Objectives exam 2

Specify the boundaries and contents of the following regions: adductor canal

The adductor canal is an intermuscular passageway that occurs posterior to the sartorius muscle in the middle third of the thigh. The adductor canal begins at the apex of the femoral triangle and ends at the adductor hiatus - an opening in the tendon of the adductor magnus muscle at the knee

Explain the clinical significance of the anatomical snuff box.

The anatomical snuffbox is an important landmark for several structures, but is especially significant with respect to the scaphoid bone, which can be palpated in its floor. The scaphoid is the most frequently fractured carpal bone and also one of the bones most susceptible to osteonecrosis. Pain felt deep within the snuff box indicates a fracture of the scaphoid.

List the three compartments of the thigh and indicate the primary actions of the muscles contained within each

The anterior compartment of the thigh contains muscles that mainly extend the leg at the knee joint. ▪ The posterior compartment of the thigh contains muscles that mainly extend the thigh at the hip joint and flex the leg at the knee joint. ▪ The medial compartment of the thigh consists of muscles that mainly adduct the thigh at the hip joint

Specify the ligament typically injured in hyperextension injuries of the cervical column.

The anterior longitudinal ligament helps prevent anterior dislocation of vertebrae. This ligament can be injured in forceful hyperextension of the neck (hyperextension injuries), such as occurs in motor vehicle accidents.

Explain the anatomical basis of the most common direction of shoulder dislocation; specify the nerve most at risk in this injury.

The axillary nerve may be injured in dislocations of the glenohumeral joint and secondary to fractures of the surgical neck of the humerus. Injury to the axillary nerve, which is the sole motor supply to the deltoid muscle, causes the deltoid muscle to atrophy. There is also loss of sensory sensation within the cutaneous domain of the axillary nerve, on the lateral aspect of the deltoid muscle. more

Specify the pulse point of the brachial artery

The brachial pulse can be palpated in (1) the cubital fossa, just medial to the large tendon of the biceps brachii muscle and (2) in the medial aspect of the arm, mid-way between the shoulder and elbow joint. In the arm the artery can be pressed against the humerus where it lies between the muscles of the anterior and posterior muscle compartments.

Specify the spinal cord segments assessed by the calcaneal (Achilles, ankle-jerk) deep tendon reflex.

The calcaneal (Achilles, ankle-jerk) reflex is assessed by tapping the calcaneal tendon superior to its attachment at the calcaneal tuberosity. When struck, the triceps surae will contract reflexively and the ankle will plantarflex. The calcaneal reflex is used to assess the S1 and S2 spinal cord segmentsand the tibial nerve

Understand the basis of neglect and constructional disability Neglect:

The consequence of failure to attend towards contralesional stimuli attributed to the hypoarousal of the damaged hemisphere most profound in right lateral inferior parietal lesions.

Define and be able to use in proper context the following terms used to describe the gait cycle: stance phase, swing phase, heel-strike, push-off (toe-off).

stance phase: begins with heel-strike" and ends with "toe-off"; stance phase is therefore the time when the limb is supporting weight.•swing phase: begins at "toe-off" and lasts until "heel-strike"; swing phase is therefore the time when the limb is not supporting weight. Heel-strike: At heel-strike the thigh is partially flexed, the leg is slightly flexed at the knee (apparently in part to help absorb the shock of contact of the limb with the ground), and the foot is in a mid-position (or neutral position) between dorsiflexion and plantar flexion. To avoid rapid plantar flexion of the foot during heel-strike, the muscles of the anterior compartment of the leg, particularly the tibialis anterior, contract. As the heel makes contact, the intrinsic muscles of the foot contract to support the arches of the foot.

Compare the actions and innervation of the intrinsic versus extrinsic back muscles.

The extrinsic muscles are involved with movements of the upper limbs and thoracic wall and, in general, are innervated by anterior rami of spinal nerves. The superficial group of these muscles is related to the upper limbs, while the intermediate layer of muscles is associated with the thoracic wall. Innervated by anterior rami. All of the intrinsic muscles of the back are deep in position and are innervated by the posterior rami of spinal nerves. They support and move the vertebral column and participate in moving the head. One group of intrinsic muscles also moves the ribs relative to the vertebral column. innervated by dorsal rami.

Specify the location for clinically accessing the following veins: femoral, great saphenous

The femoral vein is not palpable, but can be reliably located medial to the femoral artery. A catheter inserted into the femoral vein and fed superiorly through the inferior vena cava is used to take pressure recordings from the right atrium and/or pulmonary artery, and to evaluate the venous system. by medial malleoulosu

Explain the relationship of the external abdominal oblique to the inguinal ligament and specify the ligament's medial and lateral attachments.

The inguinal region (groin) is the area of junction between the anterior abdominal wall and the anterior thigh. Anatomically it is a region where structures pass to and from the abdominopelvic cavity and lower limb. These structures, most notably the femoral nerve and vessels, as well as the iliopsoas muscle of the lower limb, pass through a narrow aperture or space that exists between the free inferior-lateral margins of the external oblique, internal oblique and transversus abdominus muscles of the anterolateral abdominal wall, and the iliopubic ramus of the pelvis. This space is referred to as the subinguinal space due to its location inferior (and also posterior) to the inguinal ligament. The inguinal ligament attaches to anterior superior iliac spine and the pubic tubercle

Explain the anatomical location of a femoral hernia

The medial compartment of the femoral sheath is termed the femoral canal. The open, superior border of the femoral canal is the femoral ring. The femoral ring is bounded medially by the rigid, and sharp-edged lacunar ligament. In femoral hernias, abdominal viscera protrude through the subinguinal space and femoral ring and enter the femoral canal. Because femoral hernias protrude through such a small defined space, they frequently become incarcerated or strangulated.

Specify the primary actions (both unilateral and bilateral) and innervation of the muscles of the multifidus muscle groups.

The multifidus muscles act to extend the spine and rotate it to the opposite side. The thick lumbar multifidus muscles are important stabilizers of the lumbar spine. Innervated by dorsal (posterior) primary rami Bilateral action: extend vertebral coloumn unilateral action: laterally flexes and contralatterally rotates vertebral column

Compare the actions of the intrinsic back muscles on the vertebral column with those of the muscles of the abdominal wall.

The muscles of the anterolateral and posterior abdominal wall assist the intrinsic back muscles in generating movements of the thoracic and lumbar spine, and in stabilizing the spine and maintaining posture. The two oblique muscles of the anterolateral body wall assist in lateral flexion of the lumbar vertebrae and rotation of the lower thoracic spine. The rectus abdominis, located immediately anterior to the lumbar spine, is a powerful flexor of the lumbar spine. The quadratus lumborum, located posterolaterally, assists in lateral bending.

List the internal and external rotators of the thigh

The muscles of the gluteal region cross the hip joint posteriorly and posterolaterally and act to extend and abduct the hip, and medially and laterally rotate the thigh at the hip joint

Explain the anatomical basis of varicose veins.

The normal flow of blood in the venous system depends upon the presence of competent valves, which prevent reflux. Venous return is supplemented with contraction of the muscles in the lower limb, which pump the blood toward the heart. When venous valves become incompetent they tend to place extra pressure on more distal valves, which may also become incompetent. This condition produces dilated tortuous superficial veins (varicose veins) in the distribution of the great (long) and small (short) saphenous venous systems.

Specify the locations, and contents of the following passageways between the lower limb, pelvis & abdomen obturator canal

The obturator artery, obturator vein, and obturator nerve all travel through the canal.

