Anatomy Exam 3 (Ii)

Front 1

Cerebrum

Back 1

-largest portion of brain
-lateral ventricles
-each hemisphere has four lobes connected by corpus callosum

Front 2

3 parts of diencephalon

Back 2

-thalamus
-hypothalamus (third ventricle)
-limbic system (emotions, memories)

Front 3

Cerebral hemispheres

Back 3

-right and left hemispheres
-connected by white matter (corpus callosum)
-surface is gray matter

Front 4

What is the precentral gyrus of the frontal lobe?

Back 4

somatomotor strip (upper motor neuron)

Front 5

What is the motor speech area (Broca's area) arterial supply?

Back 5

left middle cerebral artery

Front 6

What are the functions of the frontal lobe?

Back 6

-planning and organization
-problem solving
-personality
-"higher cognitive functions" including behavior and emotions

Front 7

What is the postcentral gyrus of the parietal lobe?

Back 7

Somatosensory strip

Front 8

What are the functions of the parietal lobe?

Back 8

Visual-spatial relations
Sensory perception

Front 9

Which sulcus is in the occipital lobe and what is it for?

Back 9

calcarine sulcus-vision

Front 10

What is the function of the occipital lobe?

Back 10

processing visual information

Front 11

What are the 2 parts of the temporal lobe and what are they for?

Back 11

Superior temporal gyrus: hearing
Wernicke’s Area: receptive speech

Front 12

What is the function of the temporal lobe?

Back 12

-organization of sensory input
-language

Front 13

What happens in a Broca's stroke?

Back 13

patient can hear and understand, can’t express themselves through speaking

Front 14

What is the function of the thalamus?

Back 14

relays sensory information

Front 15

What is the function of the hypothalamus?

Back 15

-control of pituitary gland
-sleep and wake states
-homeostasis

Front 16

What are the 2 parts of the limbic system and what are they responsible for?

Back 16

hippocampus and amygdala
-visceral motor activity
-emotions

Front 17

Midbrain

Back 17

-CN III and IV
-Superior part of Brain stem
-Cerebral aqueduct

Front 18

What are the 3 parts of the hindbrain?

Back 18

-pons
-medulla oblongata
-cerebellum

Front 19

Pons

Back 19

-CN V
-visual relay center, sleep cycles

Front 20

What can be found at the junction of the pons and medulla?

Back 20

CN VI, VII and VIII

Front 21

Medulla oblongata

Back 21

-CN IX, X, XII
-breathing, circulation
-4th ventricle
-where brain death is determined (once failure to maintain breathing and circulation, patient is brain dead)

Front 22

Where is cerebellum located?

Back 22

below tentorium cerebelli

Front 23

What is located in the deep nuclei of the brain and what does it modify?

Back 23

basal ganglia - modify movement

Front 24

Huntington's Disease

Back 24

-Programmed degeneration of basal ganglia
-Autosomal dominant
-Causes irregular movement
-Eventually leads to death

Front 25

Parkinson's Disease

Back 25

-Decrease in dopamine-secreting in substania nigra
-Movement disorder

Front 26

What are the 3 fibers of white matter?

Back 26

Commissural fibers
Association fibers
Projection fibers

Front 27

What do the commissural fibers of the white matter do?

Back 27

Connect two hemispheres

Front 28

What do the association fibers of the white matter do?

Back 28

Connect areas in the same hemisphere

Front 29

What do the projection fibers of the white matter do?

Back 29

Connect cortex w/ lower brain and SC

Front 30

What are upper motor neurons?

Back 30

cortical neurons that innervate lower motor neurons

Front 31

What are the two tracts of upper motor neurons?

Back 31

-corticospinal tracts
-corticobulbar tracts

Front 32

Where do corticospinal tracts of UMN begin and end?

Back 32

Begin in somatomotor cortex end at Spinal cord

Front 33

Where do corticobulbar tracts of UMN begin and end?

