Neuro 1 pt 2

*V1: Ophthalmic Division* 1. What region of the head does this innervate? 2. 5 named branches we need to know

1. Forehead & bit'o nose 2. i: Supratrochlear ii: Supraorbital iii: Lacrimal iv: Infratrochlear v: External (dorsal) Nasal (pay attention to locations, you will be quizzed later) {LISSE}

Rules to remember for the pathway 1. What does the Basal ganglia structures release? 2. What do the "other" structures release? 3. What does substantai nigra release?

1. GABA 2. Glutamate 3. Dopamine

1. Where would you find the *Inferior Laryngeal Nerve & Artery*? 2. What is the *Inferior Laryngeal Artery* a branch of? 3. What is the *Inferior Laryngeal Nerve* a continuation of?

1. Gap 4 (under Inferior Constrictor Muscle) 2. Inferior Thyroid A. 3. Recurrent Laryngeal N.

REVIEW 1. Is Parkinson's hyper or hypokinetic? 2. What about huntington's?

1. Hypokinetic 2. Hyperkinetic

*Spinal Cord Pain Mechanisms:* 1. Specific properties of nociceptive and non-nociceptive signals together code for pain perception where? 2. Some spinal cord layers contribute to pain-modulatory pathways by _______-________-________ mechanisms

1. In the Spinal Cord 2. *spino-bulbo-spinal*

1. Where do we meet the 3rd neuron in this chain? 2. T or F: all ascending general and visceral sensory pathways synapse in ventral posterolateral nucleus.

1. In the VPL of the thalamus. 2. True. Well, he says pretty much all of them.

*Cerebrospinal Fluid:* 1. Where will you find the CSF? (hint what layer?)

1. In the subarachnoid space around brain and spinal cord

*Developing Cerebral Cortex* 1. In the developing cerebral cortex, in what zone do cells proliferate? 2. After proliferating, how do they migrate closer to the surface? 3. What zone do neuronal cells migrate through to become more superficial? 4. Where do neuronal cells settle down and start putting down roots (or projections, whatever floats your boat)? 5. What zone do they start to send out projections to? What covers this zone?

1. In the ventricular zone 2. Via radial glial cells (they send up long projections to the cortical plate). 3. They migrate through the intermediate zone 4. They settle down in the cortical plate and begin differentiation (i.e start to send out projections to the marginal zone. 5. Marginal zone and it is covered by pia mater.

*Laryngopharynx* - Recall: 1. What's the superior boundary? 2. What's the inferior boundary? 3. What's the anterior boundary?

1. Inferior surface of epiglottis 2. Esophagus 3. Posterior Larynx, ant. pharyngeal wall & *Aditus* (opening to larynx)

1. What are corticoafferant neurons? 2. What are corticoefferents neurons? 3. What type of signals are layers II and III most concerned with? 4. What type of signals is layer IV concerned with? 5. What type of signals is layers V and IV concerned with?

1. Information coming *into the cortex! from thalamus*, association fibers, and commissural fibers. 2. Information going *out of the cortex going to the thalamus* (allows thalamus to work as gatekeeper), brain stem, spinal cord, and cerebral cortex. 3. Layers II & III: Out to cerebral cortex 4. Layer IV: In from Thalamus 5. Layers V & VI: Out to Basal ganglia, thalamus, brain stem, and spinal cord

1. How does the orientation of the sensory fibers from the lower body change as it ascends through the spinal cord? 2. Where are the two columns formed (what is the cut off point for each)? 3. Where would these columns synapse? On what?

1. Initially, they enter the spinal cord and are more lateral. As they ascend, they get pushed more medial by incoming sensory fibers. At the end, the lower body fibers are most medial and upper body fibers are more lateral. 2. Gracilie fasiculus gets input from BELOW T6. Cuneate fasciculus gets input from ABOVE T6. 3. Synapse in the medulla in the posterior column nuclei (FG = NG and FC = NC).

What are the 2 roles of the *Superior Constrictor* in swallowing?

1. Initiates peristaltic-like movements to advance food bolus toward esophagus 2. Seals of Nasopharynx (in conjunction w/soft palate)

Commonalities of *Muscles of Facial Expression* 1. Where do they insert most often? 2. What joints do they cross? 3. Most (*not all*) act on at least 1 of what 2 structures?

1. Insert on other muscle or skin (not bone) 2. *Don't* cause movement across a joint 3. Eyes or Mouth

1. What type of bone development does the bones of the skull undergo? 2. How many bones are found in a baby's skull? What about in adults? 3. How many soft spots are in a baby's skull? What are each called? 4. When will they close up?

1. Intermembranous ossification 2. 41 for babies and 28 for adults. 3. There are 6 (Anterior fontanelle, posterior fontanelle, 2 anteriorlateral, and 2 posteriorlateral). 4. 6 months, except for the anterior, it usually closes at 18 months old.

What are the main branches (5) off of the Superior Cervical Ganglion?

1. Internal Carotid n. 2. Postganglionic fibers to spinal nn. C1-C4 3. External Carotid n. 4. Pharyngeal branches 5. Superior cervical cardiac n.

1. What is the track of the internal carotid a. ? 2. Does it have any branches prior to entering the canal? 3. What does it supply at its terminal structures?

1. Internal carotid a. - ascends within the carotid sheath to the base of the skull where it enters the carotid canal. 2. Prior to entering the canal, it has no branches. 3. lntracranially, it supplies the orbit and brain.

*Layers of the Neocotex* 1. What is the name of zone V? 2. What is the major cell type found here? 3. What is a different name for the cells in #2? 4. What is layer VI named? 5. What is important about this layer? 6. What are the major cell/neurons types found here?

1. Internal pyramidal layer 2. Pyramidal cells, also known as cortical-striate fibers 3. Betz cells 4. Polymorphic layer 5. Following the migration of the molecular layer, *this is the second layer to develop and migrate and this is the layer that all the rest of the cells with migrate through during development.* 6. intralaminar synapses, cortico-thalamic fibers

1. How do peripheral nerves from multiple levels communicate & work in concert? 2. Q1 have different properties whether they innervate what 2 different areas of body? 3. Interneurons feeding *Axial* musculature are more {medial OR lateral}, {unilateral OR bilateral}, {many OR less} collaterals? 4. Interneurons feeding *Limb* musculature are more {medial OR lateral}, {unilateral OR bilateral}, {many OR less} collaterals?

1. Interneurons! 2. Axial or limb lower motor neurons 3. Axial: medial, bilateral, many collaterals 4. Limb: lateral, unilateral, less collaterals

1. Where is the Posterior spinocerebellar tract brining information from? 2. Where is the Cuneocerebellar tract brining information from? 3. Where is the Anterior spinocerebellar tract brining information from? 4. Where is the Rostral spinocerebellar tract brining information from?

1. Ipsilateral trunk & lower limb 2. Ipsilateral upper limb 3. Ipsilateral trunk & lower limb 4. Ipsilateral upper limb

1. Do we have predictable behaviors? What can we use them for? 2. If mental status is compromised, what is a good idea to do? 3. What test to we give?

1. It is assumed that we have predictable behaviors that are appropriate for given situations. *When behavior is misaligned with a situation, cognitive capacity is called into question.* 2. Whenever any findings suggest there is CNS pathology, *it's a good idea to follow up with a mental status exam to determine if/which brain areas affected* 3. Using the *MMSE*, neuropsychological tests, and case history, can localize Learning the functional organization of the cortex is important for understanding MMSE/Neuropsychological/Behavioral findings

*Retina:* The retina has an inverted design, light has to pass thru lots of stuff before it can be detected by the photo receptors. This is not great for visual acuity. 1. Why the flip is it that way then?

1. It is thought that absorbing light generates lots of heat. Chorid may serve as a heat sink. Best way to get photoreceptors near the vasculature is thru the inverted design

Course of CN XI... 1. What foramen does it exit? 2. Passes b/w what 2 vessels immediately? 3. What muscle does it then enter & at what margin?

1. Jugular foramen 2. Internal carotid a. & Internal jugular v. 3. Medial Superior aspect of SCM.

*Lacrimal Gland:* 1. What is the name of the artery and nerve going to the lacrimal gland? 2. The secretory Acini have what type of epithelium? 3. What will it secrete? 4. The secretory acini are surrounded by what cells? 5. What do the cells in #4 do?

1. Lacrimal Artery and nerve 2. Simple columnar 3. mostly serous 4. Myoepithelial cells 5. They squeeze the Secretory acini to push the secretions into the ducts

*Bones of the Nasal Cavity:* 1. What small bone helps form the lateral wall of the nasal cavity? (we haven't talked about in this set yet) 2. What are the last 2 concha that will jut into the nasal cavity that we haven't named yet?? 3. What is the space lateral to #2?

1. Lacrimal bone 2. Inferior Concha 3. *Inferior Meatus*

*thyroid cartilage:* Anteriorly 1. What is the smooth and flat part of the thyroid cartilage on both sides called? 2. how many lamina are there? 3. They connect midline and protrude midline to form what?

1. Lamina 2. 2 3. the adams apple or laryngeal prominence

1. What is the pathway of the brain when someone is asked to repeat something out loud? (3) 2. What about reading something aloud? (4)

1. Language information arrives in Wernicke's area 2. Then travels through the parietal lobe in the arcuate fasciculus to Broca's area. 3. Adjacent cerebral cortex for the tongue, lips, larynx, and pharynx 1. Visual impulses are received by the left and right occipital visual cortex regions. 2. Both regions send impulses to a left parietal lobe association region (the oval), 3. Converts text to language. 4. Impulses from the left visual field, which are initially received in the right cortex, must first pass through the posterior corpus callosum to reach the language centers (Then from here its much like the last pathway) 5. Get to the arcuate fasciculus 6. Arrive at Broca's area, move to adjacent cerebral cortex for the tongue, lips, larynx, and pharynx.

*Thoracic region* 1. What is the White Matter like (1)? 2. What is the Grey Matter like (3)? why?

1. Large *single* posterior funiculus 2. i: Small dorsal & ventral horns (not allata motor or sensory info here) ii: Lateral horn is present (T1-L2) (lotsa organs here carrying *visceral efferents*) iii: *Nucleus Dorsalis* is present

*Layers of the Neocotex* 1. What is layer II called? 2. What is found in layer II? 3. What structure do they pass on their way? 4. What is found in layer III? 5. What is layer III called?

1. Layer II— External granular layer 2. Small pyramidal neurons, cortico-cortico fibers (fibers that go from one part of cortex to another part of cortex) 3. LAYERS II and III connected between hemispheres via corpus callosum (these are called comissural fibers) 4. Layer III—Med. pyramidal neurons, cortico-cortico fibers 5. External pyramidal layer

*Layers of the Neocotex* 1. What is layer IV called? 2. What is found in layer IV? 3. What is the main info that is received in this zone? What type of synapses are found here? 4. What would it mean for the areas with if found in an area of the brain with higher amounts of sensory information?

1. Layer IV—Internal granular layer 2. Stellate and granule cells 3. MOSTLY RECEIVE SENSORY INFO (thalamocortical synapses) one would be much thicker 4. This zone would be much thicker as compared to other zones as well as compared to this zone in other parts of the brain.

1. What are the left dominant traits? 2. What are the right dominants traits? 3. On what side is the planum temporale larger in humans? What goes on around this sulcus?

1. Left-Dominant Traits: -Language -Calculation -Logic/Storytelling 2. Right-Dominant Traits: -Visuospatial Relationships -Music -Facial Recognition 3. left side, This is the area for speech comprehension and language, all going on around this sulcus.

*Posterior Column - Medial Lemniscal Pathway* 1. What would a lesion to this pathway cause (2)?

