Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
500 Cards in this Set
- Front
- Back
|
What causes the axis (C2) to fracture between the superior and inferior articular facets?
|
hanging injury forces the dens into the medulla killing the person
|
|
|
what is a pressure point to control bleeding from the carotid artery? hint found in the cervical vertebrae
|
carotid tubercle
|
|
|
what are 2 unique processes to the lumbar vertebrae?
|
mamillary process and accessory process
|
|
|
what is unique to the sacral vert
|
fused, promontory, cornua, median crest, and sacral hiatus
|
|
|
What creates the outer fibrous part of the intervertebral disks? concentric rings of longitudinal ligaments
|
anulus fibrosus
|
|
|
What is inside the anulus fibrosus?
|
Nucleus pulposus- cartiliginous, highly elastic, and absorbs shock
|
|
|
subluxation
|
atlantoaxial dislocation injurying the spinal cord and medulla. Caused by rupture of cruciform ligament caused by trauma and rheumatorid arthritis or congenital (Down Syndrome)
|
|
|
What does the interspinous ligament do?
|
limits flexion and joins adjacent spinous processes
|
|
|
What does the supraspinous ligament do?
|
limits flexion and expands to form ligamentum nuchae, connects the spinous processes
|
|
|
What does the ligamentum flavum do?
|
limits flexion, yellow (due to elastic tissue), and joins adjacent laminae
|
|
|
Posterior longitudinal ligament?
|
limits extension, prevents hyperflexion, weak band, extends from C2 to sacrum, and has nociceptive nerve endings
|
|
|
Anterior Longitudinal ligament?
|
limits flexion, strong band, and extends from occipital to sacrum. Injured in whiplash
|
|
|
Region of spine with smallest disks and largest
|
thoracic- thin
lumbar- thick |
|
|
What vert is a lumbar puncture taken at and from what space?
|
L4 in the subarachnoid space
|
|
|
What is the test for a herniated disc?
|
Straight leg test- supine leg with knee fully extended. Slowly raise the leg. Positive if there is pain. More pain will be produce from dorsiflexion of the foot and relief from bending the knee.
|
|
|
What herniated disc disease occurs in L4-S3 and the pain during the straight leg test is almost always relieved when the pt bends the knee?
|
sciatica
|
|
|
What are the types of vertebrae and how many of each are there?
|
7 cervical (convex), 12 thoracic (concave), 5 lumbar (convex), 5 sacral (concave), and 3-5 coccyx (concave)
|
|
|
What is a lateral curvature of the spine?
|
scoliosis
|
|
|
What is a curvature of the spine that is convex posteriorly
|
kyphosis- women with osteoporosis after there have been compression fractures of the vertebral bodies
|
|
|
What is a curvature of the spine that is convex anteriorly?
|
lordosis- sometimes a temporary result of pregnancy and develops with obesity in both genders
|
|
|
Characteristics of the cervical vertebrae?
|
atlas (no body), axis (strongest of cervical vert), small, transverse processes with a transverse foramen, uncus (joint of lushka)
|
|
|
Characteristics of Lumbar Vertebrae
|
large bodies to support the weight, inferior vertebral notches are deeper, articular processes are vertical for flexion, extension, and beding but not rotation, mamillary and accessory processes
|
|
|
What shaped does the lateral surface of the sacrum have?
|
auricular (ear shaped)
|
|
|
Is the sacrococcygeal articulation movable?
|
slightly, moves freely during pregnancy, later in life the coccyx and sacrum fuse in females
|
|
|
Annulus fibrosus?
|
outer ring of intervertebral disc, concentric lamillae of fibrocartilage, attaches of anterior and posterior longitudinal ligaments
|
|
|
Nucleus pulposus?
|
cartiliginous, highly elastic, high water content, avascular and receives nutrients from annulus fibrosus
|
|
|
Zygapophyseal joints
|
facet (synovial), allows the back to move
|
|
|
Pars Interarticularis
|
region between the superior and inferior articulating facets. frequently the site of fracture in spondylolysis
|
|
|
atlantoccipital joint
|
between the occipital condyle and superior articular face of the atlas, penetrated by vertebral artery and suboccipital nerve, allows flexion and extension of the head, little lateral flexion, but no rotation
|
|
|
What does the nuchal ligament do?
|
prevents excessive flexion
|
|
|
What does the amount of movement depend on?
|
ratio between the height of the discs and the vertebral bodies
|
|
|
factors that limit mvmt in the thoracic region
|
thin discs, attachment of ribs, attachment of sternum, frontal orientation of articular processes, overlapping of laminae and spinous processes
|
|
|
What abnormality is due to the defect in lamina formation of the L5?
|
Spondylolisthesis (back and forth), spondylolysis (fracture of pars interarticularis), and spondylosis (fusion of the pars interarticularis)
|
|
|
The spinal cord is inferior to the ____ ____ and continuous with the ____ ____.
|
foramen magnum, medulla oblongata
|
|
|
terminal end of spinal cord proper
|
conus medullaris
|
|
|
What are the two enlargements in the spinal cord?
|
cervical (brachial plexus) and lumbosacral
|
|
|
What are the 3 meninges?
|
dura mater (outermost, covers brain and spinal cord, fuses with periosteal, and separated from the vertebral wall by the epidural space), arachnoid mater (delicate, sends trabeculae to pia mater), and pia mater (very thin vascular layer that adheres to brain and spinal cord and extends beyond the conus medullaris)
|
|
|
Describe a caudal epidural anesthesia
|
a needle is placed in the epidural space to inject anesthetic around the roots of the lower lumbar and sacral spinal nerves without entering the subarachnoid space.
|
|
|
When a disc ruptures the nerve root compressed is the one ____ to the disc.
|
inferior
|
|
|
What is a common pathway for tumor cells or infection in the vertebrae?
|
paravertebral venous drainage
|
|
|
What disease is described as a narrow vertebral canal and is treated by a surgical procedure that either excises the vertebral laminae or the entire vertebral arch (decompressive laminectomy)?
|
Lumbar stenosis
|
|
|
Name visible palpable features of the back.
|
acromion, C7, greater tubercle of the humerus, scapular spine, T7, T12, L4 (at top of iliac crest), posterior median furrow, spinalis of erector spinae,
|
|
|
dorsiflexion
|
flex
|
|
|
plantarflexion
|
point
|
|
|
What are the 3 parts of the transversospinalis?
|
semispinalis, mutifudus, and rotatores
|
|
|
Name the fascia of the deep muscle.
|
nuchal, cervicothoracic, thoracolumbar, and lumbar
|
|
|
Back strain most often occurs in what muscle.
|
erector spinae
|
|
|
The superficial muscles of the back control what mvmt?
|
limb mvmt
|
|
|
The intermediate muscles of the back control what?
|
control respiratory mvmt and propioreception
|
|
|
Deep muscles control what?
|
act on the vertebral column and mvmts and maintaining postures
|
|
|
When muscles are injured, what do they do as a protective mechanism to avoid further strain?
|
spasms and cramping
|
|
|
The minor deep layers of muscle in the back are
|
interspinales, intertransversarii, and levatores costarum
|
|
|
In small-large muscle groups, what is the function of each muscle?
|
small-propioreception, large- produce motion
|
|
|
suboccipital triangle boundaries
|
medial- rectus capitis posterior (major and minor), lateral-obliquis capitis superior, and inferior- obliques capitis inferior;floor-atlantooccipital membrane and roof- trapezius and semispinalis captitis
|
|
|
contents of the suboccipital triangle
|
suboccipital nerve and vertebral artery
|
|
|
triangle of auscultation
|
trapezius, latissimus dorsi, vertebral border of the scapula, and the floor is rhomboid major
|
|
|
Lumbar triangle (of Petit) borders
|
latissimus dorsi, external oblique, iliac crest, and internal oblique
|
|
|
Latissimus dorsi
|
thoracodorsal artery
thoracodorsal nerve C7, 8 extends the arm and rotates the arm medially |
|
|
Levator scapulae
|
dorsal scapular artery and nerve C5, upper pt C3-4
elevates the scapula |
|
|
rhomboid major and minor
|
dorsal scapular artery and nerve C5
retracts, elevates, and rotates the scapula inferiorly |
|
|
trapezius
|
transverse cervical artery, spinal accessory (XI), elevates and depresses the scapula, rotates the scapula superiorly, and retracts the scapula
|
|
|
greater occipital
|
C2
|
|
|
thoracolumbar fascia
|
attaches the latissimus dorsi to the vertebrae
|
|
|
anterior scalene
|
ascending cervical, brachial plexus (C5-C7), elevates the first rib, flexes and laterally bends the neck
|
|
|
deltoid
|
posterior circumflex humeral, axillary nerve (C5, 6)
abducts arm, anterior fibers flex and medially rotate the arm; posterior fibers extend and laterally rotate the arm |
|
|
iliocostalis (lumborum, thoracis, and cervicis)
|
deep cervical a, posterior intercostal, subcostal aa, lumbar aa; dorsal primary rami of C4-S5; extends and laterally bends the trunk and neck
|
|
|
infraspinatus
|
suprascapular a and n; laterally rotates the arm
|
|
|
longissimus (thoracis, cervicis, and capitis)
|
deep cervical artery, posterior intercostal aa, subcostal aa, and lumbar aa; dorsal primary rami of C1-S1; extends and laterally bends the trunk, neck, and head
|
|
|
longus capitis
|
deep cervical a, cervical plexus, ventral primary rami of C1-C4; flex the head and neck
|
|
|
longus colli
|
deep cervival a; cervical and brachial plexus (C2-7); flex neck, rotate and laterally bend neck
|
|
|
posterior serratus (inferior and superior)
|
intercostal a and n; elevates upper ribs or pulls down lower ribs
|
|
|
serratus anterior
|
lateral thoracic a; long thoracic nerve (C5-C7); draws the scapula forward, inferior fibers rotate the scapula superiorly
|
|
|
spinalis (thoracic, cervicis, and capitis)
|
deep cervical a, posterior intercostal a, subcostal a, and lumbar a; dorsal primary rami of C2- L3; extends and laterally bends trunk and neck
|
|
|
subscapularis
|
subscapular a; upper and lower subscapular nerves (C5, 6); and medially rotates the arm, assists extension of the arm
|
|
|
supraspinatus
|
sub scapular a and n; initiates abduction of the arm
|
|
|
teres major
|
circumflex scapular a, lower subscapular n (C5, 6) from the posterior cord of the brachial plexus; adducts the arm, medially rotates the arm, and assists in arm extensions
|
|
|
teres minor
|
circumflex scapular a, lower subscapular n (C5, 6) from the posterior cord of the brachial plexus; laterally rotates the arm
|
|
|
triceps brachii
|
deep brachial a radial nerve, and extends the forearm, the long head extends and adducts the arm
|
|
|
interspinales
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dorsal primary rami of spinal nerves (C1-L5); extends the trunk and neck
|
|
|
intertransverse
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dorsal primary rami of spinal nerves (C1-L5); laterally bend trunk and neck
|
|
|
levatores costarum (longus, breves)
|
deep cervical a and intercostal aa; dorsal primary rami of spinal nerves (C7-T11); elevates the rib
|
|
|
multifidis
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dorsal primary rami of spinal nerves (C1-L5); extend and laterally bend the trunk and neck, rotate to opposite sides
|
|
|
rotatores (longus, brevis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dorsal primary rami of spinal nerves (C1-L5); rotates the vertebral column to the opposite side
|
|
|
semispinais (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dorsal primary rami of spinal nerves (C1-T12); extends, laterally bends, and rotates the trunk
|
|
|
obliquus capitis (inferior, superior)
|
occipital a, suboccipital nerve (DPR of C1), extends the head and rotates the head to the same side
|
|
|
rectus capitis posterior (major, minor)
|
occipital a, suboccipital nerve (DPR of C1), extends the head and rotates the head to the same side
|
|
|
semispinalis capitis
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa; dpr of C1-T12; extends, laterally bends, and rotates (opposite) the trunk
|
|
|
sternocleidomastoid
|
sternocleidomastoid branch of the occipital; accessory nerve (XI) with sensory supply from C2 & C3 (for propioreception); bilaterally- pull chin in or protrude it out, bilaterally- rotates the ear toward the shoulder on the same side
|
|
|
Are cranial nerves I and II considered typical peripheral nerves?
|
No because they are direct extensions of the brain
|
|
|
What makes cranial nerve XI different from the other cranial nerves?
|
derived from spinal nerves C1-5
|
|
|
How many different regions are there and how many spinal nerves come from each region?
|
8C, 12T, 5L, 5S, and 1 coccygeal
|
|
|
What is a neuron with a single process that is divided into two axons?
|
psuedounipolar
|
|
|
Where are pseudounipolar neurons located?
|
dorsal root ganglia and mesencephalic nucleus of cranial nerve V
|
|
|
What classification of neuron is usually associated with special sense (ex. retina, or olfactory epithelium)?
|
bipolar neurons
|
|
|
What calssification of neuron has many dendrites and 1 axon?
|
multipolar- motor neurons from the ventral horn gray matter and intermediolateral cell column of the spinal chord and the autonomic ganglia
|
|
|
Ganglia are
|
groups of neurons associated with the PNS
|
|
|
What are the neurons from the central nervous system referred to as?
|
nucleus
|
|
|
What are the three types of fascia that bundle the nerves together?
|
epineurium, perineurium, and endoneurium
|
|
|
What ramus is not involved in plexus formation?
|
Dorsal primary ramus
|
|
|
What are the 4 major plexuses formed by spinal nerves?
|
cervical (C1-5), brachial (C5-T1), lumbar (L1-L4), and sacral (L4-S4)
|
|
|
Why do plexuses form?
|
To allow a particular spinal nerve to have a wider distribution.
|
|
|
What spinal nerve are these parts of the body landmarks to test.
Thumb? middle finger? fifth finger? |
C6
C7 C8 |
|
|
What spinal nerve are these parts of the body landmarks to test.
sternal angle? nipples? umbilicus? |
T2
T4 T10 |
|
|
What spinal nerve are these parts of the body landmarks to test.
knee? medial foot? lateral foot? |
L3
L5 S1 |
|
|
The neural tube gives rise to which part of the nervous system?
neural crest? |
spinal cord
ganglia of the PNS |
|
|
What does the abd reflex test for?
|
T7-T9 and T10-12
|
|
|
What is the cremasteric reflex?
|
stroke skin on medial side of the thigh and testis should elevate (L1-2)
|
|
|
What is the plantar reflex?
|
scratch sole of foot on lateral aspect from heel to toe causing a plantarflexion (L5-S1)
|
|
|
What is the anal reflex?
|
scratch perianal and should get a contraction of the external sphincter (S2-4)
|
|
|
What are the 5 important tendon reflexes?
|
biceps brachii, brachioradialis, triceps, patellar, and achilles
|
|
|
The motto of the parasympathetic is
|
rest and digest
|
|
|
The motto of the sympathetic NS is?
|
fight or flight
|
|
|
The sympathetic NS arises from what nerves and is called what?
|
T1-L3: thoracolumnar outflow
|
|
|
The parasympathetic NS arises from?
name the outflow. |
cranial nerves 3, 7, 9, and 10 and S2-4
craniosacral outflow |
|
|
Parasympathetic control such things as
|
Salivation, lacrimation, urination, digestion, and defecation
|
|
|
The white rami communicans consists of
|
the myelinated presynaptic fibers
|
|
|
The gray ramus communicans consists of
|
unmyelinated postsynaptic fibers
|
|
|
The abdominopelvic splanchnic nerves consists of pre or postsynaptic nerves
|
Presynaptic which synapse in the prevertebral ganglia
|
|
|
The cardiopulmonary splanchnic nerves are pre or postsynaptic nerves?
|
postsynaptic nerves
|
|
|
What muscles form the floor of the posterior triangle?
|
Semispinalis capitis, splenius capitis, levator scapulae, scalenus posterior and medius, and scalenus anterior
|
|
|
What nerves innervate the trapezius muscle?
|
Accessory nerve (CN XI)
|
|
|
What are the sensory components of the cervical plexus?
|
Emerges around the posterior border of the sternocleidomastoid with the lesser occipital (C2), greater auricular (C2, 3), transverse cervical (C2, 3), and supraclavicular (C3, 4).
|
|
|
action of external obliques
|
flexes and laterally bends the trunk
|
|
|
Latissimus Dorsi
|
thoracodorsal a, thoracodorsal nerve (C7, 8), extends the arm and rotates the arm medially
|
|
|
levator scapulae
|
dorsal scapular a, dorsal scapular nerve (C5), upper pt of C3, 4; elevates the scapula
|
|
|
rhomboid major, minor
|
dorsal scapular a; dorsal scapular nerve (C5); retracts elevates and rotates the scapula inferiorly
|
|
|
trapezius (inferior, middle, superior)
|
transverse cervical a; spinal accessory (XI), C3-4; elevates and depresses the scapula, rotates the scapula superiorly, retracts scapula
|
|
|
greater occipital
|
C2
|
|
|
axillary
|
deltoid m, teres minor m
|
|
|
anterior scalene
|
ascending cervical a, brachial plexus, C5-C7; elevates the first rib, flexes and laterally bends the neck
|
|
|
deltoid
|
posterior circumflex humeral a, axillary nerve (C5, 6); abducts arm, anterior fibers flex and medially rotates the arm; posterior fibers extend and laterally rotate the arm
|
|
|
iliocostalis (lumborum, thoracis, cervicis)
|
deep cervical a, posterior intercostal a, subcostal a, lumbar a; dorsal primary rami of spinal nerves C4-S5; extends and laterally the trunk, neck, and head
|
|
|
infraspinatus
|
suprascapular a, suprascapular nerve; laterally rotates the arm
|
|
|
longissimus (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal a, subcostal a, lumbar a; DPR of C1-S1; extends and laterally bends the trunk, neck, and head
|
|
|
longus capitis
|
deep cervical a, cervical plexus, VPR C1-4; flex the head and neck
|
|
|
longus colli
|
deep cervical a, cervical and brachial plexus, C2-7; flex neck, rotate and laterally bend neck
|
|
|
posterior serratus (inferior, superior)
|
intercostal a, intercostal n; elevates upper ribs, pulls down lower ribs
|
|
|
serratus anterior
|
lateral thoracic a, long thoracic nerve (VPR C5-7); it draws the scapula forward, the inferior fibers rotate the scapula superiorly; a lesion of the long thoracic nerve will cause winging of the scapula
|
|
|
spinalis (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal a, subcostal a, lumbar a; DPR C2-L3; extends and laterally bends the trunk and neck
|
|
|
subscapularis
|
subscapular a, upper and lower subscapular nerve (C5, 6); medially rotates the arm, assists extension of the arm; part of the rotator cuff
|
|
|
supraspinatus
|
suprascapular a, suprascapular n (C5, 6); abducts the arm (initiates abduction)
|
|
|
teres major
|
circumflex scapular a, lower subscapular nerve (C5, 6) from the posterior cord of the brachial plexus; abducts the arm, medially rotates the arm, assists in arm extension
|
|
|
triceps brachii
|
deep brachial (profunda brachii) a, radial nerve; extends the forearm, the long head extends and abducts the arm
|
|
|
teres minor
|
circumflex scapular a, axillary n (C5, 6) from the posterior cord of the brachial plexus; laterally rotates the arm
|
|
|
dorsal scapular n
|
levator scapulae m, rhomboid major/ minor m
|
|
|
deep branch of the transverse cervical a
|
levator scapulae m, rhomboid major/minor m
|
|
|
dorsal scapular a and nerve
|
levator scapulae m, rhomboid major/minor m
|
|
|
thoracodorsal a and n
|
latissimus dorsi m
|
|
|
superficial branch of the transverse cervical a
|
trapezius m
|
|
|
accessory nerve (CN XI)
|
trapezius m
|
|
|
axillary n
|
deltoid m, teres minor m
|
|
|
lateral thoracic a
|
serratus anterior m
|
|
|
posterior circumflex humeral a
|
teres minor m, deltoid m
|
|
|
suprascapular a
|
supraspinatus m, infraspinatus m
|
|
|
long thoracic n
|
serratus interior m
|
|
|
posterior circumflex humeral v
|
deltoid m, teres minor m
|
|
|
dorsal root n
|
entirely sensory in function
|
|
|
erector spinae m
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-S5; extends and laterally bends the trunk
|
|
|
iliocostalis (lumborum, thoracis, cervicis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C4-S5; extends and laterally bends the trunk and neck
|
|
|
interspinales
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-L5; extends the trunk and neck
|
|
|
levatores costarum (longus, brevis)
|
deep cervical a, intercostal aa, DPR C7-T11; elevates the ribs
|
|
|
longissimus (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-S1; extends and laterally bends the trunk, neck, and head
|
|
|
multifidus
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-L5; extends and laterally bends the trunk neck and head, rotate to opposite side
|
|
|
rotatores (longus, brevis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-L5; rotates the vertebral column to the opposite side
|
|
|
semispinalis (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C1-T12; extends and laterally bends the trunk, rotates the trunk to the opposite side
|
|
|
spinalis (thoracis, cervicis, capitis)
|
deep cervical a, posterior intercostal aa, subcostal aa, lumbar aa, DPR C2-L3; extends and laterally bends the trunk and neck
|
|
|
splenius capitis, cervicis
|
deep cervical a, posterior intercostal aa; DPR C2-6; extends and laterally bends the neck and head, rotates the head to the same side
|
|
|
ventral root
|
T1-L2
|
|
|
What does the greater occipital do?
|
motor: posterior neck muscles
sensory: skin of the posterior surface of the scalp |
|
|
collum
|
latin for neck
|
|
|
cervix
|
latin word for neck
|
|
|
nucha
|
arabic, nape of the neck
|
|
|
scala
|
latin, ladder (scalene muscles)
|
|
|
vagus
|
latin, wanderer
|
|
|
Describe the location of the hyoid to other structures?
|
C3, superior to the thyroid, the greater horn is just anterior to the sternocleidomastoid, doesn't articulate with the rest of the skeleton, pt of attachment for infra and suprahyoid m
|
|
|
Describe the position of the thyroid cartilage.
|
forms laryngeal prominence (Adam's apple), largest cartilage of larnyx, consists of the 2 quadrilateral laminae, superior border gives rise to thyroid notch
|
|
|
cricoid cartilage
|
level of C6, inferior to thyroid cartilage and articulates with, ring shaped and wider posteriorly
|
|
|
jugular notch
|
rounded depression on superior border of the manubrium sternum, bound laterally to the medial ends of the clavicle
|
|
|
superficial fascia
|
in the head and neck, continuous with the pectoral, shoulder, and back region
|
|
|
3 layer of the deep fascia of the neck
|
Superficial (external) investing layer
pretracheal prevertebral |
|
|
Describe the superficial investing fascia
|
continuous with ligamentum nuchae posteriorly, anterior line, and fascia of the head, encloses traps, omohyoid, and sternocleidomastoid, and parotid gland; roof of posterior triangle, contribute to the carotid sheath
Attaches to the hyoid, clavicle, and lower border of the mandible |
|
|
Suprasternal space
|
a region where there is communication between the 2 anterior jugular veins; enclosed by the superficial investing fascia of the neck
|
|
|
pretracheal layer of the deep fascia of the neck
|
prolongation of the visceral fascia of the mediastinum (which is continuous with the fibrous pericardium); encloses the esophagus, trachea, thyroid gland, pharnyx, and larnyx; contributes to the carotid sheath w/ the superficial investing fascia; forms buccopharyngeal fascia
Attaches to the pharyngeal tubercle at base of skull, the thyroid cartilage, and the posterior side of the sternum and the fibrous pericardium |
|
|
Prevertebral Layer of deep fascia of the neck
|
encloses deep muscles of the spine
"floor" of the lateral triangle covers scalene muscles (called scalene fascia here) Attaches at transverse processes, anterior lamina blends w/ fascia of the upper esophagus and posterior lamina continues downward along the front of the thoracic vertebral column |
|
|
cervicoaxillary sheath
|
extension of the prevertebral fascia that envelopes the brachial plexus and axillary vessels
|
|
|
Sibson's fascia
|
cervicothoracic aperture, the prevertebral fascia expands over the apex of the lung to form the cervical diagphram
|
|
|
Pretracheal space
|
directly anterior to the trachea
from the thyroid cartilage to the superior mediastinum enclosed by the pretracheal layer of the deep cervical fascia |
|
|
retropharyngeal space
|
potential space between the prevertebral layer of the deep cervical fascia and the buccopharyngeal fascia around the pharynx
from cranial base to superior mediastinum around the T2 level |
|
|
How do you treat infections in the 2 potential spaces of the neck?
|
antibiotics
|
|
|
How do you find infections in the retropharyngeal spaces?
|
CT
|
|
|
Where do infections usually begin that travel to the 2 potential spaces?
|
tonsils, gums, salivary glands, sinuses, and nasopharynx
|
|
|
Are infections in the potential spaces more common in children or adults?
|
children
|
|
|
What are the boundaries of the posterior triangle?
|
(post) sternocleidomastoid, (ant) trapezius, and the clavicle; inferior belly of the omohyoid divides it into the occipital triangle and the omoclavicular or supraclavicular triangle
|
|
|
Roof of the post triangle?
|
superficial layer of deep fascia and the platysma muscle
|
|
|
floor of the post triangle?
|
all 3 scalenus, levator scapulae, semispinalis capitis, and splenius capitis which are invested by the prevertebral fascia
|
|
|
alternate name for posterior triangle
|
lateral cervical triangle
|
|
|
How many triangles does the sternocleidomastoid form? How many heads does it have?
|
2, 3
|
|
|
What forms the supraclavicular fossa?
|
2 heads of the sternocleidomastoid and the clavicle
|
|
|
Sternocleidomastoid
|
CN XI, ventral rami C2-C4; billaterally-bring the chin to the chest or protrude; unilaterally- rotates the ear toward the shoulder on the same side
|
|
|
What is torticollis (wry neck)?
|
shortening of the sternocleidomastoid as a result of an accessory nerve lesion
|
|
|
splenius capitis and cervicis
|
deep cervical a, posterior intercostal aa; dorsal primary rami of spinal nerves (C2-6); bilaterally- extends the neck, unilaterally- pulls the head to the side rotating it
|
|
|
obliquus capitis (inferior, superior)
|
occipital a, suboccipital n (DPR of C1); bilaterally extends the head, unilaterally- rotates the head to the same side
|
|
|
Scalenus Anterior
|
ascending cervical a., a branch of the thyrocervical trunk
VPR C4-6 elevates the first rib; flexes the neck forward or rotates the neck, raises the first 2 ribs, most active in inspiration |
|
|
scalenus medius
|
ascending cervical a., a branch of the thyrocervical trunk
VPR C3-8 elevates the first rib; flexes the neck forward or rotates the neck, raises the first 2 ribs, most active in inspiration |
|
|
scalenus posterior
|
ascending cervical a., a branch of the thyrocervical trunk
VPR C5-8 elevates the first rib; flexes the neck forward or rotates the neck, raises the first 2 ribs, most active in inspiration |
|
|
What nerves are on the floor of the posterior triangle?
|
brachial plexus and accessory nerve
|
|
|
What are the veins of the posterior triangle?
|
external jugular and subclavian
|
|
|
What are the arteries of the posterior triangle?
|
occipital a, transverse cervical a, suprascapular a, subclavian a
|
|
|
What vein is a confluence of the post auricular and retromandibular v and then empties into the subclavian?
|
external jugular
|
|
|
Where does the occipital artery supply blood?
|
supplies the scalp region
|
|
|
Where did the transverse cervical branch from?
|
thyrocervical trunk
|
|
|
Where did the suprascapular a branch from?
|
thyrocervical trunk
|
|
|
Muscles that the suprascapular supplies
|
supraspinatus and infraspinatus, sternocleidomastoid and subclavius m, skin of the upper shoulder and thorax
|
|
|
What does the dorsal scapular supply?
|
rhomboids, latissimus dorsi, and trapezius
|
|
|
What does the transverse cervical supply?
|
trapezius m and rhomboid mm
|
|
|
Describe the accessory nerve (CN XI)
|
cranial and spinal roots; C1-5 travel up foramen magnum to the medulla oblongata leave the post cranial fossa through the jugular foramen (CN X splits to the vagus nerve) to innervate the sternocleidomastoid, through the post triangle, and then to the trapezius
|
|
|
What is the most commonly damaged iatrogenically (in the course of treatment) and why?
|
accessory (CN XI) nerve because of its long course and superficial location. Lymph node biopsy in the posterior triangle present a particular risk
|
|
|
Symptoms of damaged accessory nerve.
|
shoulder pain, limitation of arm abduction, drooping shoulder from paralysis or atrophy, winging of the scapula (pt may be able to shrug b/c of levator scapulae but not abduct the arm above horizontal).
Secondary traction on the brachial plexus could cause parasthesias in the hand. Due to sternocleidomastoid, turning the head toward the uninjured side may be difficult w/ resistance |
|
|
Describe cervical plexus
|
C1-5; sensory C2-4; emerges on the middle posterior border of the sternocleidomastoid to supply the skin, scalp, and anterior aspects of the chest and shoulders. Components include: lesser occipital (C2), greater auricular (C2-3), transverse cervical (C2-3), and supraclavicular (C3-4)
|
|
|
Dorsal scapular and long thoracic
|
C5, C5-7; arise from the middle scalene to supply the rhomboids, levator scapulae, and serratus anterior
|
|
|
phrenic n
|
(C3-5) branch of cervical plexus; anterior surface of anterior scalene and descends; innervates the diaphragm
|
|
|
brachial plexus
|
C5-T1
|
|
|
Anterior triangle borders
|
ant sternocleidomastoid, ant midline of the neck, and inferior border of the mandible
|
|
|
What is the sensory component of the cervical plexus?
|
Erb's point
|
|
|
What are the arterial variations of the dorsal scapular a? And what % of people have each variation?
|
branches from the subclavian- 70%
branches from the transverse cervical a- 30% |
|
|
What are the 3 arteries that provide blood for the shoulder region and what is their significance?
|
dorsal scapular a, suprascapular a, circumflex scapular a; important b/c if 1 gets damaged, the others can supply the blood for those muscles. Must keep in mind that if you pinch 1 off, the others will still be able to bleed out.
|
|
|
What is the anterior triangle divided into
|
submental, submandibular, muscular, and carotid triangles
|
|
|
What are the borders of the submental triangle?
|
anterior bellies of the digastric and hyoid bone; unpaired; drains the veins and lymph from this region; contains proximal anterior jugular
|
|
|
What are the borders of the submandibular triangle?
|
inferior border of the mandible, inferior and superior bellies of the digastric
|
|
|
What are the borers of the carotid triangle?
|
post belly of the digastric, sternocleidomastoid, and superiod belly of the omohyoid; common carotid divides into internal and external, facial and lingual a; hypoglossal n, spinal accessory n, vagus, & ansa cervicalis
|
|
|
What are the borders of the muscular triangle?
|
hyoid bone, midline of the neck, superior belly of the omohyoid, and the sternocleidomastoid
|
|
|
What is the role of the anterior triangle?
|
To steady or move the hyoid bone and larynx
|
|
|
What are the suprahyoid muscles? Function?
|
mylohyoid, geniohyoid, stylohyoid, and digastric; elevate the hyoid during swallowing and speaking
|
|
|
What are the infrahyoid muscles? Function?
|
sternohyoid, omohyoid, thyrohyoid, and sternothyroid; depresses the hyoid bone and larynx during swallowing and speaking ("strap muscles")
|
|
|
During development, the infrahyoid muscles are part of a continuous longitudinal sheet with which muscles?
|
sternalis and rectus abdominis
|
|
|
digastric
|
o- mastoid notch of temporal bone
i- mandible near symphysis action- raises hyoid and base of tongue, steadies hyoid and depresses the mandible n- facial n and mandibular division of the trigeminal artery: ant- submental a, post- occipital a |
|
|
stylohyoid
|
o- styloid process of the temporal bone
i- body of hyoid bone a- elevates and retracts the hyoid n- facial n a- ascending pharyngeal |
|
|
mylohyoid
|
o- mylohyoid line of the mandible
i- median raphe and hyoid bone a- elevates hyoid and base of tongue, depresses the mandible, raises the floor of the mouth n- mylohyoid branch of the mandibular division of the trigeminal n a- mylohyoid branch of the inferior alveolar a |
|
|
geniohyoid
|
o- genial tubercle of the mandible
i- body of the hyoid a- elevates hyoid bone and base of tongue n- C1 coursing with the hypoglossal n |
|
|
sternohyoid
|
o- posterior surface of manubrium and medial end of clavicle
i- lower border of body of hyoid a- depresses hyoid and larynx n- C1-3, ansa cervicalis a- superior thyroid a |
|
|
sternothyroid
|
o- post surface of manubrium
i- oblique line of thyroid cartilage a- depresses thyroid cartilage n- C1-3, ansa cervicalis a- superiod thyroid a |
|
|
omohyoid
|
o- medial lip of scapular notch
i- lower border of hyoid a- steadies hyoid bone; depresses and retracts hyoid and larynx n- C1-3, ansa cervicalis a- transverse cervical a |
|
|
thyrohyoid
|
o- oblique line of thyroid cartilage
i- lower portion of body and greater horn of hyoid a- depresses hyoid; elevates thyroid cartilage n- c1 coursing with the hypoglossal n a- superior thyroid a |
|
|
What is the floor of the submental triangle?
|
mylohyoid
|
|
|
What is the floor of the submandibular triangle?
|
mylohyoid m, hypoglossal m, and middle pharyngeal constrictor m
|
|
|
What are the contents of the submandibular triangle?
|
submandibular gland, duct, and lymph nodes, hypoglossal n (CN XII) mylohyoid n (CN V), facial a & v (submental a&v)
|
|
|
What is the floor of the carotid triangle?
|
middle pharyngeal constrictor m, inferior pharyngeal constrictor m, and thyrohyoid m
|
|
|
What is the floor of the muscular triangle?
|
infrahyoid m, viscera of the neck (thyroid gland, parathyroid glands, larynx, pharynx, and esophagus)
|
|
|
What are the arteries of the post triangle?
|
occipital, transverse cervical, suprascapular, and subclavian
|
|
|
How many nerves can you name to which C3 contributes?
|
post rami, lesser occipital, greater auricular, supraclavicular, cervical plexus, ansa cervicalis, ventral rami, phrenic
|
|
|
Where are most of the motor portions of the cervical plexus?
|
ansa cervicalis (superior C1-2 and inferior from C2-3), located in the anterior triangle and innervates the infrahyoid muscles and geniohyoid
|
|
|
What is the most important motor nerve that doesn't branch from the ansa cervicalis?
|
phrenic (C3-5)
|
|
|
What is the motor contribution from the cervical plexus to the subtrapezial plexus?
|
C2
|
|
|
What is the motor contribution from the cervical plexus that innervates the sternocleidomastoid?
|
C2-4
|
|
|
What is the motor contribution from the cerical plexus that innervates the levator scapulae and medial scalene?
|
C3-4
|
|
|
What are the sensory nerve of the cervical plexus?
|
lesser occipital, greater auricular, transverse cervical, and supraclavicular
|
|
|
What does the carotid sheath enclose?
|
common carotid a, internal jugular v, vagus n, deep cervical lymph nodes, and the superior ramus of the ansa cervicalis
|
|
|
Which root of the ansa cervicalis is more medial?
|
superior
|
|
|
Name the 3 branching patterns of the facial and lingual a.
|
each branch separately off of the external common carotid
Common trunk branches off common carotid and then splits Common trunk branches from the external cc and then splits |
|
|
At what level does the common carotid split into external and internal?
|
C3 or 4
|
|
|
What is the internal artery called?
|
carotid sinus (walls contain baroreceptors)
|
|
|
Where is the chemoreceptor that senses the chemical changes in the blood?
|
carotid body (senses changes in O2 and CO2, changes rate of breathing, pulse or BP appropriately)
|
|
|
Describe the internal common carotid in the neck
|
no branches, next to the longus capitis and the cervical sympathetic trunk
|
|
|
What artery is the most inferior branch of the external carotid? And what branches off of it?
|
Superior thyroid artery; superior laryngeal artery
|
|
|
What artery supplies the tongue and what muscle does it lie on?
|
lingual artery; middle pharyngeal constrictor m
|
|
|
Which artery gives rise to tonsillar, palatine, and submanibular branches? It also may or may not arise off of the lingual a.
|
Facial artery
|
|
|
What supplies the pharynx, prevertebral muscles, middle ear, and meninges? Located on the deep side of the internal carotid.
|
Ascending pharyngeal a
|
|
|
What artery arises at the level of the facial artery and courses along the digastric to supply the posterior part of the scalp?
|
occipital a
|
|
|
What supplies the parotid gland, facial n, external ear, and scalp?
|
posterior auricular a
|
|
|
What are the terminal branches of the external common carotid?
|
superficial temporal a and maxillary a
|
|
|
What begins at the superior bulb at the jugular foramen and eventually unites w/ the subclavian?
|
internal jugular
|
|
|
What are the major tributaries of the internal jugular v?
|
facial, lingual, pharyngeal, superior, and middle thyroid veins and possibly occipital
|
|
|
Where is the supraclavicular fossa?
|
lateral to the inferior attachment of the sternocleidmastoid and posterior to the clavicle
|
|
|
What is the cupula?
|
cervical pleura (lungs in the neck) covered by sibson's fascia. Must be careful not to hit when placing a central line
|
|
|
What muscles get motor innervation from the ventral rami of cervical nerves?
|
sternohyoid, sternothyroid, and omohyoid
|
|
|
Do the transverse cervical nerve and transverse cervical artery run together?
|
no about the same place but not together
|
|
|
Describe Anterior Jugular
|
superficial vein that starts at the hyoid and drains into the subclavian or external jugular;1 on either side
|
|
|
Which brachiocephalic v is longer?
Which common carotid a is longer? |
Left
Left |
|
|
How do you puncture the subclavian?
|
superiorly, medially toward the suprasternal notch
|
|
|
What is the main lymphatic duct? And where is it located?
|
thoracic duct; junction between L subclavian and L internal jugular
|
|
|
What branches off of the subclavian a medial to the anterior scalene?
|
vertebral a, thyrocervical trunk, and internal thoracic a
|
|
|
Where does the left subclavian branch from?
|
aortic arch
|
|
|
Where does the R subclavian branch from?
|
brachiocephalic trunk
|
|
|
Where and what is the subclavian renamed to?
|
at the lower border of the first rib it is renamed to axillary nerve
|
|
|
Where is the first part of the subclavian located?
|
medially to the anterior scalene in the triangle of the vertebral artery
|
|
|
What are the sides and apex of the triangle of the vertebral artery?
|
anterior scalene, longus colli, and anterior tubercle of the 6th cervical transverse process
|
|
|
What are the contents of the triangle of the vertebral artery?
|
vertebral artery and vein, sympathetic trunk, and the middle cervical ganglion
|
|
|
What is in front of the triangle of the vertebral artery?
|
carotid sheath, phrenic nerve, inferior thyroid artery, and on left the thoracic duct
|
|
|
Give the course of the vertebral artery.
|
branches from the subclavian, apex of the triangle of the vertebral artery, transverse foramen of the 6th cervical vert to the foramen magnum, to join with the other vert artery to form the basilar artery and supply the brain
|
|
|
Where does the internal thoracic branch in the neck.
|
It doesn't it goes into the thorax
|
|
|
What are the 4 branches of the thyrocervical trunk?
|
inferior thyroid artery, transverse cervical artery, suprascapular artery, ascending cervical artery (and the inferior laryngeal artery)
|
|
|
What does the transverse cervical artery supply?
|
muscles of the posterior triangle, trapezius, and rhomboid mm
|
|
|
What supplies the muscles in the posterior aspect of the scapula?
|
suprascapular artery
|
|
|
What is the branch of the 2nd part of the subclavian artery?
|
costocervical trunk
|
|
|
What are the branches of the costocervical trunk?
|
deep cervical artery and highest intercostal artery
|
|
|
What does the deep cervical artery supply?
|
deep muscles of the neck
|
|
|
What supplies the first 2 intercostal spaces posteriorly?
|
highest intercostal artery
|
|
|
What are the branches of the 3rd part of the subclavian?
|
none but occassionally the suprascapular and dorsal scapular artery
|
|
|
What is the problem with a cervical rib and how often does it happen?
|
less than 1% of people. rib on C7 and if there is an injury, then thoracic outlet can occur. Compression of the subclavian artery btwn the rib and anterior scalene causing ischemia. Embolism produces arm pain, cramping, coldness, pallor, and paresthesias.
|
|
|
What is a cause of thoracic outlet syndrome besides a cervical rib?
|
Compression on the subclavian artery or brachial plexus (neurological thoracic outlet syndrome) from overuse or trauma to this area
|
|
|
How common is thyroid ima artery and what is its course?
|
arises from the aortic arch and ascends on the anterior side of the trachea to the isthmus of the thyroid gland. In 10% of individuals
|
|
|
Where does the vertebral artery arise in less than 1.2% of individuals?
|
aortic arch
|
|
|
What are the deep muscles of the neck? And what do they do?
|
longus colli, longus capitis, rectus capitis anterior, rectus capitis lateralis, and scalenes. Flex the neck, flex the head forward or laterally on the neck. Supplied by the ventral rami from the cervical or brachial plexus.
|
|
|
Where is the longus colli and how many parts does it have?
|
most medial of the prevertebral muscles; inferior, middle, and superior; runs from C1-T3; fibers running medial to lateral for superior and inferior and middle running longitudinally
|
|
|
Where is the rectus capitis in comparison the longus colli?
|
posterior
|
|
|
Where is the rectus capitis anterior located?
|
connects the atlas to the occipital bone
|
|
|
Where is the rectus lateralis located?
|
transverse process of the atlas to the jugular process of the occipital bone. Lateral to the longus capitis and rectus anterior
|
|
|
What is the course of the vagus nerve?
|
jugular foramen to posterior part of the carotid sheath, thorax, abdomen
|
|
|
What are the branches of the vagus nerve?
|
recurrent laryngeal n, superior laryngeal n, pharyngeal branches, meningeal branches, auricular branches, carotid branches, and cardiac branches
|
|
|
Course of the recurrent laryngeal.
|
around subclavian on R and aorta on the L, pass posterior to the thyroid gland and ascend to the larynx, to all the intrinsic muscles of the larynx
|
|
|
What are the branches of the superior laryngeal and what do they do?
|
internal laryngeal- to larynx (sensory)
external laryngeal- cricothyroid (motor) |
|
|
Where do the pharyngeal branches go?
|
chief motor fibers to pharynx and soft palate
|
|
|
What is the pharyngeal plexus made of?
|
pharyngeal branches of the vagus n, glossopharyngeal n, and superior cervical ganglion
|
|
|
What supplies the dura of the posterior cranial fossa?
|
meningeal branches of the vagus n
|
|
|
What supplies to the auricle and external acoustic meatus?
|
auricular branches of the vagus n
|
|
|
What assists the carotid branches of the vagus n in supplying the carotid sinus and body?
|
glossopharyngeal n
|
|
|
Where do the cardiac branches of the vagus nerve arise and what are they called?
|
superior and inferior cervical cardiac nerves
|
|
|
What nerve supplies the diaphragm? What is it derived from? And where is it located?
|
phrenic nerve (motor & sensory); principally C4 also C3 & 5; down the anterior scalene posterior to the transverse cervical and suprascapular btwn subclavian v and a into the thorax btwn pericardium and parietal pleura
|
|
|
Glossopharyngeal (CN IX)
|
jugular foramen-superficial to stylopharyngeus, btwn external and internal carotid, distributes to posterior 3rd of the tongue; includes muscular branch, pharyngeal bb, sinus nerve, tympanic n, tonsillar, palatine arch, and soft palate, lesser petrosal n
|
|
|
What does the muscular branch of the CN IX do?
|
innervates the stylopharyngeal muscle
|
|
|
What does the pharyngeal branch of the CN IX do?
|
sensation from pharyngeal mucosa
|
|
|
What does the sinus nerve do?
|
afferent fibers from the carotid sinus. If stimulated makes a drop in bp.
|
|
|
What does the tympanic n do?
|
sensory- auditory tube, tympanic membrane, and mastoid air cells
|
|
|
What does the tonsillar, palatine arch, and soft palate of the glossopharyngeal n do?
|
sensory- swallowing reflex
|
|
|
What does the lesser petrosal n do?
|
joins with facial n that synapses the otic ganglion which then does parasympathetic secretomotor to the parotid salivary
|
|
|
What is the ansa subclavian made of?
|
a continuation of the thoracic sympathetic trunk where it becomes the cervical sympathetic trunk and circles the subclavia; is posterior to the carotid sheath
|
|
|
What does the cervical sympathetic trunk split into?
|
superior cervical ganglion, middle cervical ganglion, and cervothoracic ganglion (superior, middle, and inferior cervical cardiac nerves arise perspectively)
|
|
|
Describe the superior cervical ganglion.
|
anterior to the transverse processes of the axis; makes up the first 4 cervical nn, cranial nerves IX, X, and XII, internal and external carotid arteries, pharyngeal plexus, and superior cervical cardiac n
|
|
|
Describe the middle cervical ganglion.
|
smallest, close to inferior thyroid artery, C5-6 and middle cervical cardiac n
|
|
|
Describe the cervicothoracic ganglion.
|
combo inferior cervical and 1st thoracic; posterior to the vertebral a; gives rise to lower cervical and upper thoracic spinal n, inferior cardiac cervical n
|
|
|
What is Horner's Syndrome?
|
Damage to cervical sympathetic trunk and the pre and post ganglionic fibers. Results in constriction of the pupils, delayed dilation, drooping upper eyelids (ptosis), and raised lower eyelid. Preganglionic- vasodilation and absence of sweating on 1 side of the face
|
|
|
Name 1 cause of Horner's syndrome.
|
tumors to the apex of the lung (pancoast tumor)
|
|
|
Which direction are cervical ribs oriented?
|
vertically
|
|
|
How would blood return to the heart from the facial vein?
|
common facial v- internal jugular- subclavian- brachiocephalic- superior vena cava- heart
|
|
|
Is there a L brachiocephalic trunk? L brachiocephalic v?
|
N; Y
|
|
|
What is a blastomere?
|
a fertilized ovum in which the zygote has entered into mitosis
|
|
|
What is a the stage after a blastomere has continued to divide forming a solid mass of cells?
|
morula
|
|
|
What is a zona pellucida? and when does it disappear?
|
amorphous membrane around a morula that disappears at day 4 when the morula enters the uterine cavity
|
|
|
What are the inner cells of the morula?
|
embryoblast
|
|
|
What are the outer cells of the morula?
|
trophoblast
|
|
|
What is the cavity in the center of the blastocyst?
|
blastocoele
|
|
|
When does implantation occur?
|
5-6 days
|
|
|
What are the carbohydrate binding proteins on the trophoblastic cells that bind to carbohydrate receptors on the endometrial lining cells which intiate "capture" of the blastocyst to the endometrium?
|
L-selectins
|
|
|
What are molecules expressed by the trophoblast attached to the endometrium via receptor sites on laminin molecules in the extracellular matrix of the endometrium?
|
integrin
|
|
|
What are the molecules responsible for migration of the blastocyst into the endometrium?
|
fibronectin
|
|
|
What are the 2 components of the placenta that the trophoblast gives rise to?
|
synctiotrophoblast and cytotrophoblast
|
|
|
What is synctiotrophoblast?
|
an amorphous multinucleated layer that erodes into the endometrium and maternal blood vessels
|
|
|
What is the cytotrophoblast?
|
mononucleated cell layer that gives rise to the synctiotrophoblast
|
|
|
What do the lacunar spaces within the synctiotrophoblast fill with?
|
maternal blood (10-11 days)
|
|
|
What will be added to the inner surface of the cytotrophoblast to complete the 3rd layer of the placenta?
|
extraembryonic mesoderm (10-11 days)
|
|
|
What gives rise to the embryo?
|
embryoblast (inner cell mast)
|
|
|
What is the primitive endoderm that gives rise to the exocoelomic membrane that lines the primary yolk sac?
|
hypoblast
|
|
|
What is adjacent to the trophoblast and gives rise to all 3 definitive germ layers of the embryo?
|
epiblast
|
|
|
What are amnioblasts and what do they form?
|
derived from epiblasts and form the amniotic membrane over the disc
|
|
|
What is extra embryonic mesoderm?
|
This is derived from the primary yolk sac and epiblasts and fills the blastocyst cavity
|
|
|
What forms within the extraembryonic mesoderm and divides it into splanchnopleuric and somatopleuric extraembryonic mesoderm?
|
chorionic cavity (12-13 days)
|
|
|
Where does the primitive streak appear and what does it do?
|
Appears at the caudal end of the germ disk and signals the beginning of gastrulation,
|
|
|
What does the primitive streak consist of>
|
primitive groove, primitive node, and primitive pit
|
|
|
What do cells that move through the streak do?
|
replace the hypoblast to form the definitive endoderm and also establish the intraembryonic mesoderm
|
|
|
What do cells that remain in the epiblast do?
|
become the definitive ectoderm
|
|
|
What do cells that move through the primitive node form>
|
prechordal plate, notochord, and paraxial mesoderm
|
|
|
What is gastrulation?
|
happens in the 3rd week, development that results in formation of the 3 definitve germ layers (ectoderm, mesoderm, and endoderm), 3 structures (primitive streak, primitive node, and neural plate), and 3rd fetal membrane (allantois).
|
|
|
When does gastrulation begin?
|
when the primitive streak appears
|
|
|
What is the process in which epiblast cells move to the primitive streak and beneath the epiblast?
|
invagination
|
|
|
What two areas of the germ disc does the mesoderm not infiltrate?
|
buccopharyngeal membrane and cloacal membrane
|
|
|
When is the buccopharyngeal membrane gone? and the cloacal membrane?
|
4th week
7th week |
|
|
What is a dense cluster of midline mesodermal cells that migrated through the primitive pit?
|
prechordal plate. These cells are responsible for induction of the forebrain in the overlying ectoderm
|
|
|
What hollow structure do the prenotochordal cells form from the primitive pit?
|
notochord
|
|
|
What does the neurenteric canal do?
|
brings amniotic yolk sacs into continuity for a brief time
|
|
|
What are tissue tumors called that arise from remnants of the primitve streak (after 4 weeks)?
|
Sacrococcygeal teratomas
|
|
|
Where else can teratomas arise?
|
primordial germ cells that don't make the complete migration into the developing gonads or in the gonads
|
|
|
What is the intraembryonic mesoderm derived from?
|
primitive node and streak
|
|
|
What is the prechordal plate and notochord derived from?
|
cranial portion of node
|
|
|
What is the paraxial mesoderm derived from?
|
node and cranial portion of primitve streak
|
|
|
What is the intermediate mesoderm derived from?
|
mid primitive streak
|
|
|
What is the lateral plate mesoderm derived from?
|
cranial primitive streak
|
|
|
What is the extraembryonic mesoderm derived from?
|
most caudal primitive streak
|
|
|
What expresses transcription factors essential for head formation?
|
Anterior Visceral Endoderm (AVE)
|
|
|
What initiates and maintains the primitive streak?
|
nodal
|
|
|
What 2 things work in concert to ventralize mesoderm that contributes to kidneys, blood, and body wall mesoderm?
|
Bone Morphogenic Protein 4 (BMP-4) and Fibroblastic growth factor (FBF)
|
|
|
What 3 elements are expressed in the primitve node and antagonize the action of BMP-4 that result in the dorsalization of the notochord and paraxial mesoderm?
|
noggin, chordin, and follistatin
|
|
|
What factor regulates dorsal mesoderm formation in the caudal region of the germ disc?
|
Brachyury (T) gene. Absence leads to sirenomelia (caudal dysgenesis)
|
|
|
What is the importance of Hepatic Nuclear Factor- 3beta?
|
maintains primitive node and necessary for forebrain and midbrain differentiation
|
|
|
What is the thyroid joined in the middle by?
|
isthmus
|
|
|
What % of people is the thyroid in?
|
50%
|
|
|
What are the vessels of the thyroid?
|
superior and inferior thyroid artery and superior thyroid, middle thyroid, and inferior thyroid vein
|
|
|
Describe parathyroid gland.
|
usually 2 per lobe; superior or inferior, supplied by inferior thyroid artery and drain through the thyroid plexus of veins
|
|
|
Describe the posterior wall of the trachea.
|
flat made of smooth muscle and contacts the esophagus
|
|
|
Where should a tracheostomy be made?
|
btwn ring 1 & 2 but for infants lower than 2nd. Thyroid ima artery can be problematic.
|
|
|
What is a better alternative for infants and why?
|
cricothyroctomy b/c may hit brachiocephalic trunk or cut through the trachea to the esophagus (due do tracheal rings being open posteriorly) b/c cricoid cartilage has a large posterior plate
|
|
|
Where does the esophagus start?
|
inferior border of cricoid cartilage
|
|
|
What are the divisions of the pharynx
|
naso, oro, and, laryngo
|
|
|
What is the course of the thoracic duct?
|
L of esophagus between the carotid sheath and the cervical sympathetic trunk to enter the brachiocephalic v at the junction of the subclavian and internal jugular vv
|
|
|
Surgery to remove cancerous lymph nodes in the neck can create a potential risk to what nerve?
|
accessory n
|
|
|
What are the factors that induce the left side?
|
FGF-8, lefty-2, PITX2 (produce on L side)
Lefty-1- barrier (produced by floor plate of the neural tube) Sonic hedgehog (Shh)- suppresses L genes on R (from notochord) |
|
|
What is polyhydramnios? and what are some causes?
|
too much amniotic fluid; anencephalia, gastrointestinal atresia, and diabetes
|
|
|
What is oligohydraminos? and what are some causes?
|
too little amniotic fluid; urinary system malformation, renal atresia, hypoplasia, and polycystic kidneys
|
|
|
What are the 7 functions of amniotic fluid?
|
symmetrical growth, prevents adherence, maintains T, prevents mechanical trauma, allows mvmt, fluid wedge at partuition, and for estimation of fetal maturity
|
|
|
Use of yolk sac and what does it give rise to after birth?
|
serum protein production and rise to germ cells; Meckel's diverticulum
|
|
|
When does allantois appear? function? and become?
|
16th day
formation of vitelline and umbillical vessels median umbilical ligament |
|
|
What does the ectoderm give rise to?
|
CNS, PNS (sympathetic, parasympathetic, & DRG), sensory epithelium, epidermis, pituitary gland, and enamel of teeth
|
|
|
What does the mesoderm give rise to?
|
supporting tissues, muscle, blood & lymph, heart and lymph vessel walls, kidney, gonads, gland cortex, and spleen
|
|
|
What does the endoderm give rise to?
|
lining of gut and parenchyma associated organs, lining of tympanic cavity & auditory tube, resp system, urinary bladder, and thyroid and parathyoid
|
|
|
What 3 factors inactivate BMP-4 causing the ectoderm to become neuralized?
|
Noggin, Chordin, and follistatin
|
|
|
What 2 hormones are necessary to allow induction of the caudal neural plate to form hindbrain and spinal chord?
|
WNT-3a and FGF
|
|
|
What induces the plate to ventralize and the floor plate to form by repression of PAX and MSX (basal plate)?
|
Shh
|
|
|
___ upregulates ___ expression in the dorsal neural tube that will form the roof plate and alar plate.
|
BMPs; PAXs
|
|
|
What are the 3 primary vesicles?
|
forebrain, midbrain, and hindbrain
|
|
|
What are the secondary vesicles of the neural tube?
|
telencephelon, diencephelon, mesencephalon, metencephelon, and myelencephelon
|
|
|
What are the ventricles formed?
|
lateral, interventricular foramena (monro), third, cerebral aqueduct (sylvius), and pontine
|
|
|
What are the brain flexures formed?
|
cervical, cephalic (midbrain), and pontine. Look at figure 5 in notes to view the flexure formation.
|
|
|
What forms the neural tube?
|
When the spinal cord elongates, the neuroepithelial cells rapidly divide thereby thickening the wall of the tube
|
|
|
What kind of cells is the mantle layer made of? and what type of cells are these derived from?
|
neuroblasts; neuroepithelial cells
|
|
|
Where is the mantle layer located? And what layer of the spinal cord does the mantle layer become?
|
surrouding the neuroepithelial cells; gray matter
|
|
|
What type of cells are each of the following derived from
astrocytes oligodendroglia microglial cells |
neuroepithelial cells
neuroepithelial cells mesoderm |
|
|
What type of cells line the cavity of the neural tube and what type of cells will these cells become?
|
neuroepithelial cells
ependymal cells |
|
|
What is the outer layer of the spinal cord, where all of the neuroblasts extend their processes?
|
marginal layer (white matter)
|
|
|
What does the neural crest develop into?
|
Dorsal root spinal ganglia, schwann cells, sympathetic ganglia, leptomeninges, melanocytes, odontocytes, head mesoderm (pharyngeal arches), suprarenal medulla, and heart (septum)
|
|
|
How long is the spinal cord intitially? and at birth? in adulthood?
|
entire length of vertebral column; L3; L2-L3
|
|
|
Describe spina bifida occulta?
|
no neural tissue, a split in the vertebral column marked on the surface as a patch of hair (L4-S1)
|
|
|
Describe Spina Bifida Cystica.
|
THere is an actual protrusion outside of the body from a defect in the vertebral arches. Can cause neurological defects but doesn't necessarily cause mental retardation.
|
|
|
Meningocele
|
fluid filled meninge protrusion
|
|
|
meningomyelocele
|
meningial sac outside of the body filled with spinal tissue
|
|
|
What is the malformation called that is due to a herniation of the cerebellum due to a tethering cord in spina bifida cystica?
|
Arnold-Chiari
|
|
|
What is myeloschisis?
|
neural folds don't elevate and remain as a flattened mass of neural tissue
|
|
|
What is meningoencephalocele?
|
a meninge sac protruding from the head filled with neural tissue
|
|
|
What is a meningohydraencephalocele?
|
a meninge sac protruding from the head filled with brain tissue and ventricular lumen
|
|
|
What is exencephaly?
|
the cranial neural tube fails to close
|
|
|
What is craniorachisis?
|
skull fails to close
|
|
|
What is anencephaly?
|
NTD defect where the tube and skull remain open, babies born with this condition are missing the forebrain, caused by exencephaly and craniorachisis
|
|
|
What is hydroencephalus?
|
occurs as the spinal column lengthens with spina bifida cystica; the foramen magnum gets blocked not allowing brain fluid to flow causing mishapen head due to the fluid
|
|
|
What parts of the pituitary does Rathke's pouch form?
|
Adenohypophysis (anterior pituitary), pars tuberalis (sheath around the pituitary stalk), and pars intermedia (boundary btwn the 2 lobes)
|
|
|
What does the diencephalon give rise to in the pituitary?
|
neurophysis (posterior pituitary) or pars nervosa and the stalk (connects pituitary to the hypothalamus)
|
|
|
What cranial nerves arise from the brainstem?
|
all except olfactory (I), optic (II), and accessory (XI)
|
|
|
Where do all of the cranial nerves from the brainstem arise? Which don't?
|
rhombencephalon; except oculomotor (III) and trochlear (IV) which are from mesencephalon
|
|
|
Where is the molecular signaling from that influences development of the rhombencephalon (hindbrain)?
|
occipital somites
|
|
|
Where do the motor nuclei develop in the neural tube?
|
rhombomeres
|
|
|
What motor neurons does the rhombomeres give rise to?
|
V, VI, VII, IX, X, and XII
|
|
|
What do ectodermal placodes do?
|
give rise to sensory ganglia along with neural crest cells
|
|
|
What are the different types of placodes?
|
nasal (sensory epithelium in nose), otic (ear), and epibranchial (contribute ganglia to the CN V, VII, IX, and X which supply the pharyngeal arches
|
|
|
What are the 2 branches of the autonomic nervous system?
|
parasympathetic and sympathetic
|
|
|
What does the parasympathetic ganglia consist of?
|
fibers carried by CNs III, VII, IX, and X; ganglia derived from the neural crest and S2-4
|
|
|
What does the sympathetic ganglia consist of?
|
T1-L3; chain ganglia, preaortic (collateral) ganglia, sympathetic organ plexus ganglia (cardiac, pulmonary, and gi), preganglionic fibers, white ramus communicans, postganglionic fibers, and gray ramus communicans
|
|
|
What is the chain ganglia formed from?
|
from neuroblasts of the thoracic neural crest that migrated the length of the spinal cord
|
|
|
What is the area called when cells proliferate toward the midline?
|
paraxial mesoderm
|
|
|
What are splits into the somatic and visceral mesoderm?
|
lateral plate mesoderm
|
|
|
What is the space formed by the splitting of the lateral plate? What is this continuous with and when does it stop being continuous?
|
intraembryonic coelom; chorionic cavity until 4 weeks
|
|
|
What does the intermediate mesoderm give rise to?
|
nephrons of the kidney and gonads
|
|
|
What previous structure becomes the gut?
|
yolk sac
|
|
|
What layer of mesoderm do the somitomeres arise from?
|
paraxial mesoderm
|
|
|
In the cranial region, what contributes the largest part of the head mesenchyme?
|
somitomeres
|
|
|
What is the rate of somite organization in the body?
|
3 pairs/day
|
|
|
What is the typical # of somites for each anatomical region?
|
4 occipital, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 8-10 coccygeal
|
|
|
What do somites differentiate into?
|
sclerotome- vertebral column
dermomyotome- myotome (segmental musculature) and dermatome (segmental skin components) |
|
|
What layers does the skeleton develop from?
|
paraxial mesoderm, lateral plate mesoderm, and neural crest
|
|
|
Give the course from sclerotome to blasts.
|
sclerotome- mesenchyme- migration around notochord and neural tube- differentiate into fibroblasts, osteoblasts, and chondroblasts
|
|
|
What is membranous ossification?
|
development of osseous tissue within mesenchymal tissue w/o prior cartilage formation
|
|
|
What is endochondral ossification?
|
ossification of the cartilage
|
|
|
What is the neurocranium?
|
encases the brain
|
|
|
What layers form the neurocranium and what method?
|
neural crest and paraxial mesoderm by membraneous ossification
|
|
|
WHat are the sutures on the neurocranium plates called?
|
fontanelles
|
|
|
Describe prechordal neurocranium.
|
formed form neural crest to form the body of the sphenoid and body of the ethmoid
|
|
|
Describe chordal chodrocranium.
|
from paraxial mesoderm; parachordal cartilage and 3 occipital sclerotomes that all combine to form the base of the occipital bone
|
|
|
What are the mesenchymal condensations?
|
lesser wing of sphenoid, greater wing of sphenoid, and mastoid and petrous parts of the temporal bone
|
|
|
What is the viserocranium consist of and what is it formed from?
|
bones of the face; from first 2 pharyngeal arches
|
|
|
What are the 1st arch visceral components of the viscerocranium?
|
maxilla, zygomatic bone, squamous portion of the temporal bone, malleus, and incus
|
|
|
What are the first arch ventral components of the viscerocranium?
|
mandible
|
|
|
What are the components of the second arch of the viscerocranium?
|
styloid process, upper part of hyoid bone, and stapes
|
|
|
What are some malformations of the skull?
|
cranioschisis- anencephaly, encephalocele, craniosynostosis- premature closure of sutures (scaphocephaly-sagittal, acrocephaly- coronal, and plagiocephaly- coronal & lamboid on 1 side)
|
|
|
When does limb development take place?
|
end of 4th week- 8th week and ossification by the 12th week
|
|
|
What starts the limb growth?
|
induced by FGF-10 from lpm but BMPs from ventral ectoderm induce formation of the AER; growth continues b/c of factors from the core mesenchyme and AER
|
|
|
What cells produce retinoic acid (vit A)?
|
cells forming the zone of polarizing activity (ZPA)?
|
|
|
What does RA initiate?
|
Shh which is responsible for craniocaudal patterning
|
|
|
In the hand, the stronger signal causes which digit to form?
|
digit 5
|
|
|
AER cell death induces elements that induce the formation of digital rays. One of which may be what?
|
BMP-4- in hand and foot for separation of fingers and toes
|
|
|
What factor causes the limbs to form dorsal sides as opposed to forming ventral? What regulates it?
|
Wnt7 which is blocked on the ventral side ectoderm; regulated by LMX1
|
|
|
What factors does the AER have?
|
FGF-4 (maintain) and FGF-8 (initiate)
|
|
|
What gene is responsible for the regional differentiation of bones in proximodistal development? And what other factors are necessary?
|
HOXD (9-13); FGF-8, FGF-4, RA, and BMPs
|
|
|
When does limb rotation occur and what are the rotations?
|
7th week; upper limb rotates 90 degrees in lateral direction and lower limb rotates 90 degrees in medial direction
|
|
|
What are some common malformations?
|
meromelia and amelia (partial and complete absence of a limb), polydactyly (too many digits), ectrodactyly (absence of 1+ digits), and syndactyly (fusion)
|
|
|
Describe vertebral columndevelopment.
|
4th week; sclerotomes of segmental somites surround the notochord and neural tube, split and recombine to form intersegmental vertebrae, mesenchyme remaining btwn the vert rudiments becomes intervertebral disc
|
|
|
Where are the intersegmental arteries present?
|
mesenchyme btwn the somites
|
|
|
How many true ribs are present and how many false?
|
true-7, false- 5
|
|
|
What do the costal processes develop from?
|
small mesenchymal condensations of the sclerotomes
|
|
|
What are transverse foramina from a developmental aspect?
|
costal process that incompletely united
|
|
|
What fuses to form the ala of the sacrum?
|
3 sacral costal processes
|
|
|
Describe the development of the sternum.
|
sternal bars form from the mesenchyme of the somatic mesoderm, meet in midline and fuse cranial to caudal ending at xyphoid process
|
|
|
What type of development are the ribs and sternum formed from?
|
endochondral ossification
|
|
|
What layer are the skeletal muscles formed from? and the smooth and cardiac muscles?
|
paraxial mesoderm
splanchnic mesoderm |
|
|
What creates the dermis of the skin?
|
dermatome (a portion of dermomyotome) and somatic mesoderm
|
|
|
Epimeres
|
give rise to deep intrinsic muscles that are innervated by dorsal pri rami and are epaxial
include erector spinae and transversospinalis |
|
|
Hypomere
|
lateral and ventral flexor muscles, innervated by ventral pr and are hypaxial
|
|
|
What are the hypomere of the neck?
|
scalenes, geniohyoid, and infrahyoid
|
|
|
What are the hypomere of the thoracic?
|
external and interanl intercostals, innermost intercostals (transverse thoracic)
|
|
|
What are the abdominal hypomere muscles?
|
external and internal obliques, transverse abdominal, and rectus abdominis
|
|
|
What are the sacral and coccygeal muscles of the hypomere?
|
pelvic diaphragm and external schincter ani
|
|
|
What are the head muscles of the hypomere?
|
extrensic eye, tongue, and pharyngeal arch
|
|
|
What are the limb muscles of the hypomere?
|
flexors and adductors, extensors and abductors
|
|
|
What parts of the skull are made from the paraxial mesoderm?
|
dorsal; parietal, occipitals, and pet temporal
|
|
|
What are the components of the visceral cranium?
|
maxilla, zygomatic bone & process, Meckel's cartilage, squamous temp, mandible, hyoid bone, thyroid cartilage, incus, stapes, styloid process, and stylohyoid ligament
|
