Irene Gold Spinal Anatomy

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Irene Gold Spinal Anatomy
2011-03-15 18:37:31
NBCE Spinal anatomy

Flashcards based on Irene Gold board review of spinal anatomy
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  1. What are the three germ cell layers?
    Endoderm (epithelium of respiratory tract and GI tract), mesoderm (everything else) and ectoderm (epidermis, hair, retina, anterior pituitary, CNS, PNS, adrenal medulla)
  2. What does the neural tube give rise to?
    brain, spinal cord, ventricles, retina, posterior pituitary
  3. What does the neural crest give rise to?
    Sympathetics, Schwann cells, Melanocytes, Meninges, Brachial arches, Adrenal medulla, Dorsal root ganglion, Meissner's plexus, Auerbach's plexus "SM SM BAD MA"
  4. What are the primary and secondary vesicles?
    Proencephalon (forebrain --> Telencephalon and Diencephalon), Mesencephalon (midbrain --> Mesencephalon), Rhombencephalon (hindbrain --> Metencephalon and Myelencephalon) "Tel Di Mes Met My"
  5. What does the telencephalon give rise to?
    cerebrum, lateral ventricles, septum pellucidum, caudate and lenticular nuclei
  6. What does the Diencephalon give rise to?
    Thalamus, epithalamus, hypothalamus, hypophysis, infundibulum, optic chiasm, 3rd ventricle, mammillary body
  7. What does the Mesencephalon give rise to?
    midbrain, cerebral peduncles, aqueduct of sylvius
  8. What does the Metencephalon give rise to?
    Pons and cerebellum
  9. What does the Myelencephalon give rise to?
    Medulla oblongata, 4th ventricle
  10. What are the glia cells?
    astrocyte (support blood brain barrier), microglia (macrophage of brain, from mesenchyme), ependymal (lines ventricles and makes CSF), oligodendrocytes (makes myelin in CNS), Schwann cells (makes myelin in the PNS)
  11. Sympathetic nervous system
    T1 to L2, fight or flight (visceral motor, autonomic, not thinking), vasoconstriction of central arteries and vasodilation of arterioles of muscles and capillaries of skin, arector pili, sweat glands
  12. Pathway of sympathetics
    IML (intermediate lateral cell nucleus) in the spinal cord) leave the cord via white (myelinated) rami communicates (preganglionic type B fibers), synapse on Sympathetic chain ganglion then leave via grey (unmyelinated) rami communicantes (postganglionic type C fibers), Norepinephrine and epinephrine are released
  13. What fiber does not synapse?
    fiber to the adrenal medulla
  14. What is a pheochromocytoma?
    gray color cell tumor which causes hypertension (HTN) by secreting excess epinephrine
  15. What is the superior sympathetic chain ganglion?
    above C4 pupil dilation
  16. What is the middle sympathetic chain ganglion?
    C4 to C5
  17. What is the inferior sympathetic chain ganglion?
    C6 to C8
  18. What is the Stellate ganglion?
    C8 to T1, merger between inferior sympathetic chain ganglion and upper thoracic ganglion
