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116 Cards in this Set
- Front
- Back
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Landmark for a pudendal nerve block:
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Ischial spine
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Landmark for the Appendix:
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McBurney's point
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Where is McBurney's point?
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2/3 of the way from the umbilicus to the ASIS (ant sup iliac spine)
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Landmark for a lumbar puncture:
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Iliac crest
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C2
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Back half of a skull cap
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C3
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High turtleneck shirt
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C4
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Low collar neck
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T4
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nipple
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T7
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xiphoid process
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T10
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Umbilicus
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L1
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Inguinal ligament
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L4
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kneecaps (down on all fours)
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S2-S3-S4
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Erection/sensation of penile and anal zones
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How to remember penile dermatomes
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S2-3-4 keep the penis off the floow
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What are the 4 clinical reflexes that are normally tested in adults? Nerve roots?
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Achilles - L1/L2
Patellar - S3/S4 Biceps - C5/C6 Triceps - C7/C8 |
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What is the Babinski reflex?
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Dorsiflexion and spreading of the toes - abnormal, sign of a UMN lesion
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When is the Babinski reflex normal?
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1st year of life - it is a primitive reflex
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What are the 4 primitive reflexes?
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-Moro reflex
-Rooting reflex -Palmar reflex -Babinski reflex |
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Moro reflex
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Limb extension when startled
Yah! |
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Rooting reflex
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Nipple seeking
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Palmar reflex
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Grasp objects in palm
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Babinski reflex
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Dorsiflexion with plantar stimulation
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What can cause the primitive reflexes to re-emerge after they disappear in the 1st year?
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Frontal lobe lesions
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What are the 2 components of muscle spindle control?
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-Intrafusal fibers/Ia afferents
-Golgi tendon organs |
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How are Intrafusal fibers arranged with respect to Extrafusal fibers?
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In parallel
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What do muscle spindles moniter?
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Muscle LENGTH
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How do muscle spindles detect muscle LENGTH?
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When the muscle STRETCHES so does the muscle SPINDLE
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What does muscle stretching stimulate?
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The 1A afferent from the muscle spindle
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What does the 1A afferent do?
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Stimulates alpha motor neurons of extrafusal fibers
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So what is the purpose of muscle spindles?
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To detect muscle LENGTH and alter muscle contraction in response.
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What do Golgi tendon organs monitor?
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Muscle TENSION
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What is the purpose of Golgi tendon organs monitoring muscle tension?
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They make you drop a suitcase that is too heavy so you don't hurt your muscles.
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How do the Golgi tendon organs make you not hurt your muscles?
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They inhibit alpha motor neurons
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What is the GAMMA loop?
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CNS stimulation of gamma neurons that cause INTRAFUSAL fibers to contract
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What is the purpose of causing gamma neurons to contract?
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Maintains the sensitivity of the Muscle spindle reflex arc
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Most anterior cranial nerve:
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Olfactory bulb/tract - CN I
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What lies between the olfactory nerve and optic chiasm?
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Anterior perforated substance
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What does the optic chiasm split into when going back into the brain (looking at ventral surface)
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The optic TRACTS
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And where do the optic tracts go?
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To the LGN - lateral geniculate nucleus of the thalamus
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What lies just inferior to the optic chiasm?
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The infundibulum and Tuber cinereum!
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And what is just beneath the Tuber cinereum?
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Mammillary bodies
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What space is below the Mammillary bodies?
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Interpeduncular fossa
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Why is it called the interpeduncular fossa?
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Because the Cerebral peduncles - crus cerebri - lie at the back of this fossa!
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What cranial nerve emerges from the interpeduncular fossa?
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CN III - oculomotor
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What does CN III emerge ABOVE?
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The pons
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What nerve emerges LATERALLY to the top of the pons? From where?
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CN IV - trochlear - from the DORSAL aspect of the brain
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What nerve emerges laterally to CN IV, still above the pons?
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TRIGEMINAL - V
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Where does CN VI emerge from the brainstem?
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Ventrally in the midline bewtween the pons and the pyramids of the medulla
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What are the 3 nerves that emerge between the pons and medulla?
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6, 7, 8
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What cranial nerves emerge from the lateral aspects of the medulla?
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9 and 10
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Where does cn XI emerge?
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From a bunch of little nerves along the sides of the medulla that come together
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Where does CN XII emerge?
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Between the olives and pyramids of the medulla at its SUPERIOR portion.
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What looks like CN XII but emerges more INFERIORLY?
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Cervical nerve I
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So what 3 cranial nerves emerge from the MEDIAL brainstem?
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3 (x2) 6 (x2) 12
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CN I
-function -type |
Olfactory
Smell Sensory |
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CN II
-function -type |
Optic
Vision Sensory |
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CN III
-functions -type |
Oculomotor
-Move eyeball, Constrict pupils, Accomodate, Open Eyelids Motor |
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CN IV
-function -type |
Trochlear
Constricts Superior Oblique - moves eyeball inferiorly/extorts Motor |
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CN V
-function -type |
Trigeminal
Mastication and Face sensation Mixed - sensory and motor |
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CN VI
-function -type |
Abducens
Constricts Inferior Oblique Motor |
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CN VII
-functions (5) -type |
Facial
Facial movement, Taste ant 2/3 of tongue, Lacrimate, Salivate, Closes eyelids Mixed - sensory and motor |
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Where does CN VII stimulate salivation from?
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Sublingual and Submaxillary glands
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CN VIII
-functions -type |
Auditory - vestibulocochlear
-Audition and Balance Sensory |
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CN IX
-functions (4) -type |
Glossopharyngeal
Taste post 1/3 of tongue, Swallow, Salivate, Monitor Carotid body/sinus chemo and baroreceptors! Mixed - sensory and motor |
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Where does CN IX stimulate salivation from?
