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NEUROLOGY > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What is a group of nerve cell bodies in the CNS called and how is this named differently in the PNS?

A

CNS - Nucleus

PNS - ganglion

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2
Q

How can you tell the difference between an axon and the dendrites of a multipolar neuron?

A

Usually axon = longest process

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3
Q

What type of signals are usually transported via MULTIPOLAR neurons?

A

Motor efferent signals

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4
Q

What type of signals are usually transported via pseudounipolar neurons?

A

Sensory afferent signals

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5
Q

A nerve is a bundle of what?

A

Axons

this is called a tract in the CNS

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6
Q

Tracts tend to be of a “single modality”. What does this mean?

A

all axons contained within it have the same job

i.e. somatic motor/sensory, special sensory etc

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7
Q

What is meant by “mixed modality” nerves?

A

Axons for somatic motor and sensory and sympathetic all together in one nerve

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8
Q

What cranial nerves connect to the CNS in the forebrain?

A

CN I and CN II

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9
Q

What cranial nerves connect to the CNS via the midbrain?

A

CN III and CN IV

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10
Q

Where does CN V connect to the CNS?

A

Pons

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11
Q

What cranial nerves connect to the CNS at the pons-medullary junction?

A

VI, VII, VIII

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12
Q

Which of CN IX, X XI and XII does NOT connect to the CNS at the medulla?

A

CN XI connects at the spinal cord (SPINAL ACCESSORY NERVE)

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13
Q

Spinal nerves are actually very small. TRUE/FALSE?

A

TRUE - they are only found in the intervertebral foraminae as on one side they are rootlets/roots OR the opposite side = rami

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14
Q

What do the anterior and posterior rami supply?

A

Body walls (soma)

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15
Q

Are roots and rootlets single or mixed modality?

A

Single modality
Posterior rootlets/roots = somatosensory
Anterior rootlets/roots = somatomotor

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16
Q

Are spinal nerves and rami single or mixed modality?

A

Mixed modality

Anterior and Posterior roots come together and mix forming spinal nerve

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17
Q

What is the name given to the swelling on the posterior (or dorsal) root? And what does it contain?

A

Dorsal root ganglion

- contains a collection of cell bodies)

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18
Q

Rami supply what in their segment of the body?

A
  • sensory supply to area
  • somatic motor supply to skeletal muscles
  • sympathetic supply to the skin and to the smooth muscle of arterioles
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19
Q

What is a dermatome?

A

area of skin supplied with sensory innervation from a single spinal nerve
e.g. T4 dermatome (nipple level)

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20
Q

What is a myotome?

A

skeletal muscles supplied with motor innervation from a single spinal nerve

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21
Q

Myotomes lie under the corresponding spinal nerve dermatome. TRUE/FALSE?

A

FALSE - this is not always the case
e.g. C3,4,5 dermatome = shoulder and upper arm
BUT myotome = diaphragm

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22
Q

Dermatomes for spinal nerves can overlap. TRUE/FALSE?

A

TRUE

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23
Q

Why is dermatome overlap a clinical issue?

A

If patient experiences a symptom (e.g. numbness/tingling) in a specific dermatome then we must contemplate that nerves in adjacent dermatomes may also be damaged

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24
Q

What dermatome levels mark the nipple and the umbilicus?

A

T4- nipple

T10 - umbilicus

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25
Q

Roughly describe what each segement of spinal nerves innervates (I.e. cervical,thoracic, etc)

A

Cervical - Upper limbs, posterior neck and head
Thoracic - thorax
Lumbar - anterior of lower limbs
Sacral - posterior of lower limbs

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26
Q

What makes up a nerve plexus?

A

ANTERIOR RAMI

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27
Q

What anterior rami make up each plexus?

A

Cervical C1-C4
Brachial C5-T1
Lumbar L1-L4
Sacral L5-S4

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28
Q

Its is possible for more than one named cutaneous nerve to pass through 1 dermatome. TRUE/FALSE?

A

TRUE

e.g. lateral cutaneous nerve of thigh, femoral nerve and obturator nerve ALL pass through L2 dermatome

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29
Q

Between what spinal levels does sympathetic outflow leave the spinal cord?

A

T1-L2

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30
Q

What extra horns are found in the spinal cord where sympathetics or sacral parasympathetics leave?

A

Lateral horns (on edge of grey matter in spinal cord)

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31
Q

What 4 ways are used by sympathetics to leave the spinal cord?

A

1) Signal ascends sympathetic chain before synapsing
2) Signal synapses on same spinal level it leaves
3) Signal descends sympathetic chain before synapsing
4) Passes through symp. chain without synapsing, passes onto splanchnic nerves and then synapses onto viscera

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32
Q

What term is used to describe parasympathetic outflow and why is this?

A

Craniosacral Outflow

  • cranial nerves III, VII, IX and X
  • sacral spinal nerves
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33
Q

What is the difference between the extrinsic and intrinsic muscles of the back?

A

Extrinsic attach outwith back

  • attach back to pectoral girdle
  • move upper limb

Intrinsic attach within the spine

  • Maintain posture
  • Superficial - Erector Spinae
  • Deep muscles - Tranversospinalis
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34
Q

Strain of which muscle may cause lower back pain?

A

erector spinae strain

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35
Q

What nerves supply the extrinsic vs the intrinsic muscles?

A 
Extrinsic = Anterior rami
Intrinsic = Posterior rami
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36
Q

What movement is created if erector spinae contracts unilaterally?

A

Lateral flexion

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37
Q

Why do vertebrae get larger towards the lumbar region and then progressively smaller again

A

Larger to bear more weight

UNTIL weight has transferred to hip bones

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38
Q

What curves of the spine are considered SECONDARY? (AKA not present from birth, they have adapted to new functions of the spine)

A

Cervical and Lumbar Lordosis

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39
Q

Where are spinal nerves found and where is the spinal cord found in relation to the vertebrae?

A

Spinal nerves = intervertebral foramen

Spinal cord = vertebral foramen

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40
Q

What ligaments are found on the outside of the vertebral body?

A

posterior longitudinal ligament (between body and spinal cord)

anterior longitudinal ligament (wider and gives more support)

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41
Q

What ligament attaches between adjacent vertebrae?

A

ligamentum flavum

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42
Q

Where are the supraspinous ligament and interspinous ligament found?

A

supraspinous ligament = connects tips of spinous processes
(Strong)

interspinous ligament
connects adjacent spinous processes
(weak)

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43
Q

What features are typical of the cervical vertebrae?

A
  • transverse foramen
  • bifid spinous process
  • triangular shaped vertebral foramen
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44
Q

C1 does not have a body or spinous process. TRUE/FALSE?

A

TRUE

body is donated to C2 as odontoid process

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45
Q

Why is C7 important?

A

first palpable spinous process in ~70% of people

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46
Q

How does C1- Atlas connect to the base of the skull

A

Connection between occipital condyles and the superior articular facets of the atlas
- synovial joints for maximum movement

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47
Q

What movements does the Atlanto-occipital joint allow?

A

Flexion, extension

Little lateral flexion and rotation

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48
Q

How many articulations are part of the Atlanto-axial joint?

A

3 articulations – all synovial

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49
Q

What is the main function of the atlanto-axial joint?

A

Rotation

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50
Q

C1 disappears on a radiograph as it has no spinous process. TRUE/FALSE?

A

FALSE

the posterior arch appears like a spinous process would

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51
Q

It is easier to fracture cervical vertebrae than dislocate them. TRUE/FALSE?

A

FALSE
much easier to dislocate them
Sometimes they will reduce by themselves

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52
Q

What nerves pass through the anterior and posterior sacral foraminae?

A

Rami of spinal nerves

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53
Q

What is the cauda equina made up of?