  19. What is horner's syndrome?
    ptosis, meiosis, anhydrosis
  20. Parasympathetic
    • CN III --> ciliary ganglion --> pupil constriction
    • CN VII --> superior salvitory nucleus --> sphenopalantine (pterygoplatine - motor --> lacrimal gland) and sphenomandibular (submandibular) --> geniculate nucleus and salivary glands
    • CN IX --> Inferior salvitory nucleus --> otic ganglion --> parotid glands
    • CN X --> Baroreceptors in carotids and pneumotaxic center (hering brewer reflex) (stretch receptors/lung say "lungs are full" - apneustic center inhibits pneumotaxic center
    • S2 to S4
  21. Cerebrum
    • Intellect and association
    • Frontal lobe - motor
    • Parietal lobe - sensory
    • Occipital lobe - sight
    • Temporal lobe - hearing
  22. Thalamus
    relay station, sensory fibers
  23. hypothalamus
    hunger, thirst, temperature regulation, sex, rage, fear
  24. Cerebellum
    balance and equilibrium, involuntary coordination
  25. Medulla and pons
    vasomotor, cardiac center, autonomic NS
  26. Basal ganglia
    collection of cell bodies that lie within the white matter of the cerebrum, plan and coordinate voluntary movement - putamen (large, dark, lateral), globus pallidus (small, pale, medial), caudate nucleus, amygdala, substantia nigra, subthalamic nucleus
  27. Lentiform nucleus
    putamen + globus pallidus, becomes damaged in Wilson's disease
  28. Striatum
    putamen and caudate nucleus - primary control of involuntary movement and posture
  29. fibers of the cerebrum
    association (connect regions of the same hemisphere), commississural (carry impulses across the corpus callosum), projection (send impulses from below to the cortex
  30. Cerebellum lobes
    flocculondoular for equilibrium, anterior and posterior for coordination (all work ipsilaterally)
  31. fibers to the cerebellum
    climbing fibers (afferent input from inferior olivary nucleus), pontocerebellar fibers (pass through middle cerebellar peduncle) (mossy fibers), spinocerebellum tract
  32. Cerebellar nuclei
    fastigial (balance), globus (2), emboliform, dentate
  33. fibers that leave the cerebellum by superior peduncle
    go to thalamus, red nucleus, vestibular nucleus (only efferent/motor aspect of cerebellum - done by purkinje fibers)
  34. What plans and controls movement?
    cerebellum accelerates, basal ganglia brakes
  35. Sinuses of the brain
    • Superior cerebral vein --> superior sagittal sinus (drains superior) --> confluence of sinuses (level of EOP)
    • Inferior sagittal sinus and great cerebral vein --> straight sinus (drains middle) --> confluence
    • Occipital sinus (drains posterior) --> confluence
    • Confluence --> right and left transverse sinuses --> sigmoid sinus
    • Sphenoparietal --> cavernous --> superior petrosal --> sigmoid sinus
    • Sigmoid sinus and inferior petrosal --> internal jugular vein (drains the brain)
  36. Flow of CSF
    Choroid plexus in the lateral ventricles makes the CSF (ependymal cells) --> foramen of monroe (interventricular foramen) --> 3rd ventricle --> cerebral aqueduct (aqueduct of sylvius) --> 4th ventricle --> foramen of magendie (medial) and lushka (lateral) --> subarachnoid space and central canal (reabsorbed in arachnoid villi in the superior sagittal sinus
  37. What branches off of the basilar artery?
    Laberinthine arteries, pontine arteries, superior cerebellar arteries and posterior cerebral arteries
  38. What branches off of the vertebral artery?
    Inferior cerebellar artery and anterior and posterior spinal artery
  39. Lateral corticospinal
    voluntary movement
  40. ventral corticospinal
    voluntary movement to distal extremities
  41. Rubrospinal tract
    flexors of proximal upper limb
  42. Reticulospinal tract
    posterior musculature above T6 and anterior musculature below T6
  43. Olivospinal tract
    mediates equilibrium
  44. Vestibulospinal tract
    medial extensor muscles of the back
  45. Tectospinal tract
    reflexes from vision and hearing to turn the head
  46. Ventral spinothalamic
    touch, pressure
  47. Lateral spinothalamic
    pain and temperature
  48. dorsal spinocerebellar
    unconscious proprioception from upper extremity
  49. ventral spinocerebellar
    unconscious proprioception from lower extremity
  50. posterior columns
    Gracilis from lower extremity and cuneatus from upper extremity - conscious proprioception, vibration, two point discrimination, position sense
  51. Medial lemniscus
    in the medulla not the spinal cord, merger of the posterior columns and spinothalamic tracts in the medulla
  52. Lamina I
    Incoming dorsal roots - DRG (ganglion nerve cell body outside CNS), 1st synapse for all sensory nerves except for reflexes and pain (V), pain and temperature
  53. Lamina II
    Substantia gelatinosa - incoming dorsal axons, edits sensory of superior colliculus, mechanoreceptors synapse here, presynaptic pain inhibition
  54. Lamina III and IV
    Nucleus propius - for touch and pressure - receives from IV, V, VI
  55. Lamina IV
    Basal spinal nucleus - post synaptic pain inhibition, endorphins and enkephalins from periaqueductal gray from aqueduct of sylvius, nucleus propius for touch and pressure - recieves from IV, V, and VI
  56. Lamina V
    Corticospinal --> V, VI and VII, at posterior horn, pain synapses
  57. Lamina VI
    Primary sensory neurons
  58. Lamina VII
    T1 to L2, intermediolateral cell column (IML) - intermediate between dorsal an dventral nerve supply for sympathetic reflex (flight or flight) (vasodilation, sweating, controlling blood supply), dorsal nucleus of clarke makes up part of lateral horn
  59. Lamina VIII
    Descending tracts - at anterior horn, termination of ventral fibers (vestibule), alpha motor neurons to extrafusal fibers of muscle, controlled by precentral gyrus (frontal lobe)
  60. Lamina IX
    Large motor neurons - lamina to limb plexuses, gamma motor neurons to intrafusal fibers for muscle tone, controlled by dentate nucleus (cerebellum)
  61. Lamina X
    Gray commissure - surrounds central canal (small interneurons), decussating axons
