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Head, Neck and Neurological Systems > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What spinal tracts cross over at the medulla oblongata?

A

Dorsal column and lateral corticospinal tracts

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2
Q

What spinal tract crosses over in the spinal cord?

A

Spinothalamic tract

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3
Q

What disorders can be caused by incomplete SCI?

A

Central/anterior/posterior cord syndrome
Brown-Sequard syndrome
Cauda equina syndrome

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4
Q

What is central cord syndrome?

A

Low velocity hyperextension injury causes damage to the centre of the spinal cord; impairment of sensation mostly in upper limbs; preservation of proprioception/light touch

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5
Q

Why is central cord syndrome more common in elderly patients?

A

Narrowed cervical canal due to osteophytes

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6
Q

What is Brown-Sequard syndrome?

A

Penetrating injury causes damage to one side of the spinal cord; results in paralysis (corticospinal) and loss of proprioception/light touch (dorsal column) on same side and pain/temperature (spinothalamic) on opposite side

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7
Q

What is cauda equina syndrome?

A

Bony compression/disc protrusion in lumbosacral region causes non-specific symptoms (back pain, bowel/bladder dysfunction, leg numbness/weakness, saddle paraesthesia

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8
Q

What is saddle paraesthesia and what disorder is it associated with?

A

Loss of sensation restricted to the area of the buttocks, perineum area between the anus and scrotum/vulva and inner surface of the thighs
Cauda equina syndrome

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9
Q

How are SCIs immediately managed?

A

Identify
Immobilise (prevent further damage from movement)
Investigate (injuries, neurological exam, ASIA scale for motor and sensory)
Inform

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10
Q

A SCI above what level will produce significant autonomic disruption and why?

A

T5

Origin of the majority of sympathetic output

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11
Q

What is spinal shock?

A

A combination of areflexia/hyporeflexia and autonomic dysfunction that accompanies SCI immediately
Initial hyporeflexia = loss of reflexes below the level of injury
Initial loss of sympathetic outflow = hypotension and bradycardia
Eventual return of reflexes with hyperreflexia

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12
Q

What level of SCI can cause spinal shock?

A

All levels

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13
Q

How long does spinal shock last?

A

3 days to 2 weeks; depends on level and severity of injury

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14
Q

Which reflex is the first to return after spinal shock?

A

Plantar reflex/Babinski’s sign

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15
Q

What is neurogenic shock?

A

Disruption of the autonomic pathways within the spinal cord, resulting in hypotension, bradycardia and hypothermia

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16
Q

What level of SCI can cause neurogenic shock?

A

Above T6

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17
Q

What is an upper motor neuron lesion?

A

Lesion of the neural pathway above the anterior horn cell of the spinal cord or motor nuclei of the cranial nerves

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18
Q

What is a lower motor neuron lesion?

A

Affects nerve fibres traveling from the anterior horn of the spinal cord or the cranial motor nuclei to the relevant muscle

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19
Q

What are the signs of an UMN lesion?

A

Muscle weakness
Increased tone
Increased reflexes

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20
Q

What are the signs of a LMN lesion?

A

Muscle weakness and wasting
Reduced tone
Reduced reflexes
Fasciculations

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21
Q

What are SCI patients at high risk of a week after injury?

A

DVT

Pulmonary embolism

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22
Q

What additional medical complications can SCI patients experience?

A 
Asensory skin
Bladder incontinence
Inability to move bowels
Pain 
Erectile dysfunction 
Autonomic dysreflexia
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23
Q

How is the bladder affected in UMN and LMN lesions?

A

UMN - spinal reflex will cause bladder to empty spontaneously when full
LMN - spinal reflex will be absent, causing incontinence

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24
Q

What makes up the brainstem?

A

Medulla, pons, midbrain (inferior to superior)

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25
Q

What are the functions of the brainstem?

A 
CV, respiratory and GI control 
Cranial nerves 
Ascending tracts to thalamus/cortex 
Descending tracts from motor cortex
Reticular formation 
Neurotransmitters
Consciousness
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26
Q

What is CN 1 and what is it’s function?

A

Olfactory

Smell

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27
Q

What is CN 2 and what is it’s function?

A

Optic

Vision

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28
Q

What is CN 3 and what is it’s function?

A

Oculomotor

Extrinsic eye muscles, striated eyelid muscle, pupil constriction, accommodation

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29
Q

What is CN 4 and what is it’s function?

A

Trochlear

Innervates superior oblique muscle

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30
Q

What is CN 5 and what is it’s function?

A

Trigeminal
Sensory to facial skin/muscle/joints/mouth/teeth (ophthalmic, maxillary and mandibular branches)
Motor to muscles of mastication

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31
Q

What is CN 6 and what is it’s function?

A

Abducens

Innervates lateral rectus muscle

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32
Q

What is CN 7 and what is it’s function?

A

Facial
Sensory to skin of external ear and anterior 2/3 of tongue (taste)
Motor to muscles of facial expression
Secretomotor to lacrimal and salivary glands

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33
Q

What is CN 8 and what is it’s function?

A

Vestibulocochlear

Hearing and balance

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34
Q

What is CN 9 and what is it’s function?

A

Glossopharyngeal

Swallowing, carotid body, sensory to palate and posterior 1/3 of tongue (taste), parotid salivary gland

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35
Q

What is CN 10 and what is it’s function?

A

Vagus

Motor parasympathetic, visceral sensation of pharynx/thorax/abdomen, striated muscles of larynx and pharynx (speech)

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36
Q

What is CN 11 and what is it’s function?

A

Spinal accessory

Trapezius and sternocleidomastoid muscles

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37
Q

What is CN 12 and what is it’s function?

A

Hypoglossal

Innervates tongue muscles

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38
Q

What position should a muscle be in for testing reflexes?

A

Under slight tension but not bearing any weight

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39
Q

What tendon reflexes are present in the lower limb?

A

Knee - patellar tendon

Ankle - Achilles tendon

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40
Q

What tendon reflexes are present in the upper limb?

A

Biceps
Triceps
Supinator

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41
Q

What is a Jendrassik manoeuvre?

A

Method of reinforcing tendon reflexes
Upper limb - clench teeth
Lower limb - pull locked hands apart

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42
Q

What tendon reflexes are present in the head?

A

Jaw-jerk reflex - masseter muscle (not usually visible)

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43
Q

What is the nerve root level of the jaw jerk reflex?

A

CN 5

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44
Q

What is the nerve root level of the biceps reflex?

A

C5/6

45
Q

What is the nerve root level of the triceps reflex?

A

C6/7/8

46
Q

What is the nerve root level of the supinator reflex?

A

C5/6

47
Q

What is the nerve root level of the knee jerk reflex?

A

L3/4

48
Q

What is the nerve root level of the ankle jerk reflex?

A

S1/2

49
Q

What reflex is present on the sole of the foot and what does this test?

A

Plantar response/Babinski’s reflex

Integrity of pyramidal tracts

50
Q

What is a normal and abnormal plantar response?

A

Normal adult - downward curling of the toes (plantar flexion; ‘Babinski negative’)
Normal neonate or adult with a lesion of the cortico-spinal projection - the reflex movement is opposite, with withdrawal of the foot and fanning of the toes (‘Babinski-positive’)

51
Q

What are the 2 methods by which the ball of the thumb has higher sensory innervation than the upper limb?

A

Distribution of cutaneous receptors - higher density of touch receptors
Two-point discrimination - smaller and closer receptive fields

52
Q

What is the cranial cavity comprised of?

A

Anterior, middle and posterior cranial fossa

53
Q

What route does the internal carotid artery take to supply the brain?

A

Passes under the dura of the middle cranial fossa to supply the underside of the brain

54
Q

Through which hole in the skull does the olfactory nerve pass?