1. Lesion would cause: a. Impairment of tactile sensibility (ataxia) b. Loss of proprioception

*Cutaneous nerves: Ventral Rami* C2-C4 What 4 nerves come from C2-C4 and which nerves contribute to each

1. Lesser occipital nerve [C2, (C3)] 2. Great auricular nerve (C2, C3) 3. Transverse cervical nerve (C2. C3) 4. Supraclavicular nerves (C3, C4)

1. Where is the motor nucleus of the CN V? 2. What else can be found at the this level of the brainstem?

1. MID-PONS 2. this is also the site of the *MAIN SENSORY nucleus of CN V.*

*Afferent Tract Neurons* 1. The major {ascending or descending} pathways? 2. What sort of stuff does it carry (2)? 3. Different diameters of neurons dictate what?

1. Major ascending PW 2. - Soma (pain + temp & proprioception) in gray matter *and* - Myelinated axons (for all somatosensory modalities) in white matter. 3. different pathways & different functions

*Facial a.* 1. Where does it arise from (2 options)? 2. What is the course of this artery?

1. May arise from a common trunk with the lingual artery or just above it singly. 2. It courses obliquely anteriorly deep to the posterior belly of the digastric and stylohyoid and grooves the deep surface of the submandibular gland.

*Motor Homunculus* 1. Legs found where? 2. Hand found where? 3. Tongue found where?

1. Medial 2. Superior/Middle 3. Lateral

So, from the medial lemniscus fibers: 1. Where do we synapse next? 2. What order of neuron comes after the synapse? 3. #2 then [ascends/descends] in the [external capsule/internal capsule] becoming the [corona radiata/corpus collosum]. 4. Will then synapse where? What specific layer?

1. Medial lemniscus fibers Synapse in VPL of thalamus 2. 3rd order neurons 3. Ascend in Internal capsule, becoming Corona radiata 4. Synapse in Sensory cortex (layer IV)

*Palate* 1. What is contributing to the formation of the primary palate? 2. Fusion of what prominences will form this? 3. What creates the secondary palate?

1. Medial nasal prominences 2. Fusion of the medial nasal prominences (2 of them) as well as their fusion with the maxillary prominences (2 of them) are the primary palate. 3. The fusion of the two maxillary prominences.

Pathways from globus pallidus internal (medial) to Thalamus. 1. What portion does the Ansa lenticularis come? 2. What about Linticular fasciculus? 3. What is the thalamic fasciculus?

1. More medial parts of globus pallidus internal 2. more lateral area of GPi 3. white bundle that Ansa Lnticularis and lenticular fasciculus enter (also carries cerebellar info)

1. How many layers are there in the adult cerebral cortex? 2. How are they numbered? 3. How do we differentiate each layer (how are they unique)?

1. Most cerebral cortex in humans has *6* layers 2. Numbered from superficial to deep 3. Each layer has unique input/output, cell types and morphologies.

Pharyngeal plexus - *ii: CN X* 1. Mostly Motor or Sensory? 2. What muscles in the pharynx does it not innervate (2)? 3. What sensory does it do + via what branch? 4. Parasympathetics? 5. What about special sense?

1. Motor to most muscles of Pharynx & Soft Palate 2. Doesn't innervate Stylopharyngeus (IX) *or* Tensor Veli Palatini (V) 3. Sensory from *Piriform Recess* via Superior Laryngeal N. 4. Parasympathetics to Pharyngeal glands 5. Taste Pharynx/Epiglottis

*Arch 1* Muscle Derivatives 1. It becomes what group of muscles? 2. What are the 7 muscles of this group?

1. Muscles of Mastication 2. Temporalis; pterygoid mm.; masseter; anterior belly of digastric; mylohyoid; tensor tympani; tensor veli palatini

1. Do all the neurons in all the different parts of our nervous system develop at the same time? 2. Whe does gliogenesis take place during development? 3. What is the ratio between glia and neurons? 4. What 4 conditions are glial abnormalities related to?

1. NO! 2. *Gliogenesis* takes place during the second and third trimesters of pregnancy and early postnatal development 3. Glia outnumber neurons 10:1 in the fully developed brain 4. Glial abnormalities related to Alzheimer's, Multiple Sclerosis, Schizophrenia, Depression

Flip card for question

1. Name the blue box 2. What part of the brain does this wrap around? 1. Tentorial notch 2. Midbrain

What does each foramen transmit? 1. foramen cecum? 2. anterior ethmoidal foramen? 3. Posterior ethmoidal forame?

1. Nasal emissary vein 2. Anterior ethmoidal A. V. N. 3. Posterior ethoidal A. V. N.

1. What are the PNS cells differentiated from? 2. If the cells that give rise to the PNS were damaged, where else would you see defects?

1. Neural Crest Cells 2. Because they also give rise to structures in the skull as well as a myriad of other places, you would not only see PNS issues but also musculoskeletal issues (direct quote).

*Neural Tube Fusion* 1. Where do the neural folds meet first? 2. What direction does fusion continue? 3. When is the zipper finally zipped its last zip? 4. Is the neural tube an open or closed system? What are the two openings (before they are fused) called?

1. Neural folds meet first in the future cervical region 2. Fusion continues both rostrally and caudally 3. ~24-26 days of development 4. It is a closed system! the zipping will close up the entire neural tube. The rostral neuropore and the caudal neuropore

*Neurogenesis* 1. What are the progenitors for radial glial cells and neuroblasts? 2. Can neurons be made from radial glial cells? 3. What are the types of cells that radial cells can differentiate into?

1. Neuroepithelial cells 2. yes they can (according to his slide). 3. Oligodendrocytes astrocytes ependymal cells

*Surface Anatomy:* 1. external occipital protuberance and superior nuchal lines 2. What is the process of the temporal bone? 3. What are the 3 parts of the mandible?

1. Occiput 2. Mastoid process 3. Mandible - ramus, angle and inferior margin to midline (symphysis menti)

1. What artery gives rise to External Nasal, Supraorbital, & Supratrochlear aa? 2. What other sorts of branches emerge before making it onto the face?

1. Ophthalmic A (1st branch o'ICA) 2. branches to perfuse structures in eye

*REVIEW* 1. What is the cortical area for olfactory response?

1. Piriform Cortex

*Surface Anatomy:* 1. what muscle has a corrugated 'turtle neck' appearance of cutaneous muscles and is seen anteriorly and laterally upon straining?

1. Platysma

What can result from the improper placement of a needle in a central venous line? (2)

1. Pneumothorax 2. Placement of needle in subclavian artery (NOT vein)

1. Soft palate attaches [anterior or posterior?] to what bones? 2. The Hard palate is [thinner or thicker?] then it appears from anterior view?

1. Posterior, Palatine bones 2. Thinner, like me I appear way thicker then I really am

1. What is craniosynostosis? 2. What is scaphocephally? What sutures close first? 3. What is brachycephaly? What sutures close first?

1. Premature fusion of flat bones of the skull. 2. This is premature fusion of sagittal suture 3. This is premature fusion of coronal suture.

*Temporal Lobe* 1. What is Broadmann area 41? 2. 42? 3. 22?

1. Primary auditory area, A1 2. Auditory association area, A2 3. Auditory association area: posterior portion (on left) = Wernicke's area

*Occipital Lobe* 1. What is Broadmann's area #17? 2. What is 18? 19?

1. Primary visual area, V1 2. Visual association areas, V2, V3, V4, V5

GSA - Cranial and Peripheral components

1. Proprioceptive: -All SN's - CN V 2. Exteroceptive: (Ectodermal) -All SN's - CN V, VII, IX, X

SSA - Cranial and Peripheral components

1. Proprioceptive: (Balance) -CN VIII (Vestibular) 2. Exteroceptive: (Sight and Hearing) - CN II, VIII (Cochlear)

Clinical Correlation: Middle meningeal artery 1. A fracture of which bone will often tear the middle meningeal artery? 2. This often leads to blood pooling where?

1. Pterion (thinnest bone bordering lateral surface of skull) 2. blood pooling between the dura and the inside surface of the pterion (epidural hematoma)

What are three different types of peripheral neuropathies?

1. Radiculopathy 2. Mononeuropathy 3. Polyneuropathy

1. What are Spinal Cord Reflexes? 2. What are 2 *Simple spinal cord reflexes*?

1. Rapid, automated responses to stimuli that don't involve upper-level input 2. *Muscle stretch* reflex: reciprocal inhibition (later) *Flexor* reflex: crossed extension reflex (pull on leg away & tell *other* leg to support you so you dont fall over)

1. Ideally aqueous humor production matches what? 2. Imbalance of #1 can lead to what 2 things?

1. Reabsorption 2. Intraocular pressure and Glaucoma

*REVIEW* (all can participate, this is a huge card) Start from receiving light-touch or vibration information from the lower body and track it all the way to the primary somatosensory cortex. REMEBER! -Where are the primary, secondary, and tertiary neurons? -Where in the spinal cord is the tract initially located?

1. Receive the proprioceptive info from the receptor on the skin (Meissner's for fine touch and Pacinian for vibration) 2. travels through dorsal root into the dorsal columns. will be in the fasiculus gracilius which is still our primary sensory neuron (lower body). This is medial to its counterpart, fasiculus cuneatus. 3. Ascend up to the caudal medulla, synapse on 2nd degree neuron in gracile nucleus. 4. Will decussate and ascend through medial lemniscus. 5. Synapse at the VPL in Thalamus. 6. 3rd degree neuron will ascend through the internal capsule, corona radiata, and eventually synapse in primary somatosensory cortex associated with lower body.

*innervation of larynx:* 1. All intrinsic muscle *motor* fibers are through what nerves? 2. EXCEPT for what intrinsic muscle which gets its motor fibers from what nerve?

1. Recurrent laryngeal nerves 2. except cricothyroid = SLN external branch

1. What in the geometry is the *Danger Triangle*?

1. Region on the front of the face where agents can make their way into Cavernous Sinus via Intracranial Venous Connections

*Reticuospinal tract(s)* 1. Origin? 2. Decussates?If so, where? 3. Affect what musculature? 4. Controlled mostly by what motor centers? 5. When would this be used?

1. Reticular Formation 2. Decussates... somewhere 3. To axial & postural muscles 4. By *cortical* motor centers 5. Stabilizes movement on uneven surfaces *and* can provide secondary control when CST is dysfunctional

1. The notochord secretes what? What does it act on? After some time, what develops as a result of this signaling? What will this structure secrete? 2. The lateral neuroectoderm cells are secreting what factor? After significant signaling from these cells, what will form? 3. What do these signaling systems pattern?

1. SHH; it acts on the neuroectoderm to induce the folding. After some time it creates something called the floor plate and it will also start secreting SHH. 2. BMP. They will induce the neural tube to create the roofplate 3. They end up patterning the dorsoventral axis of the neural tube.

1. What are the neuronal migration disorders? 2. How do they occur?

1. Schizencephaly Heterotopias Lissencephaly 2. 1st trimester infection, insufficient fetal blood supply (like with smoking), genetic mutation.

1. If an individual had a touch sensation coming in their hand typing on their computer on their hand, what layer of the cortex would that most likely signal to? 2. If that same individual wanted to move their hand to continue to type, what layer of the cortex would that signal be coming from?

1. Sensation coming from projection fibers (from out in the body), will come into layer IV (mainly) BUT those fibers do have to potential of synapsing in layers 2-6 (mainly 4 though). 2. These fibers will originate from the infragranular layers (5-6) (major source of projection fibers), could also be the supragranular layers (2-3).

1. What info in the main *ascending* PWs of the spinal cord? 2. Where are they found (2)?

1. Sensory 2. i: Posterior column (Dorsal Feniculi) ii: Spinothalamic tract

1. What is a Romberg's Sign indicative of? 2. How do you perform it? 3. What will happen with the patient? 4. Why is this the case?