  62. How many spinal nerves are there?
    8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal (31 total)
  63. Boundaries of IVF
    anterior is disc and body, posterior is articular facets, superior is superior pedicle, inferior is inferior pedicle
  64. CN III
    Occulomotor --> ciliary ganglion --> pupillary constrictor
  65. CN V
    Trigeminal --> Gasserian ganglion (motor and sensory)
  66. CN VII
    • facial --> superior salvitory nucleus
    • 1. --> sphenopalantine (motor) --> lacrimal gland
    • 2. --> submandibular --> salivary glands --> geniculate --> taste
  67. CN IX
    Glossopharyngeal --> inferior salvitory nucleus --> otic ganglion --> parotid gland
  68. CN IX, X
    motor --> nucleus ambiguus --> muscles of pharynx and larynx
  69. CN X
    vagus dorsal motor nucleus --> parasympathetic to 2/3 of the transverse colon
  70. CN XI
    spinal accessory --> innervates SCM and trapezius
  71. Parts of the eye
    • Anterior cavity - anterior chamber (cornea to iris - filled with aqueous humor, produced by ciliary epithelium) and posterior chamber (iris to lens - filled wiht aqueous humor) - communicate by way of the pupil
    • Posterior cavity - lens to retina - filled with vitreous humor
  72. Fovea centralis
    the area of most acute vison found in the center of the macula
  73. parts of the retina
    rods and cones --> bipolar cells --> ganglion cells
  74. optic nerve (CN II)
    ganglion axons make up the optic nerve --> optic chiasm (optic chiasm lesion --> bitemporal hemianopsia) --> optic tract --> lateral geniculate body (in the thalamus - all sensory info except smell goes here) --> optic radiation --> visual cortex in occipital lobe
  75. Pathway of a loud noise that makes you turn your head
    cochlear nerve --> trapezoid body --> superior olivary nucleus --> inferior colliculus --> tectospinal pathway --> cervical muscles
  76. Superior colliculus
    Lateral geniculate/thalamus - for reflex of eyes with neck movement
  77. Inferior colliculus
    Medial geniculate/thalamus - for reflex of ears with neck movement
  78. Functions of the ear
    hearing and balance
  79. auditory pathway
    perilymph: External Auditory Meatus --> tympanic membrane --> malleus --> incus --> stapes --> oval window --> cochlea (contains organ of corti for sound perception), spiral ganglion of corti --> cranial nerve VIII (cochlear nucleus)
  80. Where does hearing travel from the cochlear nucleus?
    ventral fibers detect loudness and timing of sound and go to the secondary neurons (trapezoid body) and the dorsal fibers which detect quality of sound go to the superior olivary nucleus
  81. Where does sound travel from the superior olivary nucleus?
    via Lateral lemniscus to the Inferior colliculus to the Medial geniculate body of the thalamus then auditory radiation to the superior gyrus in temporal lobe "SLIM"