A

Nerve roots from L2 -> Co1 descending to their intervertebral foramen at their level

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54
Q

Why is it safer to perform an epidural or lumbar puncture at the level of the cauda equina?

A

No damage to the spinal cord

Nerve roots more likely to move out of way of needle

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55
Q

What can result from an epidural or lumbar puncture which damages the venous plexus in the epidural fat?

A

Epidural haematoma which can compress the spinal cord

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56
Q

What layer of meninges needs to be reached during a lumbar puncture?

A

Subarachnoid space containing CSF for extraction

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57
Q

What is a laminectomy?

A

Removal of one or more spinous processes and the adjacent lamina

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58
Q

What functions are defined as special sensory?

A 
Sight
Smell
Taste
Hearing
Balance
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59
Q

CN I only has a special sensory function. TRUE/FALSE?

A

TRUE

Only special sensory for smell

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60
Q

What is the extracranial part of CN I?

A

bipolar neurons in the olfactory mucosa of nasal cavity

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61
Q

What cranial foraminae does CN I pass through?

A

Cribriform plate of the ethmoid bone

In the Anterior cranial fossa

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62
Q

What part of CN I is intracranial?

A

olfactory bulb and tract

63
Q

Is CN II sensory or motor?

A

Special sensory - sight

64
Q

Where does CN II appear extracranially?

A

Neurons in retina connect to optic nerve at back of orbit

65
Q

What cranial foraminae does CN II pass through?

A

optic canal

In the middle cranial fossa

66
Q

What part of CN II is found intracranially?

A

optic chiasm joins to form the optic tract.

67
Q

Does CN II connect to the CNS?

A

Yes connects at Diencephalon/ Thalamus

68
Q

How is CN I clinically tested?

A

Get patient to smell a familiar smell while covering the contralateral nostril.

e.g. Orange/lemon peel, coffee or vinegar

69
Q

How is CN II clinically tested?

A 
5 Ways:
Acuity (Snellen charts)
Colour
Fields
Reflexes (this also tests efferent limb of reflex though!)
Fundoscopy
70
Q

Is CN III sensory or motor, and what are its functions?

A

Motor (moves eyes)

Parasympathetic (motor) for pupil constriction

71
Q

Where does CN III connect with the CNS?

A

Midbrain (mesencephalon)

72
Q

Where does CN III travel intracranially when attempting to reach the eye?

A

Towards the orbit in the lateral wall of the cavernous sinus, through the common tendinous ring

73
Q

Through which cranial foraminae does CN III pass through, and what other nerves also pass through here?

A

Superior orbital fissure

CN IV, V1 and VI

74
Q

Where does CN III end up extracranially?

A

Passes into orbit and supplies ALL extraocular muscles except two.
Parasympathetics synapse in ciliary ganglion

75
Q

Where does the trochlear nerve communicate with the CNS?

A

Midbrain (mesencephalon)

76
Q

Is CN IV sensory or motor?

A

Motor (moves Superior oblique muscle in eye)

77
Q

What course is taken by CN IV intracranially?

A

Travels towards the orbit in the lateral wall of the cavernous sinus, but does NOT pass through common tendinous ring

78
Q

How are CN III and IV different in they wa they innervate the muscles of the eye?

A

CN III passes through common tendinous ring to innervate from deep to the muscles

CN IV does ONT pass through ring, and instead sits on top of Superior oblique to innervate

79
Q

Is CN VI sensory or motor, and what is its main function?

A

Motor to Lateral rectus

=> abducts the eye

80
Q

Where does CN VI meet the brainstem?

A

Pontomedullary junction

81
Q

What course does CN VI take intracranially?

A

Travels towards the orbit within the cavernous sinus.

similar to CN III

82
Q

Other than CN III and VI, what other structure travels towards the orbit in the cavernous sinus?

A

Ophthalmic artery

83
Q

Where does CN VI appear extracranially?

A

Found in orbit supplying only the lateral rectus muscle.

84
Q

How can each ocular muscle be isolated to test the cranial nerves?

A

The “H” Test

85
Q

What is the function of CN VIII?

A

Special Sensory (Hearing and Balance)

86
Q

Where is CN VIII found extracranially?

A

Axons from cochlear and vestibular apparatus.

87
Q

Which of the cranial foraminae does CN VIII pass through? What other nerve passes through here?

A

Internal acoustic meatus
(In posterior cranial fossa)
- CN VI also passes through here

88
Q

Where does CN VIII meet the CNS?

A

pontomedullary junction

89
Q

How is CN VIII clinically tested?

A

Rinne and Weber tests

(Rinne's = tuning fork on mastoid process for conductive hearing loss)
(Weber's = tuning fork on forehead for Sensorineural Hearing loss)
90
Q

CN XI has a motor supply to which two muscles?

A

Sternocleidomastoid and Trapezius

91
Q

Where does CN XI connect to the CNS?

A

Connection with the CNS:
Cervical spinal cord (C1-4/5)

Cranial foramina:
Jugular Foramen
In posterior cranial fossa

Extracranial part:
Axons supply SCM on deep surface, then continue across the posterior triangle to supply trapezius and SCM

92
Q

Describe the intracranial course of CN XI, and the cranial foramina from which it exits the skull

A
  • Ascends through foramen magnum from spinal cord

- Travels towards jugular foramen to exit with CN IX and X

93
Q

Describe the extracranial course of CN XI

A

Axons supply sternocleidomastoid on deep surface

Then travel across the posterior triangle to supply trapezius

94
Q

How can CN XI be clinically tested?

A

Ask patient to shrug shoulders to test TRAPEZIUS

Ask them to flex neck and turn towards the opposite side => STERNOCLEIDOMASTOID

95
Q

If a patient has trapezium weakness but the sternocleidomastoid is intact, where may the damage/lesion be located?

A

After CN XI passes through posterior triangle, as it has already supplied SCM by this point

96
Q

Is CN XII sensory or motor? What does it supply?

A

Motor to muscles of the tongue

97
Q

Where does CN XII connect to the CNS?

A

In groove between pyramids and olives of the medulla

98
Q

What cranial foraminae does CN XII use to exit?

A

Hypoglossal Canal

99
Q

Describe the extracranial course of CN XII?

A

Descends lateral to carotid sheath.

At the level of the hyoid loops around occipital artery to change direction and supply tongue

100
Q

Which of the tongue muscles does CN XII not innervate?

A

palatoglossus.

101
Q

How can CN XII be clinically tested?

A
  • Ask patient to stick tongue straight out

- If unilateral CN XII pathology the tongue tip will point TOWARDS the side of the injured nerve

102
Q

Where does CN V connect to the CNS?

A

Pons

only one that connects here

103
Q

What cranial foraminae are used by the divisions of CN V?

A

V1 -Superior orbital fissure
V2- Foramen rotundum
V3- Foramen ovale

104
Q

What structures are found in the CN V1 dermatome?

A
  • upper eyelid
  • cornea (corneal reflex)
  • conjunctiva
  • Skin of the root/bridge/tip of the nose
105
Q

What is covered by the CN V2 dermatome?

A

From the skin of the lower eyelid over the maxilla to the upper lip

106
Q

What structures are covered by the CN V3 dermatome?

A

Skin over the mandible and TMJ

107
Q

What deeper structures do the trigeminal divisions supply under their dermatomes?

A

V1 - Bones & soft tissues of the orbit, anterior nasal cavity
V2 - posterior nasal cavity, maxillary sinus, upper dental arch
V3 - Mandible, Floor of the mouth, Buccal mucosa, lower dental arch

108
Q

What larger muscles does CN V3 supply and what is their main function?

A 
Muscles of mastication:
**CLOSE**
Masseter
Temporalis
Medial Pterygoid

OPEN
Lateral pterygoid

109
Q

What two small muscles are supplied by CN V3 and what are their functions?

A

Tensor veli palatini - tenses palate

Tensor tympani - muffles sounds

110
Q

How is the sensation of the CN V1,2,3 dermatomes tested?

A

brush the skin in each dermatome with a fine tip of cotton wool

111
Q

How is the motor function of CN V3 tested?

A
  • Palpate the contraction of masseter & temporalis by asking patient to clench teeth
  • Ask the patient to open their jaw against resistance
112
Q

Is CN VII sensory or motor?

A

Special Sensory (Taste), Motor AND parasympathetics

113
Q

How does CN VII enter and exit the cranium?

A

IN - Internal Acoustic Meatus

OUT - Stylomastoid foramen

114
Q

Describe the extracranial course of CN VII

A
  • Somatic motor axons pass into the parotid gland

- Then form 6 branches supplying muscles of facial expression

115
Q

What part of the CN VII course does the chorda tympani arise from?

A

Splits off from CN VII in facial canal
Found in temporal bone
AT posterior surface of the middle ear

116
Q

What does the chorda tympani go on to supply?

A
  • Taste - anterior 2/3rds of the tongue

- Parasympathetic - salivary glands

117
Q

What is the smallest muscle in the body, which is supplied by CN VII, and what is the function of this muscle?

A

Stapedius

- Reduces stapes movement to protect the internal ear from excessive noise

118
Q

What nerve does the Chorda tympani piggy back on, in order to supply the salivary glands and the tongue?

A

Lingual nerve (division of V3)

119
Q

What muscles of facial expression does CN VII supply?

A

Frontalis (forehead)
Orbicularis oculi
Elevators of lips
Orbicularis oris

120
Q

How are the muscles of facial expression used to test CN VII?

A

Raise eyebrows (frontalis)
Close eyes tightly (orbicularis oculi)
Smile (lip elevators)
Puff out cheeks and hold air (orbicularis oris)

121
Q

What are the many functions of CN IX?

A

Special sensory (vallate papillae - Taste)

Sensory

  • posterior 1/3rd of the tongue
  • pharynx
  • palatine tonsil
  • eustachian tube and middle ear

Motor - stylopharyngeus

Visceral afferent - carotid sinus

Parasympathetic (motor) - parotid gland

122
Q

Describe the extracranial course of CN IX in order to complete all of its functions

A

Descends towards pharynx and mouth

123
Q

Describe the extracranial structures supplied by the vagus nerve CN X?

A

Axons supply lots of structures BETWEEN the palate and the midgut

124
Q

The vagus nerve runs just lateral to the carotid sheath. TRUE/FALSE?

A

FALSE
CN XII runs just lateral to the sheath
whereas CN X runs within the carotid sheath

125
Q

What does the vagus nerve curve under on either side?

A

Left curves under arch of aorta

Right curves under subclavian

126
Q

How is the vagus nerve transported to the structures in the gut?

A

On arteries

127
Q

How can CN X be clinically tested?

A
  • Ask patient to say ‘ahhhhh’ - tests MUSCLES OF PALATE
  • Ask patient to swallow small amount of water - tests PHARYNGEAL MUSCLES
  • Listen to speech - tests LARYNGEAL MUSCLES
128
Q

Why are space occupying lesions (SOL) such a problem in the skull?

A
  • Not a lot of extra space
  • Can cause raised Intracranial Pressure (ICP)
  • Contents can be compressed or attempt to herniate
129
Q

What are the 5 layers of the scalp?

A 
S = Skin
C = Connective tissue
A = Aponeurosis
L = Loose connective tissue
P= Pericranium
130
Q

Which layer of the scalp contains the anastomotic network of arteries?

A

C = Connective tissue

131
Q

Why does the scalp tend to bleed a lot when injured?

A

Connective tissue layer housing blood vessels is very sturdy and holds vessels open when they are cut into

132
Q

What is thought to be the weakest point in the skull, and what artery is found deep to this area?

A

Pteryion
(where frontal, parietal, temporal and sphenoid bones meet and have an H shaped suture)

Middle meningeal artery found behind this

133
Q

The dura mater has two layers. What are these layers called, and what can arise between them?

A

Periosteal layer - over bone
Meningeal layer - over arachnoid layer

dural venous sinuses form between them

134
Q

A fracture of the skull is likely to penetrate through a suture. TRUE/FALSE?

A

FALSE

sutures stop the propagation of fractures in the skull

135
Q

The middle meningeal artery creates a groove in the base of the skull that leads to which foramina?

A

Foramen spinosum

136
Q

Where does the pain in meningitis arise from, and why?

A

Stretching of the dura mater

dura is only meningeal layer with sensory innervation

137
Q

What are arachnoid granulations from the arachnoid mater?

A

projections up into the dural venous sinuses which reabsorb CSF

138
Q

What layer of the dura mater does not extend down to the spinal cord?

A

Periosteal - as no part is needed to cover bone

139
Q

What tough sheet of dura mater forms a roof over the pituitary fossa?

A

diaphragm sellae

140
Q

What name is given to the sheet of dura mater which covers the cerebellum ?

A

Tentorium Cerebelli

141
Q

What is the Falx cerebri?

A

infolding of 2 dura mater layers in lilne with sagittal suture
Attaches to crista galli anteriorly and merges with tentorium cerebelli posteriorly

142
Q

How does blood from the cerebral hemispheres of the brain drain to the dural venous sinuses?

A

Cerebral veins

143
Q

What is a secondary function of the dural venous sinuses?

A

reabsorb CSF from arachnoid granulations

144
Q

Why is an infection to the facial vein (superficial) rather dangerous?

A

Can track back to cavernous sinus in brain and cause infection

145
Q

What artery does the vertebral artery branch from?

A

The subclavian artery

146
Q

What are the main arteries in the Circle of Willis supplying the cerebrum?

A

Anterior Middle and Posterior cerebral arteries

147
Q

In what layer of the meninges is the Circle of Willis found?

A

Subarachnoid space => its bathed in CSF

148
Q

When would damage to the Circle of Willis or one of its branches be suspected?

A

If blood was found in the CSF

149
Q

Describe the course of CSF from production to the subarachnoid space (and a little to centre of spinal canal)

A 
Made in choroid plexus 
Lateral ventricles 
-> foramina of Monro
-> 3rd ventricle
-> cerebral aqueduct
-> 4th ventricle
-> subarachnoid space
150
Q

What 3 situations can cause hydrocephalus?

A
  1. Overproduction
  2. Flow obstruction
  3. Inadequate reabsorption
151
Q

What intervention can be done in children for hydrocephalus?

A

ventricular peritoneal shunt

moves CSF reabsorption point down into peritoneum

152
Q

Where is it possible to bleed in the cranial cavity and what can cause this?

A

EXTRADURAL

  • between bone and dura
  • ruptured middle meningeal artery

SUBDURAL

  • separates the dura from the arachnoid
  • torn cerebral veins

SUBARACHNOID

  • bleed into the CSF of subarachnoid space
  • ruptured Circle of Willis (“berry”) aneurysm
153
Q

How can parts of the brain herniate if there is raised ICP?

A
  • *Parts ABOVE tentorium cerebelli**
    1. Subfalcine - can move under falx cerebri
    2. Central - move over the tentorium cerebelli
    3. Trancalvarial - move out through fractured bone
    4. Uncal - moves down towards tentorium cerebelli
  • *Parts UNDER tentorium cerebelli**
    1. Upward cerebellar - move towards tentorium cerebelli
    2. Tonsillar - Cerebellum moves downwards

NEUROLOGY (29 decks)

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