1. Signs of posterior column damage (proprioceptive fibers found here) 2. Ask patient to stand erect with their eyes closed, feet together 3. Patient will sway and fall if not supported. 4. "Maintaining balance and upright posture is a 3 legged stool. All the proprioception from the body is one of the legs of the stool. The second leg is the vestibular input. The third part is visual input. If there is damage to one of those legs, then you'll end up with a red stool." Jk he didnt say the last part but you get the idea.

1. Roles of Primary motor cortex (2)? 2. Roles of Premotor & Supplementary motor cortex (3)? 3. Role of Parallel systems?

1. Simple, localized execution of movement & Recruit *Single* Muscle 2. i: Control muscles used to orient & prepare for action ii: Organization, planning of muscle recruitment sequence to perform complex action iii: Recruit *Groups* of muscles, or none at all 3. Different cortical areas affect the same muscles, but *effect different types of movement*

Ventral Trigeminothalamic tract 1. What nucleus is involved? 2. What sensory modalities are found in the VENTRAL Trigeminothalamic tract? 3. Ipsilateral, contralateral or bilateral?

1. Spinal Nucleus of V 2. Crude touch Pain & temperature 3. CONTRALATERAL

Homologous structures from spinal cord and trigeminal system for *pain and temperature*. What structure in the trigeminal system is homologous to the: 1. Lissauer's tracts? 2. Posterior horn

1. Spinal tract 2. Spinal nucleus (caudal nucleus)

*Nasal Cycle:* 80% of people have a cyclical engorgement of the venous plexus underlying the respiratory epithelium. Cycle time varies from person to person and within the same person throughout the day. What are the 4 stages of this cycle?

1. Stage one: Air flows equally through both sides of the nasal cavity 2. One side becomes engorged severely restricting flow. other side is open for business still so you don't notice the problem 3. Stage 3: Both side return to open state with minimal pooling of blood in the sinusoids 4. Stage 4: the opposite side becomes engorged and so it goes..... round and round and round and round and round........ (the outside)

*Cervical Fascias: Infrahyoid fascia* 1. The deep layer invests what 2 muscles? 2. the deep layer is prolonged inferiorly to attach to the posterior surface of what bone?

1. Sternothyroid and thyrohyoid muscles 2. Manubrium

*Mucosa of the Nasal Cavity:* 1. What type of epithelium is in the Nares? 2. What type of epithelium is in the majority of the nasal cavity and all of the paranasal sinuses? 3. What type of epithelium is on the roof of the nasal canal?

1. Stratified Squamous 2. Respiratory Epithelium 3. Olfactory Epithelium

*Eyelid:* 1. what type of epithelium is on the inner surface of the eyelid? 2. Why is #1 so cool? 3. What type of epithelium is on the external surface of the eyelid? 4. How thin is #3?

1. Stratified columnar!!!!!! 2. One of the few places we actually see stratified columnar!!!!!! 3. Stratified Squamous Epithelium 4. thinnest skin on the body <5 cell layers

*Oropharynx:* 1. the oropharynx is lined with what type of epithelium? 2. What is an important component of the oropharynx?

1. Stratified squamous epithelium 2. Palatine tonsils

*Palatine tonsil:* 1. palatine tonsils are covered by what type of epithelium? 2. the epithelium invaginates on the palatine tonsil to form WHAT? 3. #2 does what?

1. Stratified squamous epithelium 2. Crypts 3. Deliver antigens to the immune cells

*Nares:* 1. What type of epithelium again? 2. in the nares there are multiple cell layers of luminal nuclei that are [round or flat?] 3. What does the epithelium sit on?

1. Stratified squamous epithelum 2. Flat that's why its squamous 3. Lamina Propria

*Stylopharyngeus* 1. Originates on what again? 2. Inserts on what? 3. Passes through what, on way to insertion?

1. Styloid Process 2. Pharyngeal wall & thyroid cartilage 3. Passes thru gap b/w Superior & Middle Constrictors?

*Suprascapular n. (C5-C6, upper trunk)* 1. Parallels course of what vessels? 2. to what area? 3. to innervate what 2 muscles?

1. Suprascapular vessels 2. Area of the scapular notch 3. Supra & infraspinatus muscles

1. What kind of sensation will glossopharyngeal do for the tongue? 2. What part of the tongue does it innervate?

1. Taste and somatic sensation (if this is confusing wait til card 16, there is a picture) 2. Posterior 1/3rd

*V3: Mandibular Division* 1. What region of the head does this innervate? 2. 3 named branches we need to know

1. Temple & Beard (red-headed chinstrap) 2. i: Auriculotemporal ii: Buccal iii: Mental (pay attention to locations, you will be quizzed later) {BAM}

Firrrrst some fixes: 1. What muscle is primarily responsible for opening the auditory tube when contracted during swallowing

1. Tensor Veli Palatini NOT the levator veli palatini like he said in his previous lecture.

*Nasal Cavity* 1. There looks like there is a lot of space in the nasal cavity until you add what? 2. The dominant Mucosa of the Nasal cavity and paranasal sinus is what type? 3. #2 overlays an extensive what?

1. The Mucosa! 2. Respiratory Epithelium 3. Venous Plexus

1. Where is a lumbar puncture typically performed? 2. Why here?

1. b/w L4 & L5 (below conus medullaris w/in Subarachnoid space) 2. So you don't damage the spinal cord while sampling CSF

*Organization* related to neural control of *movement* 1. In the spinal cord & brainstem, lower motor neurons (LMN) directly innervate what? 2. LMN are controlled by (2)? 3. What two brain structures regulate UMNs?

1. directly innervate muscle 2. i: by *local circuits* (in spinal cord/brainstem) ii: by *upper motor neurons* (UMN) 3. *Basal ganglia & Cerebellum*

*Superficial structures:* 1. What are the 2 types of Cutaneous nerves here?

1. dorsal and ventral rami

*Third Ventricle:* 1. Looks like an oddly shaped what? (hint: it makes me go nuts) 2. What is the hole in the third ventricle? 3. What does the third ventricle divide? (2)

1. looks like an oddly shaped doughnut 2. The *interthalamic adhesion* 3. Divides the thalamus and the hypothalamus

*Lymphatics: superficial cervical lymph nodes* They receive lymph from what 6 areas/things

1. lower portion of the ear and parotid region 2. the facial region 4. portions of the oral cavity 5. submandibular and sublingual salivary glands 6. skin of the anterior neck and muscles of the infrahyoid region

1. The Inferior petrosal sinus is located in which fissure? 2. Drains the cavernous sinus posterior to which junction? 3. Receives veins from what structures? (3)

1. petro-occipital fissure 2. junction of the sigmoid sinus and jugular bulb 3. pons, medulla and inferior cerebellum

1. What is the spinoreticular tract connecting? 2. What is the spinomesencephalic tracts connecting?

1. spinal cord to the reticular formation in the brain stem 2. Spinal cord up to the mesencephalon

*Cuneiform:* 1. where is it located? 2. what is it in-bedded in? 3. what does it articulate with? 4. Does it move?

1. the lateral wall of the larynx 2. the mucousa 3. NOTHING 4. YUP

*External Jugular Veins (L&R):* 1. They are formed by the union of what 2 veins? 2. where does #1 occur? 3. Course: descends from its formation [superficial or deep?] to what muscle? 4. it then pierces what fascia to gain the root of the neck behind the clavicle? 5. it then terminates in what vein?

1. union of the *posterior division of the retromandibular* and the *posterior auricular* veins 2. at the angle of the mandible 3 .*superficial* to SCM 4. Investing fascia 5. the subclavian vein

What are emissary veins? Which way do they normally flow?

1. veins which communicate between the dural sinuses and the veins of the scalp or diploe 2. Normally flow *toward sinus*. But if pressure is too high then it can go backwards.

1. So the Venturi Effect is bassically when there is a decreased pressure when the pipe [widens or narrows?] 2. So basically the bernoulli's principle is that if you increase speed the pressure will [increase or decrease?]

1. venturi effect: decrease pressure = pipe narrows 2. Bernoulli's principle: increase speed = decrease pressure

1. How does the secondary afferent neuron in the ventral trigeminothalamic tract cross the midline? 2. Which neuron will ascend?

1. via *INTERNAL ARCUATE FIBERS* in medulla. 2.after decussation the *2 order neuron* will ascend.

1. Is raw blood somewhat damaging to neuronal tissue in the brain? 2. Why would blood still be bad in the dural space even though it is not touching neurons and causing cell death?

1. yes 2. The increased cranial pressure is not good homie

*Spino-bulbo-spinal pathways:* 10. Where are the second synapses? (3) 11. in #10 which are (spinoreticular) and which are (spinomesencephalic) 12. Where is the final destination?

10 & 11. Medullary/Pontine reticular formation (spinoreticular), parabrachial nucleus (spinoreticular); Periaquedcucatal Grey Matter (spinomesencephalic) 12. *Dorsal horn of spinal cord*

*Trachea* 10. What lymph nodes will drain the trachea (category & 3 specific nodes w/in that category)?

10. *Juxtavisceral Nodes*: - Pre-tracheal nodes - Para-tracheal nodes - Inferior deep cervical nodes

*Crossed Extension Reflex* 10. What is it? 11. Why?

10. Simultaneous, *opposite* activity during Flexor reflex in *contralateral limb* 11. To maintain posture (so you don't fall over)

*(Neo)spinothalamic pathway:* 10. Where is the 2nd synapse? 11. Final destination is where via what 2 things?

10. Ventral posteriolateral nucleus (*VPL*) of the *Thalamus* 11. Final destination: *Primary somatosensory cortex* (via *internal capsule* and *corona radiata*)

*Paleospinothalamic pathway:* 11. Final destination [one sided or bilateral?] 12. Final destination includes what other 2 things?

11. *Bilateral Cortex*, *poorly localized because bilateral* 12. *includes cingulate gyrus and insula* relates to mood and how we feel

*Thyroid Gland* 11. What 3 structures does it contact medially? 12. What structure does it contact laterally?

11. *Medially*: Trachea, Recurrent laryngeal nn., Esophagus 12. *Laterally*: Carotid sheath (+contents)

*Trachea* 11. What are the 2 autonomic innervation to the trachea & where do they arise from?

11. *Sympathetics*: directly from sympathetic trunk *Parasympathetics*: from Vagus n. & Recurrent laryngeal n.

11. What is the course of the external branch (and fiber type)? What accompanies it? 12. What does it then innervate?

11. External branch (SVE) - courses lateral to the pharynx and larynx on the inferior constrictor muscle accompanied by the superior thyroid artery. 12. At the inferior border of the thyroid cartilage, it courses medially to innervate the cricothyroid muscle and inferior constrictor muscle.

11. GVA fibers provide Sensory to which portion of the pharynx? 12. How do GVE-P get to the Lacrimal, Nasal, Palatal, Oral, and Pharyngeal Mucous glands? 13. How to GVE-P get to the Submandibular and Sublingual salivary glands?

11. Uppermost (Pharyngeal Vault) 12. Via Greater Petrosal Nerve and Pterygopalatine Ganglion 13. Via Chorda Tympani and Submandibular Ganglion

*Crossed Extension Reflex* 12. What are the 5 events of the crossed extension reflex?

12. i: DRG cells synapse on *excitatory interneurons* & *cross to other side* ii: Excitatory interneurons synapse on *extensor motor neurons* iii: Motor neurons synapse on *inhibitory interneurons* iv: inhibitory interneurons synapse on *flexor motor neurons* v: Contralateral extension so you don't fall over

*Thyroid Gland* 13. What sometimes exists at the jxn of the isthmus (w/ the left lobe) & extends superiorly toward the hyoid bone? 14. From what does this arise?