Back 33

Begin in somatomotor cortex end at CN

Front 34

What 4 things happen in UMN lesions?

Back 34

-Weakness
-Mild atrophy from disuse
-Increased deep tendon reflexes (i.e. positive babinski sign)
-Increased tone

Front 35

What is a positive babinski sign?

Back 35

fanning of lateral toes and dorsiflexion of great toe

Front 36

What do the lower motor neurons directly innervate?

Back 36

skeletal muscle

Front 37

Where are the cell bodies of lower motor neurons located?

Back 37

located within the ventral horns of the spinal cord and within brainstem motor nuclei

Front 38

What happens in LMN lesions?

Back 38

-Weakness
-Atrophy pronounced
-Fasciculations
-Decreased or absent deep tendon reflexes (areflexia)
-Decreased tone (atony)

Front 39

What happens in peripheral LMN lesion?

Back 39

will lose complete movement on one side

Front 40

What happens in central LMN lesions?

Back 40

Complete intact forehead w/ wrinkling

Front 41

Where is CSF produced?

Back 41

choroid plexus of ventricles

Front 42

How many lateral ventricles and where are they located?

Back 42

2 - one within each cerebral hemisphere

Front 43

What is the intraventricular foramen?

Back 43

opening of each lateral ventricle into third venticle

Front 44

What does the cerebral aqueduct connect?

Back 44

third and fourth ventricles

Front 45

Where is the third ventricle located?

Back 45

-between diencephalons (it's very small)

Front 46

What is the fourth ventricle located?

Back 46

-shaped like a triangle between cerebellum and brainstem

Front 47

What is the central canal?

Back 47

continuation of ventricular system into spinal cord

Front 48

Where does some CSF go?

Back 48

into Subarachnoid space around SC

Front 49

Where does most CSF go?

Back 49

into cisterns (lateral and medial apertures) back to venous sinus absorbed through arachnoid granulations

Front 50

What is hydrocephalus?

Back 50

-accumulation of CSF in the cranium due to overproduction or blockage of flow/absorption
-results in ventricular dilation and increased intracranial pressure
-requires surgical intervention in the form of a shunt to relieve pressure

Front 51

What is hydrocephalus usually due to?

Back 51

usually due to blockage at cerebral aqueduct or intraventricular foramen

Front 52

What is the circle of Willis and what does it arise from?

Back 52

-arterial supply of the brain
-arises from internal carotid arteries and vertebral arteries

Front 53

What branches off the internal carotid arteries?

Back 53

-middle cerebral arteries
-anterior cerebral arteries
-anterior communicating artery
-posterior communicating artery

Front 54

What are the first branches of the subclavian arteries?

Back 54

vertebral arteries

Front 55

What do the branches of the vertebral arteries supply?

Back 55

posterior circulation of the brain
-branches are the basilar artery and the posterior cerebral arteries

Front 56

What happens in a cerebral vascular accident?

Back 56

-blood flow decreased by thrombus, emboli, or hemorrhage (aneurysm)
-deficits will be in functional area of blood distribution

Front 57

What does occlusion of the anterior cerebral artery cause?

Back 57

-unusual for complete occlusion
-motor weakness of contralateral face
-motor and sensory weakness of contralateral leg
-“split brain” corpus callosum, loss of tactile recognition

Front 58

What does occlusion of the middle cerebral artery cause?

Back 58

-gives blood supply to MASSIVE amount of brain
-common
-embolic or hemorrhagic
-contralateral motor loss
-contralateral severe sensory loss in face and arm
-if left: expressive aphasia

Front 59

What does occlusion of the posterior cerebral artery cause?

Back 59

-nerve palsy (CN III)
-homonomous hemianopsia
-cortical blindness
-eyes work, but cortex cannot interpret what’s coming in
-alexia (text-blindness)

Front 60

How many pairs of cranial nerves from the brain and where do they exit?

Back 60

-12 pairs of cranial nerves exit the cranium to get to targets (sensory and motor)

Front 61

CN I function

Back 61

-olfactory nerve (sensory)
-function: to transmit the sense of smell from mucosa in the nose
-test if it's working by having patient ID a smell

Front 62

Lesion of CN 1

Back 62

-anosmia (manifests as loss of taste)
-lesion due to fracture of cribriform plate or tumor or abscess of or near frontal lobe (unilateral or bilateral)

Front 63

CN II function

Back 63

-optic nerve (sensory)
-function: transmits visual info from retina to cortex
-to test: visual acuity, acuity fields

Front 64

Homolateral blindness (lesion of optic nerve) (A)

Back 64

lose one side of visual field

Front 65

Bitemporal hemianopsia (B)

Back 65

due to pituitary tumor

Front 66

Homonymous hemianopsia (C)

Back 66

due to CVA, TBI

Front 67

CN III somatomotor function

Back 67

occulomotor nerve
somatomotor function:
-EOM's including
-superior, medial and inferior rectus muscles
-inferior oblique muscle
-levator palpabrae muscle
-to test: test EOM's

Front 68

CN III visceral motor function

Back 68

occulomotor nerve
visceral motor function:
-PSNS to sphincter muscle of pupil
-pupillary constriction
-to test: accomodation, pupil reaction

Front 69

Lesion to occulomotor nerve

Back 69

-ipsilateral
-dilated pupil (loss of pupillary reflex)
-ptosis
-eye turned down and out
(could result due to aneurysm or herniation)

Front 70

CN IV function

Back 70

-trochlear nerve (somatic motor)
-function: EOM, superior oblique muscle
-to test: EOM, downward and intorsion

Front 71

Lesion to CN IV

Back 71

-small, rarely damaged by itself
-loss of superior oblique (cannot turn eye down without adduction)
-diploplia when looking downward

Front 72

What is a lesion to CN IV (trochlear nerve) due to?

Back 72

-TBI
-pseduotumor cerebri
-meningitis (increased intracranial pressure)
-cavernous sinus mass

Front 73

CN V function

Back 73

-trigeminal nerve (both sensory and motor)
-function varies with division (there are 3 divisions)
-to test: cotton wisp to cornea, clench teeth, sensation to face

Front 74

CN V1 function

Back 74

-opthalmic nerve
-function: sensory from skin of forehead region, cornea, sinuses

Front 75

CN V2 function

Back 75

-maxillary nerve
-function: sensation from skin over maxilla, teeth, palate

Front 76

CN V3 function

Back 76

-mandibular nerve
-function:
-sensation from skin of mandible, teeth, anterior 2/3 tongue
-motor to muscles of mastication (except buccinator)

Front 77

Lesion to CN V

Back 77

(some or all)
-paralysis of muscles of mastication
-deviation of mandible toward lesion
-loss of sensation of face
-loss of corneal reflex

Front 78

What can a lesion to CN V be caused by?

Back 78

-trauma
-mass
-meningitis
-aneurysm
-MS

Front 79

Trigeminal neuralgia

Back 79

-AKA tic douloureux
-disease of unknown cause
-irritates trigeminal nerve
-results in extreme pain radiating to the face

Front 80

Trigeminal herpes zoster

Back 80

-reactivation of the Varicella virus in the trigeminal nerve causes HZ, a painful vesicular rash of the face in the distribution of one of the three divisions of CN V. The pattern of rash will determine the particular division involved. May lead to permanent vision loss.

Front 81

What can herpes zoster opthalmicus (V1) lead to?

Back 81

may lead to permanent vision loss

Front 82

CN VI function

Back 82

-abducent nerve (motor)
-function: lateral rectus muscles
test: abduction of eyeball

Front 83

What does a lesion to CN VI result in?

Back 83

loss of ability to abduct eye (first CN injured in cavernous sinus mass or spread of infection from sinus)

Front 84

CN VII function

Back 84

-facial nerve (both sensory and motor)
-function:
-motor: to muscles of facial expression
-special sensory: taste from anterior 2/3 tongue
-PSNS: salivary and lacrimal glands
-test: show teeth, puff cheeks, wrinkle the brow, close eyes tightly, purse lips

Front 85

Lesion to CN VII

Back 85

-most frequently injured motor CN
-parotidectomy
-temporal bone fracture
-distal damage related to Bell’s palsy (LMN)

Front 86

Loss depends on region of lesion for CN VII (UMN or LMN)

Back 86

Facial asymmetry
Eyebrow droop
Loss of forehead and nasolabial folds
Drooping of corner of mouth
Uncontrolled tearing
Inability to close eye
Lips cannot be held tightly together (drooling)

Front 87

CN VIII

Back 87

-vestibulocochlear nerve (special sensory)
-function: vestibular sense from inner ear, hearing
-test: gross hearing, Weber, Rhinne

Front 88

Lesion of CN VIII

Back 88

-central lesion: both branches
-tinnitus
-vertigo (nausea, vomiting)
-hearing loss
-acoustic neuroma, trauma

Front 89

CN IX

Back 89

-glossopharyngeal nerve (somatomotor, special sensory and sensory)
-function:
-motor: small muscle of swallowing
-PSNS: visceral sensory and motor to parotid gland
-sensory:from mucosa of soft palate, pharynx and middle ear, skin of ear
-special sensory: taste from posterior 1/3 of tongue
-test: gag reflex (afferent limb)

Front 90

Lesion of CN IX

Back 90

-decreased taste
-uncommon to see alone, may see with other nerve lesions
-at jugular foramen (CN IX, X and XI)
-loss of taste posterior
-loss of gag reflex
-difficulty swallowing/dysphagia

Front 91

CN X

Back 91

-vagus nerve (motor, sensory, special sense)
-function:
-motor: pharynx, larynx, palate, upper esophagus
-PSNS: smooth muscles of trachea, bronchi, GI and cardiac
-sensory: sensory from all above
-special sensory: taste from epiglottis
-test: elevation of soft palate ("ah"), gag reflex (efferent limb)

Front 92

Lesion of CN X

Back 92

-results in dysphagia and laryngitis
-uncommon to see alone, may see with other nerve lesions (ex:at jugular foramen)
-more common to see recurrent laryngeal nerve injury (thyroidectomy)

Front 93

What 4 nerves supply the tongue and what does each one do?

Back 93

CN V: sensory to anterior tongue
CNVII: taste to anterior tongue
CN IX: taste and sensory to posterior tongue
CN X: taste to epiglottis

Front 94

CN XI

Back 94

-spinal accessory nerve (somatomotor)
-function: sternocleidomastoid and trapezius muscles
-test: resist movement of these muscles

Front 95

Lesion to XI

Back 95

-loss of ipsilateral SCM and trapezius function
-very superficial at posterior neck, easily injured during stabbings, node dissections, central line placed at IJ

Front 96

Jugular foramen syndrome

Back 96

-thrombosis, schwanomas
-CN IX, X and XI
-dysphagia, dysarthria, hoarseness of voice, ipsilateral trapezius and SCM muscle weakness, depressed gag reflex, palatal droop on affected side with ipsilateral vocal cord paralysis and loss of taste on the posterior 1/3rd of the tongue, paralysis of uvula, pharynx and larynx

Front 97

CN XII

Back 97

-hypoglossal nerve (motor)
-function:muscles of tongue
-test: side to side tongue movement

Front 98

Lesion to CN XII

Back 98

-ipsilateral paralysis of tongue
-when tongue protrudes the tip moves towards side of lesion (due to unopposed function of opposite genioglossus muscle)

Front 99

Frontal sinuses

Back 99

Developed by 7 years of age
Asymmetrical
Drain into middle meatus
Innervated by CN V1

Front 100

Frontal sinusitis

Back 100

-distal obstruction (polyps, septal deviation)
-occurs frequently with ethmoid sinusitis