For olfaction, describe the stimuli that activate olfactory receptors, characteristics of olfactory receptors, transduction process, pathways from the olfactory mucosa to the primary olfactory cortex, including the role of mitral cells and tufted cells. Define anosmia.

stimuli and receptors: 1000s of chemicals (odorants) can be detected at low concentration. each one activates many different olfactory receptors. These receptors (bipolar neurons) and their processes (#6) are located in the olfactory epithelium (#4) of the nasal cavity below the cribiform plate (#3). Odorants interact with cilia arising from the olfactory neurons dendrites. The processes (#6) penetrates the cribriform plate to synapse in the glomerular layer (#5) of the ipsilateral olfactory bulb (#1). NOTE: olfactory receptors cell bodies are part of the periphery but are NOT located in a ganglion like sensory system // NeuroT: glutamate // Receptors have limited livespan (weeks-months) and are replaced by the basal cells in #4. (388)

For each of the four rotator cuff muscles, specify their action, attachments and innervation.

supraspinatus, attaches to superior facet of greater tubercle. suprascapular nerve infraspinatus,attaches to middle facet of greater tubercle suprascapular nerve teres minor attaches to inferior facet of greater tubercle Axillary nerve subscapularis attaches to lesser tubercle. upper and lower subscapular nerves

Specify the branches of the superior trunk of the brachial plexus; list and describe the functional deficits expected with an injury to the superior trunk

the C5 and C6 ventral (anterior) primary rami: follow them distally and confirm they join to form the superior trunk; An excessive increase in the angle between the neck and shoulder, such as occurs when landing on the superior aspect of the shoulder when thrown from a horse or a motorcycle, or when delivering a newborn, can injure the superior trunk and even tear the superior roots of the brachial plexus from the spinal cord. The suprascapular nerve, being a direct branch of the superior trunk and composed exclusively of C5 and C6 fibers, is affected in these injuries as are all other nerves that include fibers from the C5 and C6 roots. These nerves include the axillary, upper & lower subscapular and thoracodorsal, all of which are composed exclusively of C5 and C6 fibers, and the lateral pectoral (C5-C7), musculocutaneous (C5-C7), median (C6-T1) and radial (C5-T1) nerves. check

Distinguish the tissues or organs of origin of the lymph received by the following groups of lymph nodes of the lower limb: popliteal; superficial inguinal, deep inguinal; specify the locations of the palpable lymph nodes of the lower limb.

The superficial inguinal nodes , approximately ten in number, are in the superficial fascia and parallel the course of the inguinal ligament in the upper thigh. Medially, they extend inferiorly along the terminal part of the great saphenous vein. Superficial inguinal nodes receive lymph from the gluteal region, lower abdominal wall, perineum, and superficial regions of the lower limb. They drain, via vessels that accompany the femoral vessels, into external iliac nodes associated with the external iliac artery in the abdomen. PALPABLE Deep inguinal nodes The deep inguinal nodes , up to three in number, are medial to the femoral vein ( Fig. 6.38 ). The deep inguinal nodes receive lymph from deep lymphatics associated with the femoral vessels and from the glans penis (or clitoris) in the perineum. They interconnect with the superficial inguinal nodes and drain into the external iliac nodes via vessels that pass along the medial side of the femoral vein as it passes under the inguinal ligament. The space through which the lymphatic vessels pass under the inguinal ligament is the femoral canal. Popliteal nodes In addition to the inguinal nodes, there is a small collection of deep nodes posterior to the knee close to the popliteal vessels ( Fig. 6.38 ). These popliteal nodes receive lymph from superficial vessels, which accompany the small saphenous vein, and from deep areas of the leg and foot. They ultimately drain into the deep and superficial inguinal nodes. PALPABLE

Distinguish the origins, routes and terminations of the cephalic and basilic veins; specify the location of the median cubital vein and explain its clinical significance.

The superficial veins of the upper extremity are the cephalic vein, which travels along the lateral aspect of the upper extremity, and the basilic vein, which travels along its medial side. Both superficial veins originate from the dorsal venous network on the dorsum of the hand he cephalic vein originates over the anatomical snuffbox and passes laterally around the distal to reach the anterolateral surface of the forearm. The cephalic vein continues proximally across the elbow and up the arm and into the clavipectoral triangle (deltopectoral groove). At the base of the clavipectoral triangle the cephalic vein pierces the deep fascia to enter the axilla where it drains into the axillary vein.The basilic veinoriginates from the medial side of the dorsal venous network. From here it passes proximally onto the anterior surface of the forearm just distal to the elbow. It continues proximally midway up the arm where it pierces the deep fascia. The basilic vein eventually joins the brachial veins to form the axillary vein. At the elbow the median cubital veinconnects the cephalic vein laterally, with the basilic veinmedially.The deep veins accompany the arteries of the upper extremity and are named according to the artery with which they travel. As in the lower extremity, deep veins typically occur in pairs around each major artery (vena comitantes).

Specify the location and contents of Guyon's canal.

The ulnar nerve crosses the wrist in Guyon's canal with the ulnar artery. This compartment is superficial to the transverse flexor retinaculum/transverse carpal ligament. It is therefore not in the carpal tunnel, but lies just superficial to it, with the transverse carpal ligament lying between.

List the structures that pass through the sub-inguinal space.

These structures, most notably the femoral nerve and vessels, as well as the iliopsoas muscle of the lower limb

List the arteries involved in the cruciate & trochanteric anastomoses around the hip joint and explain their impact on blood flow to the lower limb in cases of arterial compromise

Two important arterial anastomoses occur within the gluteal region and superior thigh: the trochanteric anastomosis is formed by branches of the medial and lateral circumflex femoral arteries and the superior and inferior gluteal arteries. This anastomosis is important in that the gluteal arteries can maintain blood supply to the head of the femur in cases of gradual occlusion of the lateral and/or medial circumflex arteries. The cruciate anastomosis is an anastomosis of the inferior gluteal artery, the lateral and medial circumflex femoral arteries, and the first perforating artery of the profunda femoris artery. The cruciate anastomosis is clinically relevant because if there is an occlusion between the femoral artery and external iliac artery, blood from the internal iliac artery can still reach the popliteal artery and distal extremity via the deep femoral artery.

For each of the two principle movements allowed at the knee joint, specify the muscles involved and their innervation; explain the role of the popliteus muscle in knee function

When the knee is fully extended the femur is rotated medially on the tibial condyles in what is referred to as a "locked" position. This medial rotation of the femur on the tibia, which occurs only during the terminal phase of full extension, is referred to asthe screw-home mechanism of the knee. The primary function of the popliteus muscle is to "unlock" or "unscrew" the knee at the initiation of flexion by laterally rotating the femur on the tibial condyles.

Specify the joint involved and the ligaments injured in various grades of shoulder separation.

Whereas dislocation of the sternoclavicular joint is quite rare, dislocation (separation) of the acromioclavicular joint is relatively common. Grades of shoulder separation are defined on the basis of the extent of ligament damage and the ligaments involved. Grades range from stretching of the acromioclavicular ligament to complete rupture of both the acromioclavicular and coroacoclavicular ligaments.

Describe the relationship between the posterior longitudinal ligament and intervertebral disc herniation.

While IV Disc herniations can occur directly posteriorly, and even anteriorly on occasion, they typically occur posterolaterally, on either side of the posterior longitudinal ligament

describe their relationship to the vertebral column and specify the movement limited by each:posterior longitudinal ligaments

While IV Disc herniations can occur directly posteriorly, and even anteriorly on occasion, they typically occur posterolaterally, on either side of the posterior longitudinal ligament limits the flexion in our spine for good reason

Given a clinical scenario be able to determine which of the following palpable landmarks of the leg, ankle & foot may be injured:

anterior border and medial surface of tibia, medial malleolus, lateral malleolus, calcaneal tuberosity.

Specify the neurovascular structures that travel together within each of the following spaces/regions of the arm: quadrangular space, radial groove

axillary nerve: this nerve, along with the posterior circumflex artery, passes out of the axilla and into the posterior shoulder through the quadrangular space. radial nerve: this nerve passes out of the axilla and into the posterior compartment with the profunda brachii artery; in the posterior arm both structures travel in the radial (spiral) groove of the posterior humerus

Explain the anatomical basis of the following pathologies of the arm and elbow: biceps tendonitis, Popeye deformity, student's bursitis.

back and forth movement of the tendon within the intertubercular groove can cause wear and tear of this tendon and lead to inflammation (biceps tendonitis). Rupture of the tendon causes the muscle belly to retract and form a large bulge in the anterior arm - a condition referred to as the "Popeye deformity". Elbow bursitis involving the subcutaneous bursa ("student's bursitis") results from repeated excessive pressure on the elbow (as in leaning your elbow on the table while reading an anatomy textbook). Bursitis of the subtendinous bursa is due to excessive friction between the tendon and the olecranon. Pain from the latter form increases substantially during elbow flexion due to compression of the bursa by the triceps tendon.

For the following ligaments, describe their relationship to the vertebral column and specify the movement limited by each:ligamentum flavum,

best seen on the interior, posterolateral wall of the vertebral canal; this ligament extends between the superior and inferior borders of adjacent vertebral laminae Based on its position between lamina and its elasticity, it helps the vertebral column resume an upright position after being flexed

Specify the primary actions (both unilateral and bilateral) and innervation of the muscles of the erector spinae

facilitate extension of the spine when acting bilaterally and side bending (lateral flexion) of the spine when acting unilaterally. Innervated by dorsal (posterior) primary rami

Specify the locations, and contents of the following passageways between the lower limb, pelvis & abdomen greater sciatic foramen, and lesser sciatic foramen

greater inferior gluteal artery and inferior gluteal nerve pudendal nerveand internal pudendal artery, sciatic nerve, piriformis muscle superior gluteal vessels and nerve lesser , tendon of obturator internus

Given a clinical scenario be able to determine which of the following palpable landmarks of the hip, thigh and knee may be injured:

iliac crest, anterior superior iliac spine, ischial tuberosity, greater trochanter, lateral epicondyle of femur, medial epicondyle of femur, patella, medial condyle of tibia, tibial tuberosity, pes anserinus, fibular head.