13. *Pyramidal Lobe* 14. Marks descent of thyroid primordium through the *Thyroglossal duct*

*Thyroid Gland* 16. What 3 major arteries supply the thyroid gland?

16. i: Superior thyroid artery ii: Inferior thyroid artery iii: Thyroid ima artery (10% of pop)

*Superior Thyroid Artery* 17. 1st branch of which artery? 18. Courses along the superior medial margin of what?

17. External carotid artery 18. Thyroid Gland

*Superior Thyroid Artery* 19. What are it's 3 major branches & where does each branch go?

19. i: *Superior Laryngeal a.*: pierces thyrohyoid membrane w/internal laryngeal n (off vagus n.) to interior of larynx ii: *Anterior branch*: to anterior bit'o thyroid (anastomose w/ contralateral ant. branch) iii: *Posterior branch*: to posterior bit'o thyroid gland (anastamose w/ inferior thyroid artery)

There're 4 important gaps around the constrictor muscles... - Where are these gaps + what do each transmit?

1: Above superior constrictor - *Auditory Tube & Levator Veli Palatini Muscle* (elevates soft palate) 2: b/w Superior & Middle Constrictors - *Salpingopharyngeus, Stylohyoid Lig, CN IX* 3: b/w Middle & Inferior Constrictors - *Internal branch o' Superior Laryngeal Nerve & Superior Laryngeal Artery* (thru thyrohyoid membrane) 4: Below Inferior Constrictor - *Inferior (cont. of Recurrent) Laryngeal Nerve & Inferior Laryngeal Artery*

What is the path of the somatic sensory fibers found within the Vagus n.? Where are the 1st and 2nd neurons found?

1st neuron --*Superior ganglion of CN X* 2nd neuron -- *Spinal trigeminal nucleus*

What ganglion/nucleus are the somatic sensory neurons from the Glossopharyngeal n. (CN IX) found within?

1st neuron ---> *Superior Ganglion of IX* 2nd neuron ---> *Spinal trigeminal nucleus* Note: Senses that aren't special will piggy back on trigeminal which is why he is talking about this stuff...

Describe the path of the parasympathetic fibers form the Vagus n.

1st neuron ---> Dorsal motor nucleus of CN X (poorly named... this does parasympathetic, Nucleus ambiguus is where LMN is found) 2nd neuron ---> Various ganglia

Where are the first and second sensory (*visceral*) neurons from the Facial n. (CNVII)?

1st neuron ---> Geniculate Ganglion 2nd neuron ---> Solitary nucleus George says we will revisit this stuff later.

What boundary is separates the coticobulbar projections which can occur?

2 Different Corticobulbar Projections: *BRONCHIOMERIC mm., Facial expression ABOVE the eyes will have different projection than facial expression mm. BELOW the eyes & tongue.

Innervations 2. What innervates the dura of the posterior cranial fossa? 3. C1 and C2 follow which nerve to get where they are going?

2. *vagus* and cervical spinal nerves *C1 and C2* 3. *CN XII* through the hypoglossal canal into the posterior fossa Note: Fibers of Ct & C2 may also follow the path of the vagus n. into the posterior cranial fossa.

*Lymphatics* 2. PW of lymphatic drainage of lateral bit o'head?

2. Superficial Parotid Nodes → Superior Deep Cervical Nodes

*Thyroid Gland* - Innervation 2. *Preganglionic* sympathetic fibers arise from which spinal cord levels? 3. How do they get to the region of the thyroid? 4. Preganglionic sympathetic fibers synapse where?

2. T1-T4 spinal cord levels 3. Ascend sympathetic chain 4. Superior, Middle, & Cervicothoracic ganglia

*Vestibulospinal tracts* 2. UMNs found where? 3. Both Lateral & Medial tracts can be activated by what 2 things?

2. UMNs in brainstem (*NOT cortex*) 3. Inner ear *OR* Cerebellum

2. 5 *specific* characteristics that change throughout the cord? 3. In what regions of the body would you see large ventral horns?

2. i: Proportion of gray/white matter ii: Shape of gray matter iii: Presence of specific nuclei iv: Size of posterior columns v: Size of ventral horns 3. Areas that have motor nerves going to limbs (Cervical & Lumbo/Sacral)

*Spinoreticular and spinomesencephalic tracts:* 1. where is the 2nd synapse for the spinoreticular tract? (2) 2. Where is the 2nd synapse for the spinomesencephalic tract?

2nd synapse: 1. Spinoreticular: Reticular formation in Pons & Medulla 2. Spinomesencephalic: Periaquedcucatal Grey Matter

More Muscles! 3. What's the cheek muscle? 4. Attaches to what bones? 5. Primary function? 6. Why is this muscle considered a muscle of facial expression? 7. This muscle lies {deep OR superficial} to Zygomaticus Major & Risorius? 8. What structure pierces this muscle?

3. *Buccinator* 4. Attaches to maxilla & mandible 5. Keep food on teeth 6. Innervation is the same as other muscles of facial expression 7. Deep 8. Parotid duct

3. SVE provides _______ innervation to ________ M. originating from the _______ pharyngeal arch. 4. Which muscles originate from the arch in #3? 5. Upon EXITING through the ___________ __________, CN VII now ONLY contains SVE fibers.

3. Motor; Skeletal; Second (2nd) 4. M. of Facial Expression (Mimetics), Stylohyoid, Post. belly of Digastric and Stapedius. 5. Stylomastoid Foramen

3. What's the 1st branch off the Facial (VII), even before entering parotid? 4. 1st 2 nerves after division in parotid?

3. Posterior Auricular 4. *Temporofacial & Cervicofacial Divisions*

*Interneurons* 3. One type: *Renshaw cells* - what is their function? 4. Why is this necessary?

3. Provide (-) feedback on LMNs [keeps break on motor neurons] 4. Constant inhibition needed b/c LMNs can fire randomly on their own

3. The pharynx is shared by what 2 systems? 4. What is the dual role of the pharynx?

3. Respiratory & Digestive Systems 4. Conduit for Air & Food (Aero-digestive tract)

3. WHere are the primary afferent cell bodies in the MSN/ML & Dorsal Trigeminothalamic tracts?

3. Trigeminal ganglion (also semilunar or gasserian ganglion)

*Lower Sacral* 3. Where is this spinal cord segment located relative to the *vertebral column*?

3. Way more superior than the actual Sacral region (ie. upper lumbar/lower thoracic region of spinal cord)

What will be transmitted through the Sphenomaxillary fissure?

3rd portion of Maxillary a. Posterior superior alveolar n.

4. What is located at the dilated distal common carotid and proximal internal carotid? What is its main job? 5. What is located at the carotid bifurcation? What is its main job?

4) Carotid sinus - located at the dilated distal common carotid and proximal internal carotid; pressure receptor (t in P =+HR) 5) Carotid body - located at the carotid bifurcation; chemoreceptor - senses changes in oxygen tension (t in 02 =t in rate and depth of respiration)

4. Why do we have patchy dermatomes in our limbs, but striped dermatomes on our trunk?

4. Development (differential lengthening of limbs) [this is not explained well, if you don't understand it, ask Rob]

*Caput succedaneum* 4. Location of edema? 5. Seen most often in what population?

4. Scalp (above aponeurosis) 5. Most babies delivered vaginally

*Generalized Ascending Pathway (cont.)* 4. On what does it then synapse [primary/secondary/tertiary]? 5. What is the usual route for #4? 6. What does #4 then synapse on? Where does this usually happen? 7. Where does this then go?

4. The synapses on the secondary neuron. 5. Usually goes through the spinal cord and decussates at some point along the way (either in the SC or the brainstem). 6. Synapses on a tertiary neuron in the thalamus usually. 7. Tertiary usually heads from the thalamus out to the cerebral cortex.

*Paleospinothalamic pathway:* 5. Where primary cell bodies are located? 6. Where 1st synapse is? 7. Where in the spinal cord it enters?

5. *DRG* 6. *Lamina I-VI* 7. *Dorsal horn (Lissauer's Fassciculus to ascend at least 1 segment)*

*Paleospinothalamic tract:* 5. 2nd synapse is where in the thalamus? 6. 3rd synapse is where? 7. is the 3rd synapse on one side of the brain or bilaterally?

5. *IL* = Intralaminar nuclei 6. Across cortex 7. 3rd synapse bilaterally across cortex

*Facial Artery* 5. Supplemented by what 2 arteries (& from what do they branch)? 6. Through what foramina do they exit?

5. *Infraorbital* & *Mental* (branches of *Maxillary*) 6. *Infraorbital* & *Mental* foramina

5. After the synapse, what happens? 6. Where do they then ascend? In what tract? where is it located?

5. Dorsal horn neurons (2nd order) Cross midline in ventral white commissure 6. Ascend as Spinothalamic tract. Anterior aspect of lateral funiculus

Pharyngeal plexus - *i: CN IX* 5. Runs along which muscle? 6. How does it access the internal Pharynx?

5. Runs along *stylopharyngeus* 6. Passes thru gap 2 w/stylopharyngeus

*Corticospinal tract*: Brainstem 5. Axons of cerebral peduncles continue descent through where & become what?

5. Travel through *pons* & become *Pyramids* on ventral medulla

*Thyroid Gland* - Innervation 5. What makes up the Cervicothoracic ganglion? 6. Postganglionic sympathetic fibers travel from these ganglia via (4)? 7. 2 ways these sympathetic fibers terminate?

5. fused Inferior cervical & 1st thoracic ganglia 6. Sympathetic cardiac nn., superior & inferior laryngeal nn. & on surface of arteries 7. i: Vasomotor or ii: End near folliculuar ET cells in gland

5. 2 branches from *Temporofacial N*? 6. 3 branches from *CervicofacialN*?

5. i: *Temporal* Branch ii: *Zygomatic* Branch 6 i: *Buccal* Branch ii: *Mandibular* Branch iii: *Cervical* Branch {Ten Zebras Bit My Chin} or {To Zanzabar By Motor Car}

*Bell's Palsy* 6. 4 branches that can be affected by the herp + Symptoms if each is affected?

6. i: *Branches to muscles of face* → facial muscle paralysis/paresis ii: *Chorda Tympani* → add altered taste/decreased salivation iii: *N. to Stapedius* → add hyperacusis (loud noises) iv: *Greater Petrosal* → add decreased lacrimation/nasal mucus secretion

*Parotid Gland* 6. 2 conditions that lead to *Parotiditis*? 7. Why does it hurt so much?

6. i: *Mumps*: viral ii: *Sjogren Syndrome*: Autoimmune (salivary & lacrimal) - onset middle age, 1% o'population 7. inflammation is painful due to fascial constraints & exacerbation w/movement of mandible

*Trachea* 6. What 4 structures are found anterior to the trachea?

6. i: Isthmus of thyroid gland (rings 2-4) ii: Sternothyroid m. iii: Sternohyoid m. iv: Inferior thyroid vv.

*Posterior Column Tract PW* 7. Axons from *upper body* travel in which *Posterior Funiculus* 8. Axons from *lower body* travel in which *Posterior Funiculus*

7. *Fasiculus Cuneatus* (more lateral) 8. *Fasiculus Gracilis* (more medial)

*Esophagus* 7. Blood supply & venous drainage?

7. Inferior thyroid aa. & vv.

*(Neo)spinothalamic pathway:* 7. After first synapse what does it travel through? 8. then what does it ascend through? 9. Decussates (where)?

7. Travels through *anterior white commissure* 8. Ascends through *anterolateral spinothalamic tract* 9. *spinal cord, after 1st synapse*

*Flexor Reflex* 7. What's another name for a flexor reflex (2)? 8. Initiated by what stimulous?

7. Withdrawal Reflex or Nociceptive Reflex 8. Initiated by *Pain*

*Trachea* 7. What 2 structures are found lateral to the trachea?

7. i: Superiorly = Lobes of thyroid gland ii: Inferiorly = Carotid sheath

*Spino-bulbo-spinal pathways:* 8. It ascends through what tract after the first synapse? 9. Where/ if it decussates?

8. *anterolateral spinothalamic tract* 9. *Spinal cord, after 1st synapse*

*Cephalohematoma* 8. What limits it's movement?

8. Limited to one bone due to tight adherence of Pericranium to sutures

*Esophagus* 8. What 2 specific lymph nodes will drain the esophagus?

8. Paratracheal lymph nodes Inferior deep cervical lymph nodes

*Afferent Tract Neurons* - review 8. {Large or Small} diameter neurons synapse in the dorsal horn? 9. {Large or Small} diameter neurons synapse in the ventral horn? 10. {Large or Small} ascend the spinal cord w/o synapsing?

8. Small (on interneurons) 9. Large (on LMN) 10. Large

*Paleospinothalamic pathway:* 8. After 1st synapse, travels [laterally or bilaterally?] and ascends through what tract? 9. Where /if it decussates? 10. Where second synapse is?

8. after 1st synapse, travels *bilaterally*, ascends through *anterolateral spinothalamic tract* 9. *Spinal cord, after 1st synapse* 10. *Intralaminar nuclei* of the *Thalamus* Bilateral

*Corticospinal tract* 9. If it continues ipsilateral (20%), tract would those fibers travel in? 10. Where is this innervating? 11. If there is some later decussation in these, where will that happen? 12. If there is no decussation *at all*, where will these fibers stop?

9. *Anterior or ventral corticospinal tract* 10. Axial muscles 11. Anterior white commissure (but some won't decussate at all) 12. Travel until thoracic spinal cord

*Thyroid Gland* 9. Entire thyroid gland is invested in which fascia? 10. Medial fascial extension will attach the thyroid to what?

9. *Pretracheal Fascia* 10. Cricoid Cartilage

*Esophagus* 9. What are the 2 autonomic innervation to the esophagus & what do they influence?

9. *Sympathetics*: Sympathetic trunk (vasomotor & glandular) *Parasympathetics*: Recurrent laryngeal nn. (muscular tone & glandular)

9. SVA fibers of CN VII are responsible for providing TASTE to which portion of the tongue? 10. How do the SVA fibers get to the tongue and hard palate?

9. Ant. 2/3 10. Via Chorda Tympani

*Trachea* 9. Blood supply to and from trachea?

9. Inferior thyroid aa. & vv.

*Vestibulospinal tracts* 9. *Lateral* vestibulospinal: UMN where? 10. *Medial* vestibulospinal: UMN where?

9. Lateral vestibular nucleus 10. Medial vestibular nucleus

*Flexor Reflex* 9. What are the 5 events of the Flexor Reflex?

9. i: DRG cells synapse on excitatory interneurons (b/c they branch to multiple levels of cord) ii: excitatory interneurons synapse on motor neurons to flexors iii: *also*, motor neurons synapse on inhibitory interneurons iv: Inhibitory interneurons synapse on extensor motor neurons v: Get Flexion (NOT extension) for quick withdrawal from painful stimulus

What will be transmitted through the optic canal?

> CN II (optic n.) > Ophthalmic a.

What are the foramina in the temporal bone which are found in the middle cranial fossa?

> Hiatus for greater petrosal n. > Hiatus for lesser petrosal n.

What is transmitted through the inferior orbital fissure?

> Infraorbirtal n. (branch of V2) > Infra orbital a. > Zygomatic branch of CN V2 > orbital n. (branch of V2) > Inferior ophthalmic vein

What vessels will pass through the jugular foramen?

> Internal jugular v. > Sigmoid sinus > Inferior petrosal sinus > Posterior meningeal branches of Occipital a. > Posterior meningeal branches of Ascending pharyngeal a.

What are the two foramen found in the zygomatic bone? What passes through these foramen?

> Zygomaticofacial foramen = zygomaticofacial a. v. & n. > Zygomaticotemporal foramen = zygomaticotemporal a. v. & n.

What does the Ascending cervical a. anastamose with?

>> Vertebral a. >> Ascending pharyngeal a. >> Occipital a.

. *Practice Question* What is the last fontanelle to close? A. Anterior B. Posterior C. Anteriolateral D. Posteirolateral

A. Anterior

A 4 y/o female presents with a large, cystic growth on the lateral side of her neck, Just anterior to SCM. This anomaly most likely resulted from persistence of which embryological structure? A. Cervical sinus B. Oropharyngeal membrane C. Pharyngeal arch 5 D. Thyroglossal duct E. Ultimobranchial body

A. Cervical sinus key is lateral or side

. *Practice Question* A newborn male present with an isolated cleft palate, this is caused by a lack of fusion of the: A. maxillary prominences B. medial nasal prominence and maxillary prominance C. lateral and medial nasal prominecnes D. medial nasal prominences E. lateral nasal prominence and maxillary prominence

A. Maxillary prominecnes

. *Practice Question* A newborn female presents with an oblique facial cleft. This anomaly likely resulted from failure of which structures to fuse during development? A. lateral nasal prominence and maxillary prominence B. medial nasal prominence and maxillary prominece C. medial nasal prominences D. nasal septum and lateral prominence

A. lateral nasal prominence and maxillary prominence

*Platysma muscle:* 1. what is its actions? (3) 2. What is its innervation? which laryngeal arch?

A: Draws corner of mouth downward, assists in depressing the mandible, elevates skin of the chest N: Cervical branch of Facial N. (CN VII), second arch note: Dr. Buck calls this the turtle neck muscle. He says it makes you look bigger....

What are the different pathways to reach the THALAMUS from the globus pallidus internal ? What is the final target of these pathways?

ANSA LENTICULARIS (lens hook) -- from a more medial parts of globus pallidus internal LENTICULAR FASCICULUS (lens-like bundle) -- from a more lateral area of globus pallidus internal *these pathways will end in THALAMIC FASCICULUS

Wallenberg's syndrome results in horner's syndrome If you have horner's syndrome what is affected? (2)

Affects *position of eyelids* and *parasympathetics* in that region

*NOTE* Afferents from the above travel mainly in what? There are also minor routes through two other nerves/trunk, what are they?

Afferents from the above travel mainly in the *carotid sinus nerve (CN IX)*; minor routes include carotid *branches of the vagus* and *cervical sympathetic trunk* (Gray's Anatomy 401h Ed.)

GVA - Cranial and Peripheral components

All SN's (Ectoderm) CN's: VII, IX, X

GSE - Cranial and Peripheral components

All Spinal N's CN: III, IV, VI, XI and XII

Which trigeminal branch innervates the somatic sensory of: Cornea and conjunctiva Frontal and ehmoid sinuses Superior nasal cavity

All for V1 and V1 for all

What is the innervation of the *Omohyoid m.*?

Ansa cervicalis (C1-C3) of cervical plexus

why are you here?

Answers on next Flashcard

What transmits through the anterior ethmoidal foramen?

Anterior Ethmoidal a. v. n. (V1)

What is the origin of the Anterior scalene m.?

Anterior Tubercles of transvers processes of CV3 - CV6.

What is the origin of the Rectus capitis anterior m.?

Anterior surface of lateral mass of atlas (CV1)

What is the origin of the Longus Capitis m.?

Anterior tubercles of transverse processes CV3 - CV6

1. What are the limits of the anterior cranial fossa?

Anterior: frontal bone Posterior: lesser wings of sphenoid, chiasmatic groove Floor: orbital plates of frontal bone, ethmoid, lesser wings of sphenoid.

What are the limits of the Posterior cranial fossa?

Anterior: petrous ridge, dorsum sellae Posterior: occipital bone Floor: mostly occipital bone, small amount of temporal bone anterolaterally

In the lateral medullary syndrome, if there is a Contralateral loss of pain/temp in the body, what tract is likely affected?

Anterolateral System (spinothalamic tract)

I ask a patient to pick up a pen in their left hand, transfer it to their right and and twirl it. To the best of their ability they are unable to accomplish the task. What would this be an example of?

Apraxia. "Damage to different parts of LEFT frontal lobe result in an inability to willfully do a task"

*Clinical Note* During the surgery just noted, what is the rationale behind being able to clamp off the external carotid a.?

Arteriole anastomosis!! because of the circle of Willis, the reverse of flood of blood will feed the tissue that is on the opposite while the artery is clamped off.

What does the vertebral a. (Part 1 of subclavian a.) anastamose with?

Ascending cervical a. (branch of thyrocervical trunk)

The adventitia of the great vessels and fibrous pericardium

At the distal extent of the carotid sheath, what does it fuse with?

When does the indirect and direct pathways happen?

At the same time Terrible question... I know

A newborn male presents w/hearing loss due to a rare congenital anomaly resulting in the absence of the stapes. Which embryological structure did not form correctly. leading to this infants anomaly? Pharyngeal: A. Arch 1 B. Arch 2 C. Arch 3 D. Cleft 1 E. Pouch 1

B. Arch 2

What is the insertion of the Rectus capitis anterior m.?

Basilar portion of occipital anterior to foramen magnum.

When the occipital surround foramen magnum... what are the marginal sinuses communicating with?

Basilar sinus

On this other side of this card is truth

Be careful, this could hurt a little... (under the gown)

And just like that we are gonna start off by flipping the card set!

Because... Anatomy

Where does the sigmoid sinus drain? hint it becomes confluent with something at a foramen...

Becomes confluent with the *jugular bulb* at the *jugular foramen*

What is the Bell phenomenon? What is this a sign of?

Bell phenomenon --when patient attempts to close their eye and the eyeball rolls superiorly exposing sclera. *caused by Peripheral facial n. weakness. (ipsilaterally)

Aside form the sympathetic ganglion found within the neck; what other nerves are found within the root of the neck?

Brachial Plexus Vagus n. Phrenic n. ~Accessory Phrenic n. (C5 if present)

How is a the entire upper limb anesthetized for a procedure? Explain procedure.

Brachial Plexus Nerve Block **anesthetizes the upper limb by injecting anesthetic agent around the supraclavicular portion of the Brachial Plexus in the region superior to the middle third of the clavicle.

Where, specifically, does the thyrocervical trunk branch from the subclavian artery? What are the branches off of this trunk?

Branches from anterior-superior surface of the subclavian artery medial to the anterior scalene & opposite the internal thoracic artery. 1) Inferior Thyroid a. 2) Transverse cervical a. 3) Suprascapular a. 4) Ascending cervical a.

What type of lesion would you have if.... Fluency is: absent Repetition is: absent Comprehension is: intact

Broca's Aphasia

Welp......

Buckle in for some classic Hurst...

. *Practice Question* Early colusre of the sagittal suture will result in which of the following? A. Brachycephaly B. Coronal craniosynostosis C. Scaphocephaly D. Enlarged posterior fontanelle

C. Scaphocephaly (S with S)

There are direct branches of the Brachial plexus which will innervate the scalene muscles -- from what cord levels are these innervations?

C5 - C8 will innervate scalene muscles.

The middle cervical ganglia provide gray rami communicantes to which spinal nerves?

C5 to C6

What are the CNs which are exclusively SENSORY?

CN I --> Olfactory n. CN II --> Optic n. CN VIII --> Vestibulocochlear

What goes through the optic foramen? What bone is it on?

CN II, ophthalmic a sphenoid

The Rostral Medulla contains the Nucleus ambiguus, which cranial nerves exit this structure?

CN IX CN X

What exits the medulla b/w the pons & pyramids?

CN XII (hypoglossal n.) *these CNs exit on the OLIVES of the medulla (anterior surface)

Which system of nerves is found on the promontory of the middle ear?

Caroticotympanic Plexus **This plexus is found there in conjunction w/ CNs VII and IX

The striatum is a region of the basal ganglia that includes what specific structures (3)?

Caudate nucleus Nucleus accumbens Putamen

Which system of nerves is found on the carotid siphon?

Cavernous plexus *this plexus is from the internal carotid n. off of the superior cervical ganglion

What is the innervation of the Rectus capitis anterior m.?

Central rami of spinal nn. C1 (~C2)

What are the derivatives of the telencephalon? What two (broad) structures make up the forebrain?

Cerebral cortex Subcortical white matter Deep cerebral nuclei (Basal ganglia, Hippocampus, Amygdala) Olfactory bulb & tract Lateral ventricles (Anything you would think of as the Cerebrum comes from the telencephalon) The telencephalon and the diencephalon

What is the downward sloping portion of the basilar portion of occipital bone in posterior cranial fossa?

Clivus

What is a bridging vein?

Communication between cerebral vein and superior saggital sinus

What are the things that the reticular formation controls (2)?

Consciousness Levels of arousal

Inferiorly, the falx cerebri allows passage of what important structure?

Corpus callosum

_________ ____________ provides pathways for different cortical areas to directly communicate with the corresponding area across cerebral hemispheres

Corpus callosum

Here is a digram of the AST

Couple of notes: 1. Now that we know where these things travel, and where their nuclei are, we can cross that with the nuclei of the cranial nerves we know to try and figure out some common symptoms.

. *Practice Question* Achondroplasia results in all of the following except? A. Primary closure of primary growth plates B. Shortened long bones C. Narrow spinal canal and foramen magnum D. Abnormal intramembranous bone development E. Overactive FGF3 receptor

D. Abnormal intramembranous bone development occurs normally

Which of the following would be left exposed in a fetus that lacked the initiation of the pontine flexure? A. Rostral neuropore B. Schizencephaly C. 3rd ventricle D. 4th ventricle

D. The 4th ventricle would be left patent due to the fact that the formation of the cerebellum would not be initiated by the overgrowth of the metencephalon. It is important to note that the growth of the cerebellum rostral to the medulla is what closes the 4th ventricle.

What is the branch of the subclavian artery that arises from Part III of the artery (lateral to anterior scalene m.)? Where does this artery go?

DORSAL SCAPULAR a. (in 50-70% of pop) > Passes dorsally through brachial plexus near the middle trunk. > Reaches levator scapulae & descends under the rhomboid mm. along the vertebral border of the scapula where it accompanies the dorsal scapular n. (participates in scapular anastomosis)

What condition results from the right subclavian artery arising form the aorta distal to origin of left subclavian artery? Explain condition.

DYSPHAGIA LUSORIA ---Right Subclavian a. must pass posterior to the esophagus & trachea to course over the 1st rib in the root of the neck. ---Path of artery creates potential to compress both Trachea & Esophagus = leading to difficulty of swallowing (dysphagia)

OVERALL 1. Indirect causes what to happen at muscle?

Decrease movement

What forms the nerve of the pterygoid canal (vidian n.)?

Deep petrosal n. + Greater petrosal n. (VII)

An area of the skin that is relaying information to a single spinal cord segment is known as what?

Dermatome (They're Back!)

What does the deep cervical artery anastamose with?

Descending branch of OCCIPITAL Artery.

What division of the costocervical trunk will descend following division? What is its course?

Descends ANTERIOR to the head of 1st rib. --Provides posterior intercostal a. to the first intercostal space & terminates by forming the 2nd posterior intercostal a.

What is the innervation of the *Stylohyoid m.*?

Digastric branch of the Facial n. (*CN VII*)

I would like you to ID some things...

Do it anyway A: Stylopharyngeus B: Salpingopharyngeus C: Palatopharyngeus D: Auditory Tube E: Soft Palate F: Stylopharyngeus

Hopefully today I will learn the difference between Pharynx & Larynx

Don't pretend like you already knew what the difference was.

Welcome back...

Don't worry. You have TONS of time to prepare for this test still.

Here is a picture of the MSN/ML & Dorsal trigeminothalamic tracts. What tract is this similar to that we learned earlier?

Dorsal trigeminal is very similar to the *PCML pathway.*

Where do the vertebral & inferior thyroid vv. commonly drain?

Drain to brachiocephalic vv.

What is the difference between a dry and a wet stroke?

Dry: A clot blocks blood flow to an area of the brain Wet: Bleeding occurs inside or around brain tissue

Quiz time Which layer is prolonged along cranial nerves and will eventually fuse with neural sheaths?

Dura mater

What are endothelial lined spaces between opposed layers of dura called?

Dural venous sinuses

CASE: from the case what was the dx? why did the pt die.

Dx: Suffocation from retropharyngeal abscess.

What is the action of the Anterior scalene m.?

ELEVATES 1st rib SIDE-BENDS & ROTATES cervical column to opposite side FLEXES cervical column with contraction of both sides.

What is the action of the Middle scalene m.?

ELEVATES 1st rib SIDE-BENDS & ROTATES cervical column (one side) of the Middle scalene m.?

What is the action of the Posterior scalene m.?

ELEVATES 2nd rib SIDE-BENDS & ROTATES cervical column (one side) FLEXES vertebral column (both sides)

What bone is the cribiform plate found in? What will pass through this structure?

ETHMOID Bone *this structure will transmit CN I (olfactory n.)

Here is an example of a neocortex map

Each # is associated with the legend under the graph. 1 is motor heavy with 5 being sensory heavy.

5. What is the course of the primary afferent neurons in the MSN/ML & Dorsal Trigeminothalamic tracts after they have entered the brainstem?

Enter Pons (from trigeminal ganglion) and then will synapse in the Main Sensory nucleus. *the 2nd order neuron will ascend in medial lemniscus CONTRALATERALLY & Ipsilaterally (for oral cavity)

Where does the thoracic duct enter the root of the neck? What is the path of this duct?

Enters the root of the neck b/w the LEFT border of the esophagus & the cervical pleura. > Passes behind the carotid sheath, arches over the cupola of the left lung & enters the LEFT jugulovenous angle. > Recieves lest jugular, left transverse cervical, left subclavian, & left bronchomediastinal lymph trunks.

How does the transverse cervical a. exit the posterior triangle? What does this artery supply?

Exits by passing deep to the trapezius m. *Supplies TRAPEZIUS m.

T/F: The nucleus of the Trigeminal N. contains GVE and GVE-P cell bodies/fibers of its own.

FALSE However, b/c it distributes to the majority of structures of head and face, it is used as a CARRIER to DISTRIBUTE GVE (sympathetic) and GVE-P autonomic nerve fibers.

What is the action of the Rectus capitis anterior m.?

FLEXES

What is the action of the Longus Capitis m.?

FLEXES head & neck.

What is the action of the Longus Colli m.?

FLEXES neck Assists in ROTATION (upper fibers rotate to same side while lower fibers rotate to the side opposite)

The nasal emissary vein is transmitted through which structure? What bone is this found in?

FORAMEN CECUM >found within the Frontal bone.

What structure can be found at the junction of the sphenoid, temporal, and occipital bone? What passes through this structure?

FORAMEN LACERUM *Meningeal branch of ascending pharyngeal a.

The third branch of the trigeminal n. (CN V3) will traverse through which structure? What other structure passes through this?

FORAMEN OVALE ---accessory meningeal a. will also pass through this foramen. ---specifically it is the Mandibular n. from V3

The second branch of the trigeminal n. (CN V2) will traverse through which structure?

FORAMEN ROTUNDUM

Question on back

Facial Development Name 3 processes and 1 arch that will develop the face. Name Purple Blue Green Pink Purple= frontonasal process Blue= Maxillary process Green= Mandibular process Pink = Arch 2

Which nerve will innervate the structures which form from the pharyngeal arch 2?

Facial n. (CN VII)

T or F: all cells from the CNS are differentiated from cells derived from neural tube (neuro-ectoderm).

False. Microglia cells are derived from hematopoetic cells.

As future physicians we need to be aware of the hallucinogen problems in our country.....

Flip the cards now PUSH 2! JUST DO IT!!

round the outside, round the outside

Flip them back!!

What is the inhibitory chemical secreted by the basal ganglia?

GABA

Identify the CN's that go w/ each component GSA GSE GVA GVE-P SVA SVE SSA SSE

GSA - V, VII, IX, X GSE - III, IV, VI, XI, XII GVA - VII, IX, X GVE-P - III, VII, IX, X SVA - I, VII, IX, X SVE - V, VII, IX, X SSA - II, VIII SSE - VIII

Define GVA and GSA. Also, Explain what impulses they carry, where they originate, and where they terminate.

GVA (General Visceral Afferents): Fibers carry SENSORY (pain usually) from Visceral structures w/in body lined by epithelium of ENDODERMAL origin to CranioSpinal Ganglia GSA (General Somatic Afferents): 1. EXTEROCEPTIVE: Impulses (pain, temp., touch) from epi of ECTODERMAL origin 2. PROPRIOCEPTIVE: Impulses from sensory endings in body wall, tendons, joints

GVE-P fibers of which 3 CN's piggy back on the GSA fibers of the Trigeminal n. to provide innervation to smooth m. of the eye, and ALL GLANDS of the head (mucous, salivary, lacrimal)?

GVE-P Fibers of CN III, VII and IX

What type of lesion would you have if.... Fluency is: absent Repetition is: absent Comprehension is: absent

Global

Relative to the direct pathway, what are the additional players in the Indirect pathway?

Globus pallidus externa Subthalamic Nucleus

What are the two regions of the globus pallidus?

Globus pallidus external Globus pallidus internal

the third pharyngeal arch will form structure which are innervated by which nerve?

Glossopharyngeal n. (CN IX)

Flip the deck really quick!

Gracias

Briefly explain the homunculus to the class.

Great job, now look at the pictures.

What special sensory does CN VII, IX and X do?

Gustatory (taste)

Hmmmmmm... SCM... Kinda like....

HA! You thought i was gonna say something about SCM being my initials! But I didnt!! But check out this baby face!

Through what structure does CN XII pass through? What else will pass through this structure?

HYPOGLOSSAL CANAL *Posterior meningeal branch of ascending pharyngeal a. (some of these branches will also go through jugular foramen)

Falx cerebelli seperates what?

Hemispheres of cerebellum

Hey look...

Here is a spot where the muscle has dropped out, but the fascia remains and you can see light coming through it. (this is a really weird picture by the way)

What type of cells would we see in the molecular zone?

Horizontal cells of cajal

Let's play a game...

How many of these George's can you name? (just kidding - that's dumb)

What 3 prominent structures are attached to the *Middle* & *Inferior* Constrictor muscles?

Hyoid Bone Thyroid Cartilage Cricoid Cartilage

What is the insertion of the *Digastric m.*?

Hyoid bone via fascial sling from intermediate tendon

What passes through the hypoglossal canal? bone

Hypoglossal N (CNXII) Occipital

Identify the RESUMES OF CRANIAL NERVE COMPONENTS I II III IV V VI VII VIII IX X XI XII

I - SVA II- SSA III - GSE, GVE-P IV - GSE V - SVE, GSA VI - GSE VII - SVE, SVA, GVA, GVE-P, GSA VIII - SSA, SSE XI - SVE, SVA, GVA, GVE-P, GSA X - SVE, SVA, GVA, GVE-P, GSA XI - GSE XII - GSE

Muscles of the face are coming from what pharyngeal arches?

I and II (wohoooo!! you got an easy one!) Super random thing she mentioned, but since when is that new.

*MRI Images Coronal & Horizontal*

I don't know how to do all the fancy occlusion stuff and I have spent way too much time trying to figure it out. Flip the cards, and I will come back to these in the next few days and try again!

What is transmitted through the mandibular foramen?

INFERIOR ALVEOLAR a. v. & n.

Which branch of the subclavian artery arises opposite the thyrocervical trunk? Where does this branch travel to?

INTERNAL THORACIC a. -Descends inferiorly into the thorax posterior to the sternal end of the clavicle and junction of the subclavian and internal jugular vv. *Crosses anteriorly by the PHRENIC n.

When do impulse control deficiencies present? Later or earlier?

Impulse control deficiencies present later in disease course

OVERALL action 1. Direct causes what to happen at the muscle?

Increase movement

What is the insertion of the *Thyrohyoid m.*?

Inferior margin of body & greater horn of hyoid.

What is the insertion of the *Sternohyoid m.*?

Inferior margin of body of hyoid

The fibers from the cavernous plexus which join with the CN III will innervate which structures? Describe path of fibers.

Innervate the Dilator pupillae muscle & blood vessels of the eye. -- The sympathetic root of the Ciliary ganglion will continue w/o synapsing and course with SHORT CILIARY NERVES & gain the globe (eyeball)

Where is the trigeminal ganglion?

Inside the cranial fossa in the epidural space

Explain the direct excitation model

Involves depolarization --> action potential ---> neurotransmitter

Foramen is found within the petro-occipital fissure? What is transmitted through this foramen (8)?

JUGULAR FORAMEN 1. CN IX (glossopharyngeal n.) 2. CN X (vagus n.) 3. CN XI (spinal accessory n.) 4. Sigmoid sinus 5. Inferior petrosal sinus 6. Internal jugular vein 7. Posterior meningeal branches of occipital a. 8. Posterior meningeal branches of ascending pharyngeal a.

*Big Take Home* 1. Where is the primary neuron in this tract? 2. Where is the second neuron? 3. Where does decussation take place? And here is another diagram (answers are on the diagram).

Jk, here are the answers 1. Primary is at the dorsal root and then synapses with 2nd neuron in the I or II lamina. 2. second neuron is in the spinal cord as opposed to the brainstem like in the PCML pathway. 3. Decussation takes place a roughly the same level as the nerve enters the spinal cord. *The primary and the 3rd neuron are in pretty much the same area that they are in the PCML, the only real difference is where the 2nd neuron is*

Fancy another ID card?

Jolly Good! (Alabama Scroll Tide!!) A. Maxillary A B. Infraorbital A C. Facial A D. Angular A E. Infraorbital Foramen

Through what foramen does the Glossopharyngeal n. exit the skull? (CN IX)

Jugular Foramen

The facial n. has somatic motor fibers which begin where?

LMNs -- will come from *FACIAL MOTOR NUCLEUS*

The nucleus ambiguus will contain which fibers from the Glossopharyngeal n.?

LMNs for the *somatic motor fibers.*

What is a long-term treatment for Parkinson's disease, what are the side-effects of this?

LONG - term I-DOPA tx can lead to DYSKINESIA

What is the action of the Rectus capitis lateralis m.?

Lateral FLEXION (SIDE-BENDING) of skull.

*Eye Formation: Retina and Lens* 3rd step. What becomes detached from the ectoderm because of the previous 2 steps?

Lens Placode

What will be the result from damage to the Ansa cervicalis (C1-C3) of cervical plexus?

Loss of most infrahyoid muscles = cant open mouth

What bone is the mental foramen in? What passes through this foramen?

MANDIBLE - transmits the MENTAL a. v. & n.

Auricular branch of the vagus n. (CN X) will need to pass through which portion of the skull to exit?

MASTOID CANALICULUS > This is on lateral wall of jugular foramen.

The mastoid emissary vein will pass through which structure? Include bone.

MASTOID FORAMEN (in temporal bone)

The incisive canal is found in which bone? What passes through this canal?

MAXILLA -Transmits: *nasopalatine n. (from V2) *Greater palatine a.

FLIP IT AGAIN

ME IRL

What are the three nuclei in the sensory nucleus complex?

MESENCEPHALIC nucleus Main (principal) SENSORY nucleus SPINAL trigeminal nucleus

Which ganglion of the neck represents the fused cervical ganglion of C5 - C6? Where is this ganglion specifically located?

MIDDLE CERVICAL GANGLION *near the Inferiro thyroid a. as it arches posterior to the Carotid Sheath.

What can be found on the dorsal portion of the Rostral Medulla?

MOTOR nucleus for the CN XII (hypoglossal n.)

What nucleus in the brain stem will sense vibrotactile discrimination?

Main (principal, chief) sensory nucleus

4. WHere is the first synapse in the MSN/ML & Dorsal Trigeminothalamic tracts?

Main sensory nucleus (in pons of brainstem)

Review question What are th major arteires that contribute meningeal vessels to the dura? (5) This was boxed in his lecture...

Major parent arteries supplying dura: Ophthalmic Maxillary Ascending pharyngeal Occipital Vertebral

Occipital sinus surrounds the foramen magnum as which sinuses?

Marginal sinus in pic 9 occiptial 10 marginal

What passes through mastoid foramen? What bone?

Mastoid emissary vein Temporal

I hope we all survive this.

Me IRL

Which nerve is the largest sympathetic cardiac nerves to cardiac plexus?

Middle Cervical Cardiac n.

What is the insertion of the *Mylohyoid m.*?

Midline Raphe from symphysis menti to body of hyoid bone.

What do the minor branches of the superior thyroid artery supply (4)?

Minor branches include *muscular branches* to: Strap muscles, SCM, Inferior constrictor & Esophagus

1. What type of fibers are found w/in *Rexed lamina X*?

Mostly interneurons

New guys...

Motor tracts and stuff... A: *Lateral corticospinal* (most commonly tested clinically) B: *Ventral corticospinal* C: *Medial Longitudinal Fasciculus* (balance) D: *Lateral Vestibulospinal* (balance) E: *Tectospinal* (sup colliculi) F: *Rubrospinal* G: *Medullary Reticulospinal* H: *Pontine Reticulospinal*

Poliomyelitis is an infectious, viral disease which, in severe cases, destroys motor neurons in the spinal cord. Which of the following cell types is likely to be affected by the polio virus? A. Pseudounipolar neurons B. Bipolar neurons C. Multipolar neurons D. Basal ganglia neurons E. All of the above

Multipolar: One axon, many dendrites Motor neurons & interneurons

*Arch 6* Muscle 1. This becomes what 2 muscle groups

Muscle Derivatives: 1. Intrinsic mm. of larynx; skeletal muscle in upper esophagus

*Arch 4* Muscle derivatives 1. becomes what 3 muscles?

Muscle Derivatives: 1. Cricothyroid; levator veli palatini; pharyngeal constrictors

*Arch 2:* Muscle derivatives 1. what group of muscles does it become? 2. What other 4 muscles does it become which help with what sense?

Muscle Derivatives: 1. Muscles of facial expression 2. Stapedius; stylohyoid; posterior belly of digastric; auricular m. hearing. memorizing tool: SMILE

*Arch 3:* Muscle derivatives 1. What muscle does it become? 2. What nerve does it have? 3. As muscle cells migrate what do they do with the nerve?

Muscle Derivatives: 1. Stylopharyngeus m. Nerve: 2. Glossopharyngeal n. (CN IX) 3. As muscle cells migrate they "carry" the nerve with them

The *axillary sheath* (trunks & cords of brachial plexus & axillary artery) passes through what to enter axilla?

Must pass through the *cervicoaxillary canal* to enter axilla.

What is the innervation of the *Mylohyoid m.*?

Mylohyoid branch of Trigeminal n. (CN V)

What structure does the nasolacrimal duct pass through?

NASOLACRIMAL CANAL *this is important for the passage of tears into the nasal cavity (i.e. our nose runs when we cry)

Go to the other side of the card

Name 1 and 2 -Where is #1 found? -What is is #2 used for? 1. Clarke's nucleus 2. Posterior spinocerebellar tract -Found in the lower parts of the spinal cord. -This is where the ascending tracts that are going to the cerebellum will be found.

1. Internal carotid a. 2. Carotid sinus 3. Carotid body 4. Common Carotid a. 5. ITS NOT THERE!! IM SORRY! 6. External carotid a. 7. Facial a. 8. Opthalmic a. 9. Ant. Cerebral a. 10. Middle cerebral a. -The internal carotid runs inside of the cavernosus sinus (artery running inside of the vein) as well as CN VI runs inside there too. -The carotid siphon.

Name 1-10 -What is the significance of #7? What runs inside of it (3 total structures). -What is the route called that #7 talks about?

Answer questions on the flip side

Name 1-4 1. Lissauer's tract 2. Substantia gelatinosa 3. Ventral white commissure 4. Spinothalamic tract

1. Common Carotid a. 2. External carotid a. 3. internal carotid a. 4. vagus n. 5. sympathetic trunk -Common carotid, internal carotid, vagus, sympathetic trunk was never apart of it. Ext. jugular exits to feed the face.

Name 1-5 -Which of these structures stay within the carotid sheath?

1. Frontal horn 2. Central part/body 3. Occipital horn 4. Temporal horn 5. Atrium

Name the parts of the lateral ventricles broseph 1. Frontal horn 2. Central part/body 3. Occipital horn 4. Temporal horn 5. Atrium

question on back

Name them 1. Great cerebral vein of Galen 2. Straight sinus

What will pass through the pterygoid canal?

Nerve & Artery of Pterygoid canal.

*Arch 4* nerve 1. has what nerve and what branch specifically of that nerve?

Nerve: Superior laryngeal branch of vagus (CN X)

Signaling from the notochord induced the neuroectoderm to form what structure?

Neural plate

What are the 2 major pathways that allow DA to turn the basal ganglia "ON"?

Nigrostriatal pathway Mesolimbic pathway

Where would you find the LMNs form the Vagus n.?

Nucleus ambiguus

1. A corticobulbar tract lesion in the CN nucleus going to the Bronchiomeric mm. ABOVE the eyes will have what presentation?

Nucleus lesion will cause: -IPSILATERAL deficiency

1. What are the three nuclei in the spinal trigeminal nucleus? 2. What sensory modalities are does each carry?

Nucleus oralis ----> Fine touch orofacial Nucleus interpolaris ----> Fine touch & dental pain Nucleu caudalis ----> nociception and thermal Note: fine touch should be thought of as additional to the main sensory nucleus

danka

OK: push the "1" now

What is the insertion of the *Sternothyroid m.*?

Oblique line of thyroid cartilage

What is the origin of the *Thyrohyoid m.*?

Oblique line of thyroid cartilage

The foramen magnum is found in which bone and region of the skull?

Occipital bone -- found within the posterior cranial fossa.

Which sinus is located in falx cerebelli? It opens superiorly into what?

Occipital sinus Confluens

Where are the transverse sinuses?

Occupies the perimeter of the tentorium to a point just short of the petrous portion of the temporal bone...

*Broadmann's Areas* Here is a sweeeeeeeet chart that outlines all the areas that we still use today.

Oh dont worry, we'll go through them...

many much thank yous

Ok you can flip it back again

Cranial Nerves (12)... Strap In Gents Here is the mnemonic I learned to remember them all (Disclaimer: It's Vulgar; there are many others if you don't like this one, but you'll remember (haven't forgotten it, it's been almost 5-6 yrs)) Oh Oh Oh To Touch And Feel Virgin Girls Vaginas Ahh Heaven

Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear (Buck calls it Acoustic) Glossopharyngeal Vaugus (Spinal) Accessory Hypoglossal

*Eye Formation: Retina and Lens* 1st step. What induces overlying ectoderm to differentiate to lens epithelium?

Optic Vessicle

*Eye Formation: Retina and Lens* 2nd step. What Folds on itself and pulls the forming lens from the surface ectoderm?

Optic Vessicle

What are the impressions called on the floor of the anterior cranial fossa left by the orbital frontal gyri of the brain?

Orbital frontal plates

What is the origin & insertion of the Lower portion of the Longus Colli m.?

Origin -- Anterior surfaces of vertebral bodies below to transverse processes of vertebrae above. Insertion -- Transverse processes of vertebrae ABOVE

What is the insertion of the Posterior scalene m.?

Outer surface of 2nd rib

The Chorda tympani of CN VII will pass through which structure in which bone?

PETROTYMPANIC FISSURE *found within the Temporal bone.

The pharyngeal a. & n. will pass through which foramen?

PHARYNGEAL CANAL

What are the boundaries of the Root of the Neck?

POSTERIOR: Body of T1 (anterior surfaces) All of first rib -Head & neck of 1st rib -LATERAL: Body of 1st rib -ANTERIOR: Distal portion 1st rib Articulation of 1st rib w/ manubrium

8. WHat is the final destination in the MSN/ML & Dorsal Trigeminothalamic tracts?

PRIMATY SOMATOSENSORY CORTEX -after VPM the 3rd order neuron will travel via internal capsule & corona radiate.

What is the inferior opening of the pterygopalatine fossa? What is transmitted through this canal?

PTERYGOPALATINE CANAL > Descending palatine a. > Greater palatine a. & n. > Lesser palatine a. & n.

What sense does the spinal trigeminal nucleus receive?

Pain and temperature

Type of info in the *Ventral trigeminal tract*?

Pain, Temperature

The substantia nigra of the basal ganglia includes what specific structures (2)?

Pars compacta Pars reticulata

Describe the relationship of the pterygoid canal and pharyngeal canal.

Pharyngeal canal will be found more medial (near vomer bone) than the pterygoid canal.

What cord levels are found within the phrenic n.? What is the path of this n.?

Phrenic n. (C3 - C5) **Descends on the anterior surface of the anterior scalene m. parallel to the ascending cervical branch of the thyrocervical trunk. **Crossed by the transverse cervical & suprascapular aa. ** Enters the thorax medial to the anterior scalene b/w the Subclavian a. & v. (1st portion) --If accessory phrenic n. is present it parallels the phrenic n. laterally.

What three layers make up the cranial meninges?

Pia, Arachnoid, Dura

Where is a central venous line placed? What is this used for?

Placed in Subclavian v. (usually Right) *Used for: -Administration of parenteral fluid or drugs -Administration of Patient controlled anesthetic (PCA) -Cardiac catheterization -Measures central venous pressure

What transmits through the posterior ethmoidal foramen?

Posterior Ethmoidal a. v. n. (V1)

What is the origin of the *Stylohyoid m.*?

Posterior base of styloid process.

The *Posterior Spinal Arteries* (PSAs) are responsible for supplying blood to what 2 regions of the spinal cord?

Posterior columns & Periphery of cord

Which meningeal vessel artery is made up of branches of the ascending pharyngeal a., occipital a., vertebral a.? which cranial fossa might this be in?

Posterior meningeal artery Posterior cranial fossa

What is true of the connection between the posterior and middle scalene mm?

Posterior scalene may be partially or totally fused with the middle scalene m.

What is the origin of the *Sternohyoid m.*?

Posterior surface of manubrium at sternoclavicular joint, clavicle, & posterior sternoclavicular ligament.

What is the origin of the *Sternothyroid m.*?

Posterior surface of manubrium inferior to sternohyoid m.

What is the origin of the Middle scalene m.?

Posterior tubercle of transverse processes of CV2-CV7

What is the origin of the Posterior scalene m.?

Posterior tubercles of transverse processes CV5-CV7

What must be considered when performing a *Tracheostomy*?

Presence of *Thyroid Ima Artery* (midline incision can lacerate it → blood loss)

What is a common result of hypertrophy in anterior & middle scalene muscles?

Pressure on roots o'brachial plexus → *Thoracic Outlet Syndrome*

Which nucleus will be roughly the same level as you see the trigeminal nerve on the brainstem?

Principal (main) sensory nucleus of trigeminal nerve

What sense is the mesencephalic nucleus associated with? Is there synapse happening here?

Proprioception NO, there are pseudounipolars cell bodies here. Not like other parts that sit outside of it (similar to DRG)

What is the difference between trigeminal and PCML pathways? In other words where does proprioceptive info from the face go to?

Proprioceptive information will Ascend to the midbrain to go the *MESENCEPHALIC NUCLEUS of V.* Does not go through Dorsal Trigeminal pathway

What type of cell bodies are found in the mesencephalic nucleus?

Pseudounipolar cell bodies

Let's take a break...

Psych! Do this one... or get out A: CN X B: Superior Cervical Ganglion C: Sympathetic chain D: CN IX E: Pharyngeal Plexus F: IX G: X H: XI I: Jugular Foramen

What is located within the pterygopalatine fossa?

Pterygopalatine ganglion --the 3rd portion of the maxillary a. will also pass through here.

What condition can be described as having vasospasms of arteries supplying the upper limb & brain? What can be done to determine the severity of this condition?

RAYNAUD'S PHENOMENON >> An injection of anesthetic around the CERVICOTHORACIC GANGLION which blocks synaptic transmission through ganglion & through cervical sympathetic chain >> Injection determines need for surgical resection of the sympathetic trunk - method of reducing/eliminating excess vasoconstriction of the arteries of the ipsilateral limb.

100% of men with what behavior disorder will develop parkinsons?

REM behavior disorder

1. What three things will you have your patient do to test the motor nerves innervating the face? 2. Which nerves does this test?

Raise eyebrows SMile Stick tongue out Facial and hypoglossal

What two sinuses does the sigmoid sinus receive? And at which junctions does it receive each?

Receives the *superior petrosal sinus* at its juncture with the transverse sinus Receives the *inferior petrosal sinus* at its juncture with the jugular bulb In the pic 8 sigmoid sinus 15 superior petrosal 16 inferior petrosal 17 Internal jugular vein

What additional muscle is found in 4-5% of the population - this muscle would course from the lower cervical spinous processes to the 1st rib? What is the orientation of this muscle in relation to other muscles in the area and what can result form its presence?

SCALENIUS MINIMUS (Sibson's muscle) *This additional muscle will run b/w the anterior & middle scalenes compressing the inferior trunk of the brachial plexus.

SVA - Cranial and Peripheral components

SMELL via CN I TASTE via CN's: VII, IX, X

What nasopalatine n. (from V2) will pass through which foramen? What other structures pass through here?

SPHENOPALATINE FORAMEN > also transmits the Sphenopalatine a. and Posterior superior lateral nasal n.

What is a direct continuation of the axillary v.? What will this eventually join and form?

SUBCLAVIAN v. --> begins medial to the lateral border of the 1st rib and then joins the INTERNAL JUGULAR vv. posterior to the sternoclavicular joint to form BRACHIOCEPHALIC vv. (right & left)

What branch from the Superior cervical ganglia will descend in the neck and what does it join?

SUPERIOR CERVICAL CARDIAC n. *Joins the Cardiac Plexus of the thorax (cardioacceleratory)

What represents the fused cervical ganglia of C1-C4? Where is this located?

SUPERIOR CERVICAL GANGLION *located on anterior surface of the longus capitis muscle anterior to the pre-vertebral fascia & posterior to the carotid sheath.

Q on other side....

Scroll down for answer... A: Lissauer's fasciculus B: Marginal zone (Lamina I) C: Substantia gelatinosa (Lamina II) D: Nucleus Proprius (Lamina III-IV)

In the brain stem where should we find the sensory tracts? What about the motor? Use words like ventral/dorsal, medial/lateral

Sensory is dorsolateral Motor is more medial ventral

Where in the brainstem does the afferent portion of the Jaw Jerk reflex go?

Sensory is proprioception -- so it will travel to *mesencephalic nucleus* of the CN V *this is found in the midbrain

Some Review...

Sensory tracts and stuff... (just the blue) A: Fasciculus Gracilis B: Fasciculus Cuneatus C: Dorsal Spinocerebellar D: Ventral Spinocerebellar E: Anterolateral system (spinothalamic) F: Fasciculus Proprius

*Arch 3:* Skeletal derivatives 1. Becomes what 2 parts of the hyoid?

Skeletal Derivatives: 1. Greater horn of hyoid; lower body of hyoid

What do the fibers from the cavernous plexus which join the Long Ciliary nn. do?

Some fibers from the cavernous plexus continue through the orbit on the LONG CILIARY nn. to gain the same objectives as the Short ciliary nn. (innervate the dilator pupillae m. and blood vessels of the eye.

In which bone of the skull would you find the optic canal?

Sphenoid bone

In Lateral medullary syndrome -- if there is an Ipsilateral loss of pain/temp in the face, what tract is likely affected?

Spinotrigemnial tract.

go away

Straight Fiyahhhh

With this direct pathway what is the affect striatum will have on globus pallidus will have on thalamus and what will that have on the motor cortex??

Striatum will be inhibiting globus pallidus Globus pallidus will NOT be inhibiting thalamus so the thalamus will go on to activate motor cortex

What is the course of the subclavian artery? How is it divided?

Subclavian a. = Courses through the root of the neck from its origin laterally over the cupola of the lung to the lateral border of the 1st rib. *Divided into 3 parts by passage of the anterior scalene m. anteriorly

Where do the external jugular vv. and anterior jugular vv. drain to? be specific

Subclavian vv. ---External jugular vv. drain superior to the clavicle ---Anterior jugular vv. will drain medially prior to external jugular

What else is different about the Indirect pathway? Think receptors

Substantia nigra is releasing Dopamine but it is acting on *D2 receptors* so it *inhibits striatum*

Summary

Summary

Looky here...

Superior Laryngeal N. chillin right in that piriform recess

What provides ALL post-ganglionic sympathetic fibers to the head? Why is this important to remember?

Superior cervical ganglion --This is why there are NO pre-ganglionic ganglion fibers in the head.

Review: What provides blood to the interior of the larynx?

Superior laryngeal artery (branch of the superior thyroid a.) --reaches the larynx by piercing the thyrohyoid membrane with the internal laryngeal n. (vagus)

Which sinus is located in the superior margin of the falx cerebri?

Superior sagital sinus

What is the insertion of the Middle scalene m.?

Superior surface of 1st rib posterior to the groove for the subclavian a.

What is the origin of the Rectus capitis lateralis m.?

Superior surface transverse process of atlas (CV1)

What does the inferior thyroid a. anastamose with?

Superior thyroid a. (posterior branches) --- which is a branch of the external carotid a.

Looks on the other side for a surprise

Surprise!! ... now name this crap A: Hyoid Bone B: Hyoid Bone C: Hyoid Bone D: Superior Constrictor E: Middle Constrictor F: Inferior Constrictor

Where does the sympathetic portion of the vidian n. (nerve to pterygoid canal) innervate? What path does it take to get there?

Sympathetic portion of Vidian n. will pass through the PTERYGOPALATINE GANGLION w/o synapsing & distributes via branches of V2 to the mucosa of the nasal cavities, palate & upper pharynx.

What is found on the dorsal portion of the Caudal pons?

THe MOTOR nucleus of the Facial n. (CN VII) --CN VII would then exit the pons facial colliculus just lateral to medial longitudinal fissure.

1. Where does the pontