1 receptors increase the synthesis of prostaglandins, kinins, thromboxane etc.
103
Pain and temperature from the genitalia are mediated by what system
autonomic nervous system.
104
Site where pains are attenuated (weaken)
substantial gelatinosa
105
terminates in the substantia gelatinosa( Lamina II & III), synapse with interneuron and secrete substance P -PAIN
c fibers
106
Interneurons release
enkephalin
107
enkephalin acts on opioid receptors _____ causing decrease ca entry increase K outflux (hyperpolarization) as a result of this transmission of pain is
MU, KAPPA, DELTA reduced- no pain
108
morphine does the same way as ___ to result in no pain
enkephalin
109
Analgesia system of the brainstem and spinal cord
Interneuron connects descending (pain modulating and ascending (pain) pathways
110
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.
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
Brain Control of Substantia gelatinosa
1.Descending neurons form ________ and _________ \_\_\_\_\_ \_\_\_\_\_terminates on enkephalin-releasing interneuron in \_\_\_\_\_\_\_\_\_\_
Brain Control of Substantia gelatinosa
1.Descending neurons form **periventricular** and **periaqueductal gray matter** terminates on enkephalin-releasing interneuron in **substantia gelatinosa**
112
1.The interneuron release \_\_\_\_\_\_\_
1.The interneuron release **enkephalin**
113
1.Enkephalin inhibits release of \_\_\_\_\_\_\_\_
1.Enkephalin inhibits release of substance P
114
Decrease number of pain impulses in the ascending lateral spinothalamic tract --\> ?
Decrease number of pain impulses in the ascending lateral spinothalamic tract --\> spinal analgesia
115
Dorsolateral tract modulates pain by hyperpolarizing what?
1.Dorsolateral tract modulates pain by hyperpolarizing second order neurons
116
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ releases endorphins
1.Acupuncture releases endorphins
117
What are the
## Footnote
1.Neurotransmitters in descending pain modulation pathway
a. Enkephalin
b. GABA
c. Nor epi
d. Serotonin (5-HT
118
Substance P mediates what?
•Substance P mediates lower back pain, arthritis, fibromyalgia.
119
Over-the-counter creams containing ______ (made from chili peppers) can deplete _______ (by causing its release) from local nerve endings and hence relieve pain.
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
•Capsaicin selectively binds to \_\_\_\_\_\_\_, that resides on membranes of pain and heat sensing neurons.
•Capsaicin selectively binds to capsaicin receptor, that resides on membranes of pain and heat sensing neurons.
121
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.
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
•Prolonged activation of neurons by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, one of the body's neurotransmitters for pain and heat --\> No pain
•Prolonged activation of neurons by **capsaicin depletes presynaptic substance P**, one of the body's neurotransmitters for pain and heat --\> No pain
123
Mechanism of Analgesia Produced by Neuraxial Opioids: (5 points)
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
What is this?
Spinal sites of opioid action: m k and d agonists reduce release of substance-P
125
What is the pic on left?
What is pic on right?
Left --\> Injection sites for spinal and epidural anesthesia
Right --\> Cross section of injection sites for peripheral nerve, epidural and spinal blocks
126
127
128
Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane \_\_\_\_\_
Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane slowly
129
Name 3 things regarding spinal placement of hydrophillic opioids:
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
Name 3 things regarding epidural placement and hyrdophillic opioids:
Neuraxial (intrathecal or Epidural ) placement of Hydrophilic (water soluble) Opioids: Morphine, a hydrophilic opioid, crosses lipid membrane slowly
2. 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