Specify the locations, and contents of the following passageways between the lower limb, pelvis & abdomen subinguinal space

iliacus and psoas major muscles. These structures, most notably the femoral nerve and vessels, as well as the iliopsoas muscle of the lower limb

Distinguish the fascia lata from the deep fascia of the leg (crura fascia) and the iliotibial tract.

The outer layer of deep fascia in the lower limb forms a thick "stocking-like" membrane, which covers the limb and lies beneath the superficial fascia ( Fig. 6.39A ). This deep fascia is particularly thick in the thigh and gluteal region and is termed the fascia lata . The fascia lata is anchored superiorly to bone and soft tissues along a line of attachment that defines the upper margin of the lower limb. Beginning anteriorly and circling laterally around the limb, this line of attachment includes the inguinal ligament, iliac crest, sacrum, coccyx, sacrotuberous ligament, inferior ramus of the pubic bone, body of the pubic bone, and superior ramus of the pubic bone. Inferiorly, the fascia lata is continuous with the deep fascia of the leg. Iliotibial tract The fascia lata is thickened laterally into a longitudinal band (the iliotibial tract ), which descends along the lateral margin of the limb from the tuberculum of the iliac crest to a bony attachment just below the knee ( Fig. 6.39B ). The superior aspect of the fascia lata in the gluteal region splits anteriorly to enclose the tensor fasciae latae muscle and posteriorly to enclose the gluteus maximus muscle: ▪ The tensor fasciae latae muscle is partially enclosed by and inserts into the superior and anterior aspects of the iliotibial tract. ▪ Most of the gluteus maximus muscle inserts into the posterior aspect of the iliotibial tract. The tensor fasciae latae and gluteus maximus muscles, working through their attachments to the iliotibial tract, hold the leg in extension once other muscles have extended the leg at the knee joint. The iliotibial tract and its two associated muscles also stabilize the hip joint by preventing lateral displacement of the proximal end of the femur away from the acetabulum.

Specify the spinal cord segments and nerves assessed by the patellar (knee-jerk) deep tendon reflex.

The patellar (knee-jerk) reflex is elicited to assess the L3 and L4 spinal cord segments.

Specify the boundaries and contents of the following regions: popliteal fossa.

The popliteal fossais a diamond-shaped region on the posterior knee that marks the transition between the thigh and the leg. superomedially: semimembranosus and semitendinosus•superolaterally: biceps femoris•inferior: medial and lateral heads of the gastrocnemius muscle

Specify the primary actions, blood supply, and innervation of each of the three compartments of the leg and list the muscles in each compartment.

The primary actions of the muscles of the posterior compartment of the leg is plantarflexion of the foot and flexion of the toes; some of the muscles in the posterior compartment act to invert the foot. The gastrocnemius muscle, the soleus muscle and the plantaris muscle are all located in the superficial compartment of the posterior leg. Popliteus Flexor digitorum longus(FDL) Flexor hallucis longus(FHL) Tibialis posterior' blood supply is posterior tibial nerve is tibial nerve The primary actions of the muscles of the anterior compartment of the leg are dorsiflexion of the foot and extension (dorsiflexion) of the toes; some of the muscles in the anterior compartment act to invert the foot. The primary action of the muscles of the lateral compartment of the leg is eversion of the foot. Anterior tibialis anterior: • extensor digitorum longus • extensor hallucis longus the fibularis tertius blood supply anterior tibial nerve is deep fibular Lateral Fibularis longus: • fibularis brevis: innervated by superficial fibular fibular artery

Specify the pulse points of the femoral and popliteal arteries

The pulse of the femoral artery can be palpated just inferior to the inguinal ligament, approximately half-way between the pubic tubercle and the anterior superior iliac spine, with the thigh slightly abducted The pulse of the popliteal artery can be palpated deep within the popliteal fossa with the knee variably flexed.

Specify the pulse points of the radial and ulnar arteries

The pulse of the radial artery can be palpated at the wrist (just lateral to the flexor tendons of the wrist and digits).

Know the components of the reticular activating system and its role in consciousness

The reticular formation is actually a loosely arranged network of neurons which are distributed throughout the brainstem wherever there are no specific neural tracts or nuclei. parvicellular neurons receive inputs from the special senses (which can contribute to arousal. The gigantocellular neurons receive a large portion of inputs from the spine

Describe the anatomical relationships of the subclavian vessels, the brachial plexus rami, & the scalene muscles.

interscalene triangle in the donor. Identify the brachial plexus as it emerges from this triangle just posterior to the subclavian artery

Impaired visuoconstructive ability

is thought to be caused by more specific multimodal parietal lobe dysfunction, esp. damage to the posterolateral parietal region

Distinguish intrinsic vs. extrinsic accessory ligaments of synovial joints.

joint ligaments are classified as either intrinsic (capsular) or extrinsic (extracapsular or accessory). Intrinsic ligaments, such as those of the hip joint, are specializations or reinforcements of the fibrous capsule that encloses the synovial cavity of synovial joints. Extrinsic ligaments are independent of the joint capsule and provide additional reinforcement of a joint. The four ligaments of the knee (including the cruciate ligaments within the joint) are all extrinsic ligaments

Describe the function of synovial fluid.

joint-lubricating fluid secreted by the synovial membrane

Specify the actions and innervations of the lumbricals, the palmar interossei, and the dorsal interossei muscles

lumbricals 1 & 2: median nerve; 3 & 4: deep ulnar nerve. extension distal interphalangeal palmer interossei deep ulnar nerve abducation of digits dorsal interossei deep ulnar nerve abduction of digits

List the arteries involved in the genicular anastomosis at the knee joint as it pertains to vascular compromise of the popliteal artery.

medial superior genicular artery lateral superior genicular artery middle genicular artery lateral inferior genicular artery medial inferior genicular artery Arteries in the vicinity of joints may kink and become temporarily occluded with changes in joint position. The collateral (multiple) circulation routes formed around joints assures that adequate blood flow reaches the distal extremities at all joint positions, or in the case of injury to one route. At the knee collateral circulation is via multiple genicularbranches of the popliteal artery

Be able to recognize the cutaneous distribution of the following sensory nerves of the lower limb: femoral, lateral femoral cutaneous, obturator, posterior femoral cutaneous, ilioinguinal, clunial nerves, tibial, common fibular, deep fibular, superficial fibular

more!

Describe the function of the vertebral column and how the characteristic morphology of specific vertebrae influences those functions.

The skeletal and muscular elements of the back support the body's weight, transmit forces through the pelvis to the lower limbs, carry and position the head, and brace and help maneuver the upper limbs. The vertebral column is positioned posteriorly in the body at the midline. When viewed laterally, it has a number of curvatures The seven cervical vertebrae between the thorax and skull are characterized mainly by their small size and the presence of a foramen in each transverse process The 12 thoracic vertebrae are characterized by their articulated ribs; although all vertebrae have rib elements, these elements are small and are incorporated into the transverse processes in regions other than the thorax; but in the thorax, the ribs are separate bones and articulate via synovial joints with the vertebral bodies and transverse processes of the associated vertebrae. Inferior to the thoracic vertebrae are five lumbar vertebrae, which form the skeletal support for the posterior abdominal wall and are characterized by their large size Next are five sacral vertebrae fused into one single bone called the sacrum, which articulates on each side with a pelvic bone and is a component of the pelvic wall. ▪ Inferior to the sacrum is a variable number, usually four, of coccygeal vertebrae, which fuse into a single small triangular bone called the coccyx.

Extra info Encoding

- factors that may influence encoding strength 1. Active observation focusing attention 2. Rehearsal, emotional impact, interest, motivation 3. Prior experience and knowledge 4. What it does NOT hinge on: the intention to memorize 5. Example - Divided attention detrimental to memory function

Clinical Syndromes of Amnesia

1. Hypoxemia 2. Degenerative dementias 3. Closed head injuries 4. Thiamine deficiency (Korsakoff's syndrome) 5. Herpes simplex encephalitis 6. Transient global amnesia 7. Rare stroke syndromes

1.Understand the different types of memory and which anatomic structures subserve them.

1. Immediate (working) memory 2. Episodic memory (requires hippocampal function) 3. Long term (semantic and biographic) memory (knowledge) C. Working Memory - brain areas activated 1. articulatory loop (language areas) 2. visuospatial sketch pad (parietal association cortex) 3. central executive (frontal lobe) D. A theory of (explicit) memory formation 1. encoding (sensory input; cortex) 2. cohesion (hippocampus; cortex) 3. consolidation (primarily hippocampus) 4. semantic memory - "knowing" ("storage" in cortex) 5. episodic memory - "remembering" (cortex; hippocampus)

Retrieval

1. Long term memory (semantic) 2. Searching / Cueing 3. Consciousness 4. Example Recall vs Recognition. Recognition is easier because it provides cues Types Immediate memory -> Episodic memory-> Long term memory Lecture 37:

Define the 6 major components/subdivisions of the neurologic exam

1. Mental status 2. CN function 3. Motor function 4. Sensation 5. Reflexes 6. Coordination and gait

3. Understand the effects of lesioning different parts of the medial temporal lobe

1. The hippocampus & entorhinal cortex are essential for declarative (explicit) memory (e.g. facts, events). 2. The hippocampus converts immediate memories into episodic and long term memories, but is not the site of storage. 3. Bilateral dysfunction is required for amnesia. 4. The hippocampus also helps retrieve more recently stored memories, but is not required for older or over-learned memories (semantic knowledge).

Long-Term Potentiation

: 1. Rapid, intense stimulation of the presynaptic neurons evokes APs in postsynaptic neuron. 2. Over time, synapses become increasingly sensitive so that a constant level of presynaptic stimulation becomes converted into a larger postsynaptic output. LTP and NMDA receptors 1. Aminophosphonovaleric acid ("APV") prevents LTP. 2. APV blocks the action of NMDA receptors, a subset of postsynaptic receptors that normally respond to the excitatory neurotransmitters glutamate (Glu) and glycine (Gly). 3. NMDA receptors contain a transmembrane channel that allows for the facilitated diffusion of Ca2+ across the plasma membrane of the synapse. 4. Binding of Glu (or NMDA) to these receptors opens the channel allowing Ca2+ to flow in if — and only if — the same postsynaptic cell has been simultaneously depolarized by other synapses on it. 5. NMDA receptors are naturally blocked by Mg+ (depolarization of the postsynaptic cell membrane removes the Mg+ block, allowing calcium entry via Glu binding to the NMDA receptor)

Kluver-Bucy syndrome

= Bilateral destruction of the amygdala and inferior temporal cortex Pathology: surgical lesions, meningoencephalitis, or Pick's disease Characteristics Emotional blunting= flat affect and not respond properly to stimuli Hyperphagia= Patients often suffer from extreme weight gain. This is likely for the purpose of oral stimulation or exploration and not indicative of a satiety disorder. Compulsive placing of inedible objects in the mouth. Inappropriate sexual behavior Visual agnosia: pts suffer from psychic blindness

Understand the structures and circuits involved in emotions Feeling

= conscious sensation Mediated by cerebral cortex The cingulate gyrus and inferior frontal lobes

Emotion

= physical sensation Mediated by hypothalamus autonomic , endocrine, and skelemotor responses produce emotions

Describe the effects of lesions of the amygdala and the characteristics of the Kluver- Bucy syndrome. Amygdala

= regulates emotional responses Regulates both somatic expression and conscious feeling of emotion Direct connections w/ thalamus short lasting, primitive responses unconsciously Learned emotional responses (classical conditioning) lesions produce: Blunted affect and emotional response Inability to distinguish fear faces Disruption in generation of emotional response Core deficit: inability to learn the emotional significance of external events

Explain the mechanism of injury and anatomical basis of Nursemaid's elbow; specify the ligament involved.

A sudden, forceful tug on a child's hand can dislodge the not yet fully formed radial head from the annular ligament (Nursemaid's elbow).

Specify the spinal cord segments assessed by the following deep tendon reflexes: patellar (knee-jerk), calcaneal (ankle-jerk)

A tap on the patellar ligament at the knee tests predominantly L3 and L4. ▪ A tendon tap on the calcaneal tendon posterior to the ankle (tendon of gastrocnemius and soleus) tests S1 and S2.

Specify the muscles that attach to the following landmarks of the hip and knee: ASIS, AIIS, lesser trochanter, greater trochanter, tibial tuberosity, ischial tuberosity, pes anserinus, fibular head

ASIS which provides attachment for the inguinal ligament, and the sartorius muscle AIIS the proximal attachment of the rectus femoris muscle and iliofemoral ligament lesser trochanter The iliopsoas muscle crosses the hip joint anteriorly to reach its distal attachment (psoas major and illiacus) greater trochanter of the femur. gluteus medius, gluteus minimus, obturator internus, piriformis tibial tuberosity. Continue to follow the quadriceps (patellar) tendon ischial tuberosity the adductor magnus semimembranosus biceps femoris and the semitendinosus pes anserinus gracilis, semitendinosus, and satorius. and quads fibular head long and short heads of biceps femoruous

Explain the anatomical basis of a flat foot.

Acquired flatfeet ("fallen arches") is a condition characterized by the inferomedial displacement of the head of the talus. This condition often develops secondary to dysfunction of the tibialis posterior muscle.

List the muscles in the anterior and posterior compartments of the arm and distinguish their actions at the ulnohumeral and radiohumeral joints of the elbow; specify the innervation of each of these muscles.

Anterior biceps brachii long and short heads Flexion musculocutaneous nerve brachialis Flexion musculocutaneous nerve Posterior triceps brachii long lateral medial heads Extension radial nerve

List the muscles in the anterior and posterior compartments of the forearm; specify the action and innervation of each

Anterior pronator teres• median nerve forceful pronation flexor carpi radialis• median nerve flexion carpal palmaris longus (absent in 10-15% of specimens)• flexor carpi ulnaris• ulnar nerve flexion carpal flexor digitorum superficialis median nerve flexion metacarpals Posterior brachioradialis flexion of elbow radial never extensor carpi radialis longus radial nerve ext carpal •extensor carpi radialis brevis deep radial nerve ext carpal •extensor digitorum posterior interosseous extensor of metacrapal •extensor digiti minimi posterior interosseous extensor of metacrapal •extensor carpi ulnaris ulnar nerve radio carpal flexion

Specify the primary actions, blood supply, and innervation of each of the three compartments of the thigh and list the muscles in each compartment

Anterior compartment: knee extensors and some hip flexors; innervated by femoral nerve, blood supply by femoral artery and its branches. Medial Compartment: Hip adductors (some rotation and flexion); innervated by obturator nerve and its branch, blood supply by branches of deep femoral artery and obturator artery. Posterior compartment: Hip extensors and knee flexors; innervated by tibial or common peroneal nerves, blood supply by deep femoral artery.

Explain the mechanism of injury and anatomical basis of combined medial collateral ligament and medial meniscus tears; describe the expected clinical findings associated with lateral and medial meniscus tears

As a result of the attachment of the medial collateral ligament (MCL) to the medial meniscus, tearing of the former will likely result in tearing of the latter. Simultaneous injury of the medial collateral ligament (MCL), medial meniscus, and anterior cruciate ligament (ACL) may occur when the knee receives a lateral impact with the foot planted in a fixed position.

Understand the role of the prefrontal cortex in emotion PFC Dorsal PFC

Attention to, and effortful regulation of the arousal associated with affective states Involved in tasks where attention is directed away from the emotion toward regulation of behavior

Specify the locations of lymph nodes that drain the upper limb.

Axillary lymph nodes are 20-30 in number and are divided into five "groups": pectoral (anterior), subscapular (posterior), humeral (lateral), central and apical. The axillary lymph nodes, taken as a whole, receive three streams of lymph, one from the upper extremity (humeral), one from the adjacent thoracic and upper abdominal wall and breast (pectoral), and one from the back (subscapular). The three currents meet and fuse within the central and apical chains. From here, lymph drains to the right or left venous angle

Specify the common sites of injury for the following nerves and list the primary deficits associated with each: common fibular, superficial fibular, deep fibular, tibial, saphenous.

Because of its superficial location, the common fibular nerve is the most commonly injured nerve of the lower limb. Easily injured in blows to the lateral aspect of the leg, consequences of this injury include the inability to evert the foot due to loss or impaired of function of the lateral compartment muscles, and inability to dorsiflex the ankle and toes due to loss or impaired function of the anterior compartment muscles. The loss of dorsiflexion at the ankle causes "foot drop" and an inability for the toes to clear the ground during swing phase of the gait cycle. Additional symptoms of this injury include variable loss of sensation on the anterolateral aspects of the leg and ankle, and along the dorsum of the foot. Isolated injury to the superficial fibular nerve may occur in chronic ankle sprains. Such injuries may cause pain on the lateral aspect of the leg, ankle and dorsum of foot. Additional symptoms may include numbness and tingling in these same regions. Compression of the deep fibular nerve by tight fitting footwear and ski boots occurs where the nerve passes deep to the inferior extensor retinaculum. In these injuries pain is felt in the dorsum of the foot and in particular in the dorsal webspace between the first and second digits. Because of its deep location within the popliteal fossa and leg, isolated injury of the tibial nerve in the leg is not common. When such injuries do occur (with posterior dislocation of the knee or deep laceration injuries) the patient experiences weakness or loss of ankle plantarflexion and toe flexion, and loss of sensation on the sole of the foot. The tibial nerve is most commonly injured where it passes through the tarsal tunnel (see Exercise #3 below). In a saphenous cutdown an incision made anterior to the medial malleolus provides access to the great saphenous vein for the long-term administration of blood, plasma expanders, electrolytes or drugs. In this procedure the saphenous nerve is vulnerable to injury. Symptoms of a saphenous nerve injury include loss of sensation to the medial aspect of the ankle.

Explain the anatomical basis of Dupuytren's contracture

Because of the strength and attachments of the palmar aponeurosis in the hand, infections in the central and thenar spaces of the palm present as swelling on the dorsum of the hand.Dupuytren's contracture is a pathological condition of the palmar fascia and aponeurosis that results in its progressive shortening, thickening and fibrosis. More typically seen in men over the age of 50, the condition is characterized by a partial flexion of the ring and little fingers, similar in appearance to the "claw hand" associated with ulnar nerve injuries. Although similar in appearance, these two conditions should not be confused.

Specify the common sites of injury to the following nerves and list the primary functional deficits associated with each: radial, ulnar, median, posterior interosseous, anterior interosseous, recurrent median; explain how the sensory (if applicable) and motor functions of each of these nerves are assessed clinically

Because of their relationship to the posterior surface of the humerus, the radial nerve and deep brachial artery are at risk of injury in transverse and spiral fractures of the humerus.The radial nerve innervates all of the extensor muscles of the posterior compartments of the arm and forearm. As a result, injury to the radial nerve in the radial groove results in an inability to extend the wrist ("wrist drop). However, because the branches to the triceps brachii muscle are given off proximal to the radial groove, extension at the elbow is usually spared in these injuries. Compression of the radial nerve against the humerus for long periods of time, such as when falling asleep with the back of the arm compressed against a solid object ("Saturday night palsy", "honeymooner's palsy"), or when fitted improperly for crutches ("crutch palsy"), results in a temporary mononeuropathy characterized by numbness of the back of the hand and digits, and an inability to extend the wrist and digits the tingling sensation you feel when you hit your elbow against a solid object (hitting your "funny bone") is due to compression of the ulnar nerve against the posterior aspect of the medial epicondyle. "Tardy ulnar palsy" refers to the functional deficits that are associated with sustained compression or injury to the ulnar nerve at the elbow. The anterior interosseous nerve is a strictly motor nerve, supplying the deep digital flexors of the thumb, index and middle fingers and the pronator quadratus muscle. Anterior interosseous nerve palsy refers to injury of the anterior interosseous branch of the median nerve. This type of injury, which often occurs in displaced supracondylar fractures in children, is indicated by the pinch posture. The anterior interosseous nerve carries only motor fibers; there are no sensory deficits associated with this injury. injury to the deep branch of the radial nerve (posterior interosseous nerve) results in weakness of the extensors of the thumb and metacarpophalangeal joints. The branch of the radial nerve is assessed by asking the patient to extend these joints againstresistance RECCUERNT

Specify the names clinicians use to refer to each of the five metacarpals and each digit of the hand.

Before getting started, realize that although the digits of the hand are numbered, most clinicians prefer to refer to them by their names rather than their numbers. The names of the digits are as follows: 1 - thumb, 2 - index, 3 - long, 4 - ring, 5 - little

Explain the anatomical basis for the appropriate location for intramuscular injections in the gluteal region

Before leaving the gluteal region, restore all of the reflected muscles to their anatomical position. With the muscles restored, visualize the location of the nerves and vessels that lie deep to the gluteus maximus muscle . Realize that in light of the location of these neurovascular structures, intragluteal injections should only be performed in the superolateral quadrant of the buttocks

Specify the spinal cord segments assessed by the following deep tendon reflexes: biceps, triceps, brachioradialis.

Bicep reflex C5 and C6 spinal cord segments tricep reflex C7 and C8 spinal cord segments. brachioradialis reflex C6 spinal cord segment.

List the three arteries whose anastomoses provide a collateral circulation around a blocked or ligated axillary artery

Brachial Artery, Radial Artery, Ulnar Artery

Specify the arteries most likely compromised by femoral neck fractures

Branches of the medial and lateral circumflex femoral arteries supply the head and neck of the femur and are in danger of laceration in certain types of femoral neck fractures.

Understand the structures involved in language function and types of aphasia

Broca's Area, Wernicke's Area connected by the arcuate fasciculus in the left hemisphere

Define bursae and describe their function.

Bursae are closed sacs (or envelopes) of serous membrane Formed by delicate, transparent serous membranes that are collaped Normally collapsed Usually occur in locations subject to friction, and allow one structure to move more freely over another

Specify the courses of the radial, median and ulnar nerves around the elbow

radial nerve: this nerve passes out of the axilla and into the posterior compartment with the profunda brachii artery; in the posterior arm both structures travel in the radial (spiral) groove of the posterior humerus. Confirm that the radial nerve and profunda brachii artery travel together within the radial groove ▪ The ulnar nerve, which is ultimately destined for the hand, passes posteriorly to a bony protrusion, the medial epicondyle, on the medial side of the distal end of the humerus

Pathways:

CN VII (Ant 2/3), IX (post 1/3) and X (epiglottis and pharyngeal walls). 1° neurons are pseudo unipolar and in the peripheral ganglia and axon terminate in the gustatory region of the solitary nucleus. 2° neurons from gustatory to VPM of thalamus. 3° neurons to the ipsilateral 1° taste (gustatory) cortex (black oval in diagram) in parietal lobe.

Specify the muscles that attach to the following landmarks of the foot and ankle: calcaneal tuberosity, tuberosity of 5th metatarsal, base of 1st metatarsal.

Calcaneal tendon (Achilles tendon) a. The large tendon shared by the gastrocnemius and soleus muscles 5th metatarsal fibularis brevis base of 1st fibularis longus muscle (lateral inferior) & tibialis anterior muscle (medial inferior)

Explain the anatomical basis of compartment syndrome.

Compartment syndrome occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia. Because neurovascular damage and tissue necrosis can result in as little as 6 hours, such conditions must be recognized quickly. Compartment syndromes are resolved by opening the fascial compartment (a fasciotomy) and allowing the muscle(s) to expand. Compartment syndrome can occur wherever a fascial compartment is present: thigh, leg, hand, forearm, arm, abdomen, and buttock. However, compartment syndrome of the anterior leg is most common. Bone fractures and vascular injuries are the most common causes of compartment syndrome.

Explain the anatomical basis of the following relatively common neuropathies affecting the lower limb; specify the symptoms of each: meralgia paresthetica, sciatica.

During its course through the anterior abdominal wall the lateral femoral cutaneous nerve passes between the inguinal ligament and its attachment at the ASIS. Here it is susceptible to compression, especially in obese individuals or individuals who wear heavy tool belts as part of their occupation (i.e., police, various trades). Compression of the lateral femoral nerve manifests as meralgia paraesthetica, a condition associated with pain, sensitivity, or numbness in the lateral thigh. Sciatica refers to a set of symptoms that results from general compression and/or irritation of one or more of the nerve roots that give rise to the sciatic nerve (L4-S3). These symptoms include pain in the lower back, buttock and/or various parts of the leg and foot, numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. These symptoms are typically felt on only one side of the body. Common causes of sciatica include compression of one or more of the L4-S1 nerves by disc herniation, spondylolisthesis or degenerated IV discs. Treatment for sciatica depends on the underlying cause

Theory of emotion

Emotion-arousing stimuli simultaneously trigger: physiological responses subjective experience of emotion To experience emotion one must:be physically aroused cognitively label the arousal: "I am afraid"

List the four principal movements allowed at the radiocarpal joint; explain the role of the triangular cartilage at this joint

Examine the wrist of an articulated skeleton and confirm that only the radius is involved in the wrist (radiocarpal) joint. Verify that a large gap exists between the headof the ulnaand the carpals in the proximal row. In life this gap is filled with a cartilaginous articular disc known clinically as the triangular fibrocartilage

Specify the boundaries and contents of the following regions: femoral triangle,

Floor: formed by the iliopsoas muscle laterally and the pectineus muscle medially. •apex: located where the medial border of the sartorius muscle crosses the lateral border of the adductor longusmuscle

Explain the roles of the hamstrings, quadriceps femoris, tibialis anterior, the plantar flexors and the intrinsic muscles of the foot in the gait cycle.