  82. How is balance detected?
    endolymph: semicircular canals (detection by the christa ampullaris determines rotation and angular acceleration), utricle (responsible for static equilibrium), sacule (responsible for linear acceleration, thickening of utricle in sacule where hair cells is located is called macula)
  83. How is smell detected?
    sensory neuron --> cribiform plate --> olfactory bulb (mitral cells) -->Uncus (associated with the rhinecephalon and hippocampus
  84. parts of the limbic system
    uncus of the parahippocampus, dentate gyrus of the hippocampus, fornix, amygdaloid
  85. nasal meatuses
    superior (posterior ethmoid air cells open here) middle (maxillary and frontal sinuses drain here), inferior (nasolacrimal duct drains here)
  86. Nerves of the arm
    Axillary (C5 - from posterior cord), Musculocutaneous (C6 - from lateral cord), Radial (C6-T1 - serves all extensors - from posterior cord), Median (C6-T1 - from medial and lateral cords), Ulnar (C8-T1 - from medial cord)
  87. Nerves of the leg
    obturator (L2-4 - adductors of thigh), femoral (L2-4 - leg extensors), sciatic (L4-S3 - leg flexors), deep peroneal (medial leg and foot), superficial peroneal (lateral leg and lateral foot), tibial (posterior leg)
  88. Anterior common spinal ligaments
    • ALL (anterior longitudinal ligament in front of the vertebral bodies --> anterior atlanto-occipital from atlas to occiput) (limits extension)
    • PLL (posterior longitudinal ligament in back of vertebral bodies, anterior portion of canal --> tectoral membrane from C2 to occiput) (wider in cervicals, thinner in lumbars, homonym of sacrococcygeal, limits flexion)
    • IVD (intervertebral disc)
  89. Middle common spinal ligaments
    • LF (ligamentum flavum = yellow ligament) from lamina to lamina (posterior portion of canal) (high elastic fiber content, limits flexion) --> posterior atlantoaxial ligament from C2 to C1 --> posterior atlantooccipital ligament from C1 to occiput
    • CL (capsular ligament) - articular process to articular process
    • ITL (intertransverse ligament) - from TP to TP
  90. Posterior common spinal ligaments
    • ISL (interspinous ligament) - between the spinous process
    • SSL (supraspinous ligament) - from SP to SP
    • Ligamentum nuchae - SS ligament from C7 to occiput
  91. Upper cervical ligaments
    • TL (transverse ligament) - holds dens in fovea dentalis of atlas (fovea dentalis is on posterior side of anterior tubercle of atlas)
    • CL (cruciate ligament) - runs from occiput to body of C2, includes transverse ligament, cross-shaped (transverse ligament across part of the cross and vertical portion from axis to occiput)
    • AL (alar ligament or check ligament) - from sides of the dens to occipital condyles, limits rotation of C2
    • AD (apical dental ligament) - from apex of dens to anterior aspcect of foramen magnum, limits flexion and extension of C2
  92. Suboccipital muscles
    Oblique capitus superior (TP of C1 --> occiput above the nuchal line, extension and lateral rotation of head), Oblique capitus inferior (SP of C2 --> TP of C1, rotation of C1 on C2), Rectus capitus posterior major (SP of C2 --> lateral nuchal line, extension and lateral rotation of head), Rectus capitus psoterior minor (posterior tubercle of C1 --> below nuchal line, extension of head)
  93. Spinal enlargements
    C3 to T2 (cervical, largest at C6), T10 to T12 (lumbar)
  94. Types of joints
    Synarthrosis, Amphiarthrosis, Diarthrosis
  95. Fibrous joints
    syndesmosis (interosseous membrane, amphiarthrotic or slightly moveable), synostosis (sutures/skull, synarthroses or immovable), gomphosis (teeth, synarthrotic)
  96. Cartilaginous joints
    synchondrosis (temporary, epiphyseal plate, cartilage, synarthrotic), symphysis (IVD, pubic symphysis, fibrocartilage, amphiarthrotic)
  97. Synovial joints
    Diarthrotic or freely moveable, ginglymus (hinge, ex. elbow), trochoid (pivot/rotary, ex. A/A joint, radius/ulnar), condlymus (ovoid, ellipsoidal ex. knee, TMJ, wrist), saddle (sellar, ex. thumb), spheroideal (ball and socket), gliding (articulatio plana, ex. vertebral facets, AC joint)