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PAROTID glands
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CN X
-functions (5) -type |
Taste epiglottic region, Swallow, Palate elevation, Talk, Thoracoabdominal viscera, Monitor Aortic arch chemo/baroreceptors
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So what nerve monitors the carotid body and sinus chemoreceptors and baroreceptors?
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CN IX - glossopharyngeal, Hering's nerve
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And what nerve monitors the AORTIC chemoreceptors and baroreceptors?
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CN X - vagus
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CN XI
-function -type |
Accessory nerve
Turns head, shrugs shoulders Motor |
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CN XII
-function -type |
Hypoglossal
Tongue movement Motor |
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WHERE are the cranial nerve nuclei?
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In the brain TEGMENTUM!! Between the dorsal and ventral portions
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At what 3 levels of the tegmentum are there cn nuclei?
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Midbrain tegmentum
Pons tegmentum Medulla tegmentum |
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What CN nuclei are in the MIDBRAIN tegmentum?
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3 and 4
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What CN nuclei are in the PONS tegmentum?
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5-8
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What CN nuclei are in the MEDULLA tegmentum?
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9-12
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How are the nuclei ARRANGED?
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Medial nuclei are MOTOR
Lateral nuclei are SENSORY |
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How many VAGAL nuclei are there? What are they?
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3
-NTS - nucleus tractus solitarius -Nucleus ambiguus -DMNX - dorsal motor nucleus of X |
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Fibers of what 3 nerves are components of Nucleus tractus solitarius?
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7, 9, and 10
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What information is transmitted at the Nucleus Solitarius?
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SENSORY - taste from the tongue, baroreceptors, and gut distention
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Fibers of what 3 nerves are components of Nucleus Ambiguus?
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9, 10, 11
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What information is transmitted through Nucleus Ambiguus?
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MOTOR - to the pharynx/larynx and upper esophagus for swallowing and palate elevation
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What information is transmitted through DMNX - dorsal motor nucleus?
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PNS information to send out autonomic control of Heart, Lungs, and Upper GI
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What cranial nerve passes through the cribriform plate?
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CN I - olfactory
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What bone do cranial nerves 2-6 pass through?
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Sphenoid - in the MIDDLE cranial fossa
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What bones do cranial nerves 7-12 pass through?
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Temporal or Occipital - in the POSTERIOR cranial fossa
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What are the holes in the Sphenoid bone?
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-Optic canal
-Superior Orbital fissure -Foramen ovale -Foramen rotundum -Foramen Spinosum |
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What structures pass through the Optic canal?
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-Optic nerve CN II
-Opthalmic artery -Central retinal vein |
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What structures pass through Superior Orbital fissure?
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CN 3, 4, V1, and 6
Opthalmic VEIN |
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What passes through foramen Rotundum?
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V2 - maxillary
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What passes through Foramen ovale?
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V3 - mandibular
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What passes through Foramen Spinosum?
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Middle meningeal artery
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What are the holes in the POSTERIOR cranial fossa?
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-Internal auditory meatus
-Jugular foramen -Hypoglossal canal -Foramen magnum |
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What passes through the Internal auditory meatus?
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CN VII and VIII
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What passes through the Jugular foramen?
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CN 9-11 and Jugular vein
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Why not 12?
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12 passes through the Hypoglossal canal
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What passes through the FORAMEN MAGNUM?
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SPINAL roots of CN XI (to the trapezius)
The BRAINSTEM! Vertebral arteries |
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What IS the Cavernous Sinus?
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A collection of sinuses on either side of the PITUITARY
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So how many cavernous sinuses are there really?
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2 - mirror images on either side of the pituitary
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What is the pituitary housed within?
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Nestled in the Sella Turcica
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What sits just above the pituitary? What bone?
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Diaphragma sellae
Optic chiasm, Pituitary infundibulum, Hypothalamus |
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What does the hypothalamus encompass?
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the 3rd ventricle
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What is Sella turcica, the bone underneath the Pituitary, situated overtop?
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The sphenoidal sinuses and nasopharynx
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What are the structures that pass THROUGH the Cavernous Sinuses?
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OTOM CAt
-Oculomotor III -Trochlear IV -Ophalmic V1 -Maxillary V2 -Carotid artery (internal) -Abducens nerve VI |
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So the nerves that pass thru the Cavernous sinus are:
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3, 4, 5(1/2), 6 and postganglionic SYMPATHETIC fibers to the eye
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Which nerve is Free floating?
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Only Abducens - 6
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What can cause Cavernous Sinus Syndrome?
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Masses - tumors
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What are 3 things that will result from Cavernous sinus syndrome?
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-Opthalmoplegia
-Opthalmic sensory loss (visual) -Maxillary sensory loss (V2) |
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What WON'T be lost in Sinus syndrome?
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V3 - mandibular sensation
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What are the muscles of mastication that CLOSE the jaw?
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-Masseter
-Temporalis -Medial Pterygoids The M's munch |
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What muscle OPENs the jaw?
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Lateral pterygoids
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What nerve innervates the muscles of mastication?
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V3 - Maxillary branch of trigeminal
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What are ALL MUSCLES WITH THE WORD GLOSSUS innervated by?
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The hypoglossal nerve
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What is the ONE EXCEPTION of a muscle that contains glossus that is NOT innervated by CN 12?
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PALATOGLOSSUS
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What IS palatoglossus innervated by? Why?
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CN X - vagus; because Vagus innervates ALL MUSCLES containing the word PALATE - except one
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What is the ONE MUSCLE CONTAINING PALATE that is NOT innervated by CN X? Why?
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Tensor veli palatini - it was too tense
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What IS tensor veli palatini innervated by?
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Mandibular branch of V - V3
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