Foot Flat The hamstrings also contract, but this is usually interpreted as being primarily in order to prevent hyperextension of the leg. (If the hamstrings are paralyzed, a hyperextension deformity develops at the knee.) Swing Phase ; flexion of the leg is produced by the hamstrings (which may simply produce passive pull) and gravity. Terminal swing phase: After midswing deceleration of the limb in preparation for heel-strike occurs via contraction of the hamstrings Foot Flat The quadricepscontracts to extend the leg after the foot makes contact. Terminal Swing phase knee (by contraction of the quadriceps) begin to extend Initial Swing Dorsiflexion is mainly the result of contraction of the tibialis anterior Heel Strike To avoid rapid plantar flexion of the foot during heel-strike, the muscles of the anterior compartment of the leg, particularly the tibialis anterior, contract. Midstance AThe muscles that plantar flex the ankle (primarily the gastrocnemius and soleus - the triceps surae) contract to control this dorsiflexion and to initiate toe-off of the next cycle. Heel strike As the heel makes contact, the intrinsic muscles of the foot contract to support the arches of the foot.

Specify the mechanism of injury and bones involved in the following common fractures of the hand and wrist: Colle's, scaphoid, boxer's.

Fractures of bones of the distal forearm and wrist often occur in individuals attempting to break a fall with an outstretched limb. The bone fractured varies with age and sex. In osteoporotic women it is usually the distal end of the radius that is fractured. In the most common form of such fractures - Colles' fractures - the distal end of the radius is displaced posteriorly. In younger individuals the scaphoid is more typically fractured. The latter fractures are particularly problematic. Due to its relatively poor blood supply, the proximal portion of the scaphoid is susceptible to necrosis following fracture. A "boxer's fracture" is a fracture of the fifth (sometimes fourth) metacarpal. As its name implies, this fracture is the result of punching somethinghardwith a closed and abducted fist

Understand the necessary anatomic contributors of consciousness and current theory regarding its physiologic origins Consciousness

Generally felt to be a product of a distributed network between the thalamus and cortical regions, especially the prefrontal cortex and anterior temporal lobe In turn, activity of the cerebral cortex is dependent upon the RAS (reticular activating system) Must have simultaneous awareness of at least sensory input and and your reaction to it Other additional theorized requisites are ability to generalize, the sense of self, capacity to live things out or sense of time The bilateral removal of the centromedian nucleus of the thalamus is sufficient to abolish consciousness

Transduction:

salivary fluids with chemical molecules get into taste buds through pores—> chemical interact with membrane sites on the microvilli depolarize receptor cell by opening and closing different channels. (E.g: salty taste—> influx of Na+ and other tastes by other type of channels or G proteins)—> eventually results in the influx of Ca2+—> NeuroT released and activation of afferent nerve terminals.

Explain the anatomical basis of the common findings that disc herniations at the L4/L5 and L5/S1 IV discs present with symptoms consistent with involvement of the L5 and S1 spinal nerves, respectively.

Herniation of the L4/L5 or L5/S1 IV discs typically (but not universally) impinge upon the nerve roots of the spinal nerve exiting one level below that IV disc space rather than those of the corresponding spinal nerve. This outcome occurs because nerve roots of the lower lumbar and sacral nerves exit the vertebral canal at the superior aspect of their respective intervertebral foramina, having been "pulled" into this position as a consequence of differential lengthening of the spinal cord and spine during growth. In the case of an L5/S1 herniated disc, the L5 spinal nerve exits adjacent to the L5/S1 disc, but escapes above the herniation without injury. The S1 spinal nerve root, however, is compressed by the herniation as the nerve root descends to reach its foramen.

Specify the joint involved and the ligaments typically injured ankle sprains and high ankle sprains

High ankle sprains do involve the distal tibiofibular joint and usually both the anterior and posterior ligaments of that joint. There are other ligaments around the ankle but these are the most frequently injured. Everson injuries involve the Deltoid ligament and usually avulsion fractures of the medial malleolus. inversion

3 components of emotion perception

Identification of the emotional significance of a stimulus Production of an affective state in response to it The regulation of the affective state Mediated by 2 complementary neural systems Ventral system handles 1& 2 through amygdala, anterior insula, ventral striatum, ventral anterior cingulate and ventral prefrontal cortex Dorsal system handles 3 through hippocampus, dorsal anterior cingulate and dorsal prefrontal cortex

Explain the anatomical basis of and typical presentation of a positive Trendelenburg sign (Trendelenburg gait)

If the gluteal muscles are weak on the supporting side, lurching to the supporting side will occur, putting the weight more over the joint (Trendelenburg gait).

Explain the developmental basis of the medullary cone occurring at the L1 vertebral and its effect on the relationship between the spinal cord level of origin and location of vertebral canal exit for the lower lumbar and sacral spinal nerves.

In early embryonic life the spinal cord occupies the entire length of the vertebral canal. Soon, the vertebral column begins to grow more rapidly than the spinal cord, and the position of the caudal end of the cord, called the conus medullaris (medullary cone), gradually becomes more cranially-located in the vertebral canal. At birth, the medullary cone lies at the level of the L2 vertebra. By two months of age, the conus medullaris has attained its definitive position at the level of the L1 vertebra. The dural sac continues inferiorly and extends into the sacrum (S2 vertebral level). Since the adult spinal cord does not occupy the entire vertebral column, the dorsal and ventral ROOTS from L2-Coccygeal levels have to descend in the vertebral canal before they exit from their intervertebral foramina. These nerve roots forms a cluster that resembles a horses tail and is called the cauda equina. The cauda equina is bathed by cerebrospinal fluid (CSF) within the dural sac and is found within an enlarged region of the subarachnoid space (from vertebral bodies L2-S2) called the lumbar cistern. This cistern is most suitable to withdrawal CSF by lumbar puncture without damaging neural structures. A needle for lumbar puncture is usually inserted between L3-L4 lumbar vertebrae.

Specify the anatomical structures involved in mallet or baseball finger.

In mallet fingerthe portion of the extensor hood that attaches to the distal phalanx is torn or avulsed, usually as a result of jamming the fingertip against a hard surface. In this injury the patient is unable to extend his/her distal interphalangeal joint.

Explain the anatomical basis of performing a lumbar puncture at the level of the L3/L4 intervertebral disc.

In the further 6% of individuals the spinal cord can extend to the L2-L3 interspace. Therefore a lumbar puncture is generally performed at or below the L3-L4 interspace.

Describe the role of deep fascia in compartmentalizing the segments of the limbs (i.e., arm, forearm, thigh, leg)

In the limbs, groups of muscles with similar functions sharing the same nerve supply are located in fascial compartments, separated by thick sheets of deep fascia, called intermuscular septa, that extend centrally from the surrounding sleeve to attach to bones These compartments may contain or direct the spread of an infection or tumor Fascias (L. fasciae) constitute the wrapping, packing, and insulating materials of the deep structures of the body.

For the following ligaments, describe their relationship to the vertebral column and specify the movement limited by each: nuchal ligament.

In the neck the supraspinous ligament is expanded posteriorly to form the expansive nuchal ligament (Gilroy Fig. 2.28). This ligament serves as a site for muscle attachment in the deeply lordotic cervical spine. limits flexion

For the following ligaments, describe their relationship to the vertebral column and specify the movement limited by each: supraspinous ligament

In the neck the supraspinous ligament is expanded posteriorly to form the expansive nuchal ligament This ligament serves as a site for muscle attachment in the deeply lordotic cervical spine. limits flexion of spine

Components RAS:

Inputs from higher brain centers I.e. cerebellum, basal ganglia, cerebral cortex, hypothalamus, amygdala → gigantocelluar neuron→ ascending fibers → central tegmental tract → intralaminar nuclei of thalamus

Multimodal Association Cortex:

Integrate information from multiple different sensory inputs. Divided into: Posterior Area: Sensory integration including visuospatial localization, language, and attention. Anterior Area: motor integration including motor planning, language production and judgement. Limbic Area: integration of information necessary for memory and conscious emotion.

Neglect; hemiunconsiouness

Is failure to attend towards contralesional stimuli Pts act as if that side of space doesn't exist Consciously unaware of events Lesions is the non-dominant parietal lobe Bc lesion in dominant parietal lobe will cause language deficits for most people

Define the term "joint/articulation" as it pertains to the skeletal system. Distinguish the tissues uniting the bony surfaces in synovial joints, fibrous joints and cartilaginous joints.

Joints/articulations Unions or junctions between two or rigid parts of the skeleton Synovial joints United by a joint capsule composed of an outer fibrous layer lined by a serous synovial membrane (which spans and encloses the articular cavity) Fibrous joints United by fibrous tissue Cartilaginous joints United by hyaline cartilage or fibrocartilage

Lesions of Orbital or medial prefrontal cortex

Language, motor skills, IQ all unaffected Normal emotional responses to intense stimuli (e.g. pain) Impoverished affect (but not abolished) patients show bursts of emotional lability Inappropriate in social situations Core deficit: insensitivity to the emotional consequences of one's own actions. Lack of empathy.

Understand the categories of frontal lobe function and type of dysfunction associated with prefrontal cortex lesions (Frontal lobe function: dysexecutive syndrome)

Lecture 36:

Ventral Prefrontal Cortex:

Mediates emotional expression identification Participates in the automatic regulation of emotional behavior

Explain the role of scapular movement in glenohumeral joint function; list the joints involved and the muscle activity required to abduct the arm 180 degrees.

Movements of the scapula on the posterior thoracic wall work with those at the glenohumeral joint ("scapulohumeral rhythm") to increase the total range of motion possible at the shoulder. For example, in abducting the upper limb, the deltoid muscle, along with supraspinatus (the latter of which is said to "initiate" abduction), are capable of producing only between 60- 90° of upper limb abduction. Abduction above this level requires upward rotation of the scapula on the posterior thoracic wall and consequent superior orientation of the glenoid cavity.

Describe the two functions of the multiple accompanying veins (venae comitantes) that typically travel with deep arteries

Multiple accompanying veins Countercurrent heat exchange Warm arterial blood warms the cooler venous blood as it returns to the heart from a cold limb Ateriovenous pump Accompanying veins are stretched and flattened as the artery expands during contraction of the heart, which aids in driving beous blood toward the heart

Specify the primary actions of the muscles contained within the each of the compartments in the arm and forearm; specify the primary actions of the intrinsic muscles of the hand.

Muscles in the anterior (flexor) compartment of the forearm occur in three layers: superficial, intermediate, and deep. Generally, these muscles are associated with: ▪ movements of the wrist joint, ▪ flexion of the fingers including the thumb, and ▪ pronation. Muscles in the posterior compartment of the forearm occur in two layers: a superficial and a deep layer. The muscles are associated with: ▪ movement of the wrist joint, ▪ extension of the fingers and thumb, and ▪ supination. The anterior compartment of the arm contains muscles that predominantly flex the elbow joint; the posterior compartment contains muscles that extend the joint. Major nerves and vessels supply and pass through each compartment. intrinsic muscles occur entirely in the hand and mainly execute precision movements ("precision grip") with the fingers and thumb.

List the three compartments of the leg and indicate the primary actions of the muscles contained within each

Muscles in the anterior compartment of the leg dorsiflex the ankle, extend the toes, and invert the foot. Muscles in the posterior compartment plantarflex the ankle, flex the toes, and invert the foot. Muscles in the lateral compartment evert the foot. Major nerves and vessels supply or pass through each compartment.

Specify the muscles and/or ligaments involved in the following injuries of the elbow: tennis elbow, golfer's elbow, little leaguer's elbow.

Muscles that arise from the medial epicondyle of the humerus (common flexor origin)flex the wrist and interphalangeal joints of the digits, and pronate the forearm. Medial epicondylitis ("golfer's elbow") refers to a tendinopathy of this common flexor origin. Most of the superficial extensor muscles of the forearm have their proximal attachments on a common extensor tendon attached to the lateral epicondyle of the humerus. The common extensor muscles collectively extend the wrist and the medial digits, and supinate the forearm. Lateral epicondylitis ("tennis elbow") refers to a tendinopathy of the common extensor tendon. The ulnar collateral ligament is often injured in baseball pitchers and other athletes who engage in sports that involve powerful throwing. These injuries, referred to in children as "little leaguer's elbow", can include stretching, tearing and rupture ofthe ligament

Describe the mechanism and function of the musculovenous pump and the function of venous valves

Musculovenous pump Contraction of skeletal muscles compresses the veins, "milking" the blood superiorly to the heart Venous valves Break up columns of blood, thus relieving the more dependent parts of excessive pressure, allowing blood to flow only toward the heart

Types:

Negative: fear, ager, greif, hate Positive: love, empathy, caring, joy

Transduction:

Odorant molecules bind to receptor on surface of cilia—> at least 2 2nd messenger are involved—> influx of Ca2+ cause opening of Ca2+ gated Cl- channels—> depolarization along receptor neurons.

List the ten structures that pass through the carpal tunnel; explain the anatomical basis and common symptoms of carpal tunnel syndrome.

Officially there are 10 structure listed in the carpal tunnel 1. Flexor Tendons to the fingers and thumb, FDS, FDP, and FPL 2. The median nerve 3. The synovial membrane of the flexor tendons The most problematic structure in the carpal tunnel is the flexor tendon synovium. It is implicated in carpal tunnel syndrome associated with tendinitis. Carpal tunnel syndrome is a compression injury to the median nerve at the wrist. It is a clinical diagnosis, indicated by numbness and tingling in the thumb, index, and long fingers often waking the patient at night from sleep. Causes include inherited anatomical propensity for CTS, repetitive stress to the median nerve from forceful flexion of the wrist, exposure to vibration over a long period of time, repetitive impact like use of a jack hammer, or pounding with a hammer. It may also be associated with tenosynovitis/tendinitis of the flexor tendons.

Pathways:

Olfactory receptors axons synapse with mitral and tufted cells (#2) (main output neurons) in the glomerular layer (#5)—> their axons form the olfactory tracts—> (1) largest bundles of fibres of the tract exit from the olfactory bulb in the Lateral olfactory tract and project directly to the primary olfactory cortex (piriform cortex), amygdala and entohinal cortex (see picture for complete pathway LOL)/// (2) medial olfactory tract (less prominent pathway)—> project ipsilateral to basal limbic forebrain + fibres to contralateral anterior olfactory nucleus. ROLE NOT WELL UNDERSTOOD. (389)

Specify the ligaments and tendons that support the longitudinal arches of the foot.

Passive support of the arches is provided by numerous ligaments that span tarsal bones. The three most important ligaments are the long and short plantar ligaments and the spring (plantar calcaneonavicular) ligament. Dynamic support of the arches is provided by active and tonic contraction of the intrinsic foot muscles, as well as of the muscles whose tendons pass into the sole of the foot. Of the latter, the tibialis posterior tendon, by virtue of its attachment to the navicular, is particularly well-suited to support the head of the talus at the peak of the medial longitudinal arch.

Circuits in mem and emotion

Pathway for remembering why we were scared of something

Distinguish the movements allowed at the atlanto-occipital and atlanto-axial joints and describe the functions of the transverse ligament of the atlas and the alar ligaments at these joints.

Realize that flexion and extension (as in nodding "yes"), and a slight lateral flexion of the head are the only movements allowed at the atlanto-occipital joint. Realize that the atlanto-axial joints allow the atlas to rotate around the dens as a pivot (as in shaking your head "no").

Specify the pulse points for the posterior tibial and dorsalis pedis arteries.

Recall that the pulse of the posterior tibial artery can be palpated just posterior to the medial malleolus. Recall that the pulse of the dorsalis pedis artery can be palpated just lateral to the flexor hallucis longus tendon.

Understand concepts and locations of primary sensory cortex, unimodal association cortex and multimodal association cortex Primary Somatosensory Cortex:

Receive information directly from the outside world

Unimodal Association Cortex:

Receives and processes (secondarily) information from one primary cortex only.

Role: RAS

Regulation of arousal/vigilance/alertness Now that projections have been sent through RAS to the thalamus we have the oscillation theory The 40 Hz oscillation originates in the thalamus and triggers all the synchronized cells in the cerebral cortex that are recording sensory information. Cortex cells that are active at that moment fire a coherent wave of signals back to the thalamus. Consciousness may originate from this loop between thalamus and cortex, from the constant interaction (or "resonating activity") between them Lecture 38: Neurological Exam

Explain the anatomical basis of subacromial bursitis and supraspinatus tendinitis.

Repetitive use of the upper limb above the horizontal and use of the rotator cuff muscles can lead to degenerative tendonitis of these muscles. The supraspinatus tendon is particularly vulnerable to this condition due to its relatively avascular tendon and its potential impingement on the coracoacromial arch. Repetitive motion can also irritate the subacromial bursa leading to bursitis. Repetitive use ofthe rotator cuff muscles can lead to degenerative tendonitis of these muscles. The supraspinatus tendon is particularly vulnerable to tendonitis due to its relative avascularity and its potential to be impinged against the coracoacromial arch. Repetitive motion can also irritate the subacromial bursa leading to bursitis.

HM: got medial temporal lobectomy

Results: Complete anterograde amnesia and Retrograde amnesia for 2-3 years In amnesic patients memory declines beginning about 1 minute during word learning task. He could learn how to do new tasks like mirror drawing but couldn't remember actually doing the tast.

Patient R.B.: underwent coronary artery bypass graft that caused abnormalities were bilateral ischemic changes in the CA1 subfields of the hippocampus

Results: Severe anterograde amnesia

Explain the distribution of ventral primary rami fibers to the components of the brachial plexus including its trunks, divisions, cords, terminal branches, pre-plexus branches and non-terminal branches of the trunks and cords.

Roots (5): the ventral primary rami of the C5 to C8 and most of the T1 spinal nerves; •Trunks (3):o Superior: formed by the union of the C5 and C6 rootso Middle: the continuation of the C7 rooto Inferior: formed by the union of the C8 and T1 roots•Divisions (3 anterior, 3 posterior): an anterior/posterior pair of divisions is formed by the division of each trunk. •Cords (3 - named for their position relative to the axillary artery):o Lateral: formed from the union of the anterior divisions of the upper and middle trunks and therefore has contributions from the C5-C7 roots;o Medial: the continuation of the anterior division of the inferior trunk and therefore has contributions from the C8-T1 roots:o Posterior: formed by the union of all three posterior divisions and therefore has contributions from C5-T1 roots rhe five large nerves that are derived from the cords are considered the terminal branches of the brachial plexus. check

List in order from superficial to deep the structures the needle will pass through when performing a lumbar puncture.

Skin, superficial fascia, supraspinous ligament, interspinous ligament, Ligamentum flava, epidural space, dura mater, arachnoid mater, cisternal subarachnoid space,

2. For taste, describe the stimuli that activate taste receptors, characteristics of taste receptors, transduction process, pathways from the taste buds on the tongue to primary taste (gustatory) cortex. Define ageusia.

Stimuli and receptor: Also stimulated by chemical molecules. Different region of the tongue are more sensitive to different taste sensations (sweet, bitter, salty, sour and umami). Receptors cells are in the taste buds in various type of papillae (different for anterior 2/3 and posterior 1/3 of tongue). Structure: Pore at the tip, taste receptor cell with microvilli (10 days) and basal cells and cells in various stages of development (to replace taste receptors cells). (390)

List the muscles involved in pronation and supination of the forearm; specify innervation of each of these muscles

Supination biceps brachii musculocutaneous nerve supinator deep radial nerve pronation pronator quadratus anterior interosseous nerve forceful pronation: combined actions of a) pronator quadratus anterior interosseous nerve b) pronator teresa) b) median nerve

Explain the two major functions of the lower limbs.

Support Body weight and locomotion

Specify the branches of the inferior trunk of the brachial plexus; list and describe the functional deficits expected with an injury to the inferior trunk

the C8 and T1 ventral (anterior) primary rami: confirm that the bulk of the T1 ventral (anterior) primary ramus joins the C8 ventral (anterior) primary ramus to form the inferior trunk. The medial cord, its branches, and its terminal continuation, the ulnar nerve, are all composed exclusively of nerve fibers from the inferior trunk and therefore the C8 and T1 roots. Although far less common than superior trunk injuries, injuries to the inferior trunk do occur. In addition to the sensory deficits expected in the C8 and T1 dermatomes, inferior trunk injuries feature a characteristic posture of the hand termed "clawed hand" (not to be confused with Dupuytren's contracture). In this posture the metacarpophalangeal joints of the medial two digits are extended and the interphalangeal joints flexed due to functional loss of the medial two lumbricals and the interossei in the hand, all of which are innervated by the ulnar nerve. Moore Fig. B3.13 The motor portion of the ulnar nerve is assessed clinically by asking patients to grasp a sheet of paper between two opposed digits while attempting to pull it free. check

Specify the movements of the knee normally prevented by the anterior and posterior cruciate ligaments of the knee; explain positive anterior and posterior drawer signs with respect to the latter

the cruciate ligaments prevent anterior and posterior motion of the tibia relative to the femur, especially during knee extension and flexion. The integrity of the ligaments is determined by assessing the sliding (drawer movement) of the tibia relative to the femur. A torn ACL will result in abnormal passive anterior displacement of the tibia relative to the femur (i.e., "anterior drawer sign"); a torn PCL will result in abnormal passive posterior displacement of the tibia relative to the femur (i.e., "posterior drawer sign").

Specify the location and contents of the tarsal tunnel.

the flexor retinaculum that extends from the medial malleolus of the tibia to the medial aspect of the calcaneal tuberosity. This thickened band of deep fascia holds the three tendons of the deep posterior compartment in place during movements of the ankle and defines the passageway/space known clinically as the tarsal tunnel.

Specify the primary actions (both unilateral and bilateral) and innervation of the muscles of the splenius

the splenius muscle rotates the head and cervical spine to the same side when acting unilaterally. When acting bilaterally, the right and left splenius muscles extend the head and cervical spine. Innervated by dorsal (posterior) primary rami

Specify the vascular supply of the following muscles of the gluteal region: gluteus maximus, gluteus medius, gluteus minimus

the superior gluteal artery supplies all three gluteal muscles, as well as the tensor fasciae latae muscle. The inferior gluteal artery supplies gluteus maximus and other deep buttock muscles(but not the gluteus medius and gluteus minimus)

Explain the primary function of the upper limbs.

the upper limb is highly mobile for positioning the hand in space.

Lesion: Anosmia

—> loss of olfactory function // Hyposmia—> reduced olfactory function. Caused by aging, neurodegenerative disorder (parkinson, alzheimer..), head trauma, infection...

Lesion: Agueusia

—> loss of taste sensation. Variation like loss of particular taste (sweet, sour...)—> partial ageusia or hypogeusia—> reduced sensation of taste. NOTE: impairment of olfaction may also influence perception of taste. Lesson 35: Higher Cortical Function, Memory & Emotion I

Distinguish the action of the gluteus maximus from that of the lesser gluteals (gluteus medius & minimus) during walking.

•Foot-flat: As the stance phase proceeds toward the position of foot-flat, the weight is redistributed from the heel to the lateral side and "ball" (metatarsal heads) of the foot. Just before heel-strike, the gluteus maximus contracts to promote extension of the thigh. (A person with a weak gluteus maximus may lurch backward at heel-strike to stop the forward movement of the trunk and produce a passive extension at the hip.) The quadricepscontracts to extend the leg after the foot makes contact. The hamstrings also contract, but this is usually interpreted as being primarily in order to prevent hyperextension of the leg. (If the hamstrings are paralyzed, a hyperextension deformity develops at the knee.) •Midstance: As the cycle is proceeding to midstance, the anterior leg muscles cease contracting and passive dorsiflexion of the foot then occurs as the weight of the body is shifted forward over the foot. The muscles that plantar flex the ankle (primarily the gastrocnemius and soleus - the triceps surae) contract to control this dorsiflexion and to initiate toe-off of the next cycle. During midstance the weight of the body is over the supporting limb, while the other foot is in swing phase. At this time the gluteus medius and minimus of the supporting limb contract to prevent drooping of the unsupported side of the pelvis. Terminal The thigh (through contraction of the gluteus maximus) and knee (by contraction of the quadriceps) begin to extend.

Specify the principle joint action controlled by and the location of sensory testing for each of the ventral primary rami that contribute to the (lumbo)sacral plexus;be able to apply this information in assessing sensory and motor deficits in the lower limb

▪ Flexion of the hip is controlled primarily by L1 and L2. ▪ Extension of the knee is controlled mainly by L3 and L4. ▪ Knee flexion is controlled mainly by L5 to S2. ▪ Plantarflexion of the foot is controlled predominantly by S1 and S2. ▪ Adduction of the digits is controlled by S2 and S3.

Distinguish the origins, routes and terminations of the great and small saphenous veins.

▪ The great saphenous vein passes up the medial side of the leg, knee, and thigh to pass through an opening in deep fascia covering the femoral triangle and join with the femoral vein. ▪ The small saphenous vein passes behind the distal end of the fibula (lateral malleolus) and up the back of the leg to penetrate deep fascia and join the popliteal vein posterior to the knee.