  98. Spinal cord
    H-shaped gray area which contains the cell bodies, surrounded by an area of white matter which contains the axons that ascend the cord to the brain or descend from the brain
  99. Gray matter
    • Dorsal horn - ascending neurons and interneurons, relays incoming sensory information to higher centers
    • Ventral horn - contains descending neurons and interneurons, controls motor functions of the muscles of the trunk and limbs
    • Intermediate zone - autonomic pre-ganglionic neurons which control motor functioning of the viscera, also contain neurons (clarke's column) which send sensory information to the cerebellum
  100. White matter
    • Posterior funiculi - ascending axons which relay sensory information to the medulla oblongata
    • Lateral funiculi - contain sensory, motor and autonomic axons
    • Anterior funiculi - contain axons descending from the brain which relay motor information to the muscles
  101. Subdivisions of the spinal cord
    Bror Rexed subdivided gray matter into 10 laminae: Lamina I to VI are in the dorsal horn, Lamina VII are the intermediate zone, Laminae VIII and IX are the ventral horn, Lamina X is the gray matter surrounding the central canal
  102. Lamina I
    marginal zone, most superficial region of dorsal horn, important sensory relay for pain and temperature
  103. Lamina II
    substantia gelatinosa, receives afferent information from nonmyelinated fibers and integrates it with that from thinly myelinated afferent fibers that project to lamina I
  104. Lamina III, IV, V, VI
    contain the nucleus proprius, integrates sensory input with information that descends from the brain and the region of the base of the dorsal horn where many neurons which project into the brainstem are located
  105. Lamina VII
    contains Clarke's nucleus or cell column only in the thoracic and upper lumbar segments, this relays information about limb postition and movement to the cerebellum; the intermediolateral nucleus or cell column also located in the thoracic and upper lumbar segments contains autonomic preganglionic neurons
  106. Lamina VIII
    contains interneurons that are important in regulating skeletal muscle contraction
  107. Lamina IX the motor nuclei of the ventral horn, contains motor neurons which innervate skeletal muscles
  108. Lamina X
    receives afferent input similar to Lamina I and II
  109. Tract of Lissauer
    contains central branches of small diameter fibers
  110. Fasciculus proprius
    contains axons of propriospinal neurons that interconnect different regions of the spinal cord
  111. Pathway of the Dorsal columns
    Spinal cord (fasciculus gracilis and cuneatus) --> Nucleus Gracilis and Cuneatus --> Medulla oblongata --> Pons --> Midbrain --> ventral posterior lateral nucleus of the thalamus --> cerebral cortex
  112. Where are the dorsal columns?
    posterior funiculi, ascend the cord ipsilaterally until the medulla oblongata, where they decussate, at the cervico-medullary junction, at the level of T6 the columns divide to form two bundles --> gracile and cuneate fascicle
  113. Gracile fascicle
    ascends medially and contains fibers from the ipsilateral sacral, lumbar and lower thoracic segments
  114. Cuneate fascicle
    ascends laterally and contains fibers from the upper thoracic and cervical segments
  115. What happens after the dorsal columns divide?
    they continue traveling by way of the medial lemniscus to the VPL nucleus of the thalamus then to the posterior central gyrus of the parietal lobe, to the somatic sensory cortex (somesthetic cortex) for localization
  116. What information do the dorsal columns carry?
    discrimination touch, vibration, joint position sense, tested by rhomberg's test and touch
  117. Where is the anterolateral system?
    located in the anterolateral column, contains fibers from ascending pathways which originate in different laminae of the dorsal horn of the spinal cord, decussates segmentally and ascends the cord contralaterally, terminates in the brainsterm, hypothalamus and thalamus
  118. What tracts are in the anterolateral system?
    Spinothalamic (lateral and ventral), spinoreticular, and spinomesencephalic tracts
  119. Spinothalamic tract
    most prominant ascending nociceptive pathway in the spinal cord, carries information from neurons in laminae I and V to VII, terminates in the thalamus at the VPL nucleus, information goes from the thalamus to the somatic sensory cortex in the posterior central gyrus of the parietal lobe for locatlization
  120. Spinoreticular tract
    nociceptive information from the neurons in laminae VII and VIII, these axons terminate on neurons in the reticular formation of the medulla and pons, this information is then relayed onto the thalamus and other structures in the diencephalon
  121. What do the spinothalamic and spinoreticular tracts mediate?
    noxious and thermal sensations which are relayed to them from A-delta and C fibers, Lateral spinothalamic relays pain and temperature, ventral spinothalamic relays touch and pressure
  122. Spinomesencephalic tract
    spinotectal tract, contains information from nociceptive neurons in laminae I and V, terminates in the tectum (roof) of the midbrain, in the superior colliculus, also projects to the mesencephalic periaqueductal gray region, which surrounds the cerebral aqueduct (contains neurons that are part of a descending pathway that regulates pain trasmission
  123. What information does the spinotectal relay?
    second major ascendign system for mediation of somatic sensation, relays pain, temperature, crude touch, tested by pinwheel, temperature of water in test tubes, randomly touching the patient
  124. Spinocerebellar tracts
    located in the lateral funiculi, relay information to the cerebellum regarding body position, position of body parts relative to each other (unconscious proprioception)
  125. Pathway of the ventral spinocerebellar tracts
    lower extremity info enters the posterior spinal cord and decussates immediately, tract travels witht he anterolateral system to the brain stem where it decussates back to side of origin, enters the superior cerebellar peduncle (brachium conjunctivum), info goes ot the floccular-nodular lobe of the cerebellum, ultimately the information reaches the somesthetic cortex of the parietal lobe, the rest of the cortex including the motor area and the vestibular nuclei
  126. Pathway of the dorsal spinocerebellar
    info from upper extremities ascends the cord, do NOT decussate in the cord, neurons are in Clarke's column, enter the inferior cerebellar peduncle (restiform body), info travels to the floccular-nodular lobe of the cerebellum, this info ultimately reaches the same areas as the ventral spinocerebellar tracts
  127. Corticospinal pathway (pyramidal tracts)
    originates in the motor cortex of the brain, most decussate at the level of the medullary pyramids and continue contralaterally down the spine as the lateral corticospinal tracts, those that do not decussate at the pyramids continue down the spine as the ventral corticospinal tracts, may decussate at the segmental cord level or remain ipsilateral
  128. What do the corticospinal tracts carry?
    direct pathway for voluntary movement, function in voluntary, fine movement, innervate the fine flexors of the fingers and toes
  129. Reticulospinal pathway
    originate primarily in the reticular formation of the mesencephalon, pons and medulla oblongata, have both excitatory and inhibitory connetions with spinal interneurons and motor neurons
  130. Mesencephalic reticulospinal tracts
    descend to the cord both ipsilaterally as the homologue of the IML and contralaterally to terminate on the volunary extensor muscles of the posterior compartments of the limbs and the back
  131. Medullary reticulospinal tracts
    inhibit the action of the ipsilateral mesencephalic reticulospinal tracts
  132. What is the function of the reticulospinal tracts?
    conscious postural maintenance and pain control
  133. Vestibulospinal pathway
    originate at the vestibular nuclei, there are 4 of these, the tract from the lateral vestibular nuclei (dieter's nucleus) descends the cord ipsilaterally as the lateral vestibulospinal tract to innervate all involuntary extensor or anti-gravity muscles of the back; the tracts from the superior, inferior and medial nuclei also descend the cord ipsilaterally and contralaterally, also ascend as the medial longitudinal fasciculus to end on cranial nerves III IV (mesencephalon) and VI (pons) to drive the eyes, function in posture/extensor muscles
  134. Rubrospinal tract
    originates in the magnocellular portion of the red nucleus in the midbrain, decussates immediately and descends through the medulla to the dorsal part of the lateral column of the spinal cord, inervates the voluntary flexor musculature of the limbs above T6 (some books say in the cervical spine only)