A

Cribiform plate (roof of nasal cavity)

55
Q

Through which hole in the skull does the optic nerve pass?

A

Optic foramen

56
Q

Through which hole in the skull does the oculomotor nerve pass?

A

Superior orbital fissure

57
Q

What is the position of the trochlear nerve relative to the oculomotor nerve?

A

Behind, lateral to and smaller than the oculomotor nerve

58
Q

Where does the trigeminal nerve arise from?

A

Pons

59
Q

Through which holes in the skull do the branches of the trigeminal nerve pass?

A

Ophthalmic - superior orbital fissure
Maxillary - foramen rotundum
Mandibular - foramen ovale

60
Q

Which cranial nerve has the longest course in the cranial cavity?

A

Abducens (CN 6)

61
Q

Through which hole in the skull does the facial nerve pass and which other nerve passes with it?

A

Internal acoustic meatus

Vestibulocochlear (CN 8)

62
Q

Through which hole in the skull does the vestibulocochlear nerve pass and which other nerve passes with it?

A

Internal acoustic meatus

Facial (CN 7)

63
Q

In which bone is the internal acoustic meatus found?

A

Temporal bone

64
Q

Which nerves exit the skull through the jugular foramen?

A

Glossopharyngeal (CN 9), vagus (CN 10) and accessory (CN 11)

65
Q

Through which hole in the skull does the glossopharyngeal nerve pass?

A

Jugular foramen

66
Q

Through which hole in the skull does the vagus nerve pass?

A

Jugular foramen

67
Q

Through which hole in the skull does the spinal accessory nerve pass?

A

Jugular foramen

68
Q

Through which hole in the skull does the hypoglossal nerve pass?

A

Hypoglossal canal

69
Q

Through which hole in the skull does the trochlear nerve pass?

A

Superior orbital fissure

70
Q

Through which hole in the skull does the abducens nerve pass?

A

Superior orbital fissure

71
Q

What cranial nerves pass through the superior orbital fissure?

A

Oculomotor
Trochlear
Abducens
Trigeminal (ophthalmic branch)

72
Q

What cranial nerves pass through the internal acoustic meatus?

A

Facial

Vestibulocochlear

73
Q

What is the falk cerebri?

A

A large, crescent-shaped fold of meningeal layer of dura mater that descends vertically in the longitudinal fissure between the cerebral hemispheres of the brain

74
Q

What is the tentorium cerebelli?

A

An extension of the dura mater that separates the cerebellum from the inferior portion of the occipital lobes

75
Q

What is the function of the falx cerebri and tentorium cerebelli?

A

Stop the brain from moving excessively

76
Q

What is the superior sagittal sinus?

A

Large venous channel running front to back in the midline inside the attached edge of falk cerebri
Drains blood from central part of the forebrain and meets the inferior sagittal sinus to form the great cerebral vein

77
Q

What do the superior and inferior sagittal sinuses meet to form?

A

Great cerebral vein

78
Q

Where does the straight sinus receive blood from and where does it drain to?

A

Receives blood from the superior cerebellar veins and inferior sagittal sinus
Drains into the confluence of sinuses

79
Q

Where is the straight sinus found?

A

Junction between falk cerebri and tentorium cerebelli

80
Q

Why is there slow blood flow in the cavernous sinus and what is the clinical significance of this?

A

Meshwork/labyrinth structure
Infection (e.g. from a boil on the skin surface near this area) can cause bacteria to enter the sinus, clot the blood and cause cavernous sinus thrombosis

81
Q

What is cavernous sinus thrombosis?

A

Blood clotting in the cavernous sinus prevents blood draining from the eye, causing swelling accompanied by an increased temperature

82
Q

How might cavernous sinus thrombosis be caused by a dental infection?

A

Through the sphenoidal emissary vein which connects the back of the teeth to the cavernous sinus

83
Q

What is the confluence of sinuses?

A

Where the superior sagittal and transverse sinuses meet

84
Q

What is the sick role?

A

A role of sanctioned deviance; outlines rights and responsibilities of those affected by illness

85
Q

What is illness behaviour?

A

The way in which symptoms are perceived, evaluated and acted upon by a person wo recognises some pain, discomfort or other signs of organic malfunction

86
Q

What is the difference between disease and illness?

A

Disease - disorder of structure and/or function

Illness - expression and experience of ill health; psychological, social and cultural factors

87
Q

What is the locus of control?

A

The degree to which the person believes that control to influence events resides with themself or others

88
Q

What is internal locus of control?

A

Belief that they have the agency in their behaviour and ability to influence the world about them

89
Q

What is the external locus of control?

A

Belief that they have little control over events and that outcomes will be determined by others or by fate

90
Q

What are some common illness behaviours?

A 
Consulting behaviours
Adherence to treatment 
Health promoting behaviours 
Avoidance 
Unhelpful coping strategies – drugs, alcohol
91
Q

What is secondary gain?

A

When a patient unconsciously continues illness behaviours because of something which is positive about being ill

92
Q

What factors are involved in adjustment to illness?

A

Managing uncertainty about the future/searching for meaning/dealing with loss of control
Having a need for openness
Need for emotional/medical support

93
Q

What types of behaviour indicate good coping?

A

Optimal functioning, self-management strategies, reduced co-morbidity, helpful coping behaviours
Optimistic – maintain morale, realistic
Practical – here and now, problem-focused
Willing to consider new strategies – flexible and open to suggestions
Owns own decisions (internal locus of control)
Expresses emotion but avoids extremes

94
Q

What role do cytokines play in adjustment to illness?

A

Large number of non-specific symptoms are mediated through cytokines (e.g. weakness, fatigue, lethargy, anorexia)
Pro-inflammatory cytokines (e.g. TNF, interferon) influence psychological symptoms (e.g. MI, diabetes, cancer)
Interventions can target this (e.g. graded exercise, activity scheduling)

95
Q

How can illness be self-managed?

A 
Understanding illness
Diet, exercise, lifestyle 
Symptom monitoring 
Decision making 
Use of medication 
Concordance with treatment
96
Q

What psychological interventions are available for adjustment to illness?

A

CBT
Motivational interviewing
Acceptance and commitment therapy
Mindfulness

97
Q

In which bone is the foramen rotundum found?

A

Sphenoid

98
Q

What does the foramen rotundum transmit?

A

Maxillary branch of trigeminal nerve

99
Q

Other than CN 9, 10 and 11, what other structure passes through the jugular foramen?

A

Internal jugular vein

100
Q

Where do the first order sensory neurons of the trigeminal nerve synapse with the second order sensory neurons?

A

Spinal nucleus of the trigeminal

101
Q

Why is lumbar puncture contraindicated in a person with raised ICP?

A

Risk of neurological deterioration/herniation – low-pressure shunt is created by LP where CSF can escape which causes CSF pressure to drop and the mass which is causing raised ICP to move towards the site of the LP

102
Q

What structures pass through the foramen magnum?

A

Vertebral arteries, spinal cord/brainstem and spinal accessory nerve

103
Q

Briefly outline the passage of CSF through the ventricular system

A

Lateral ventricle → interventricular foramen → third ventricle → cerebral aqueduct → fourth ventricle → subarachnoid space of the meninges

104
Q

Where is CSF resorbed?

A

In the arachnoid granulations

105
Q

What are the arachnoid granulations?

A

Projections of the arachnoid membrane into the dural sinuses which allows CSF to pass from subarachnoid space into venous system

106
Q

What is the primary blood supply of the visual cortex?

A

Calcarine branch of the posterior cerebral artery

107
Q

What does the foramen ovale transmit?

A

Mandibular branch of the trigeminal nerve

108
Q

What is a vestibular schwannoma?

A

Benign primary intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve (8th cranial nerve)

Head, Neck and Neurological Systems (6 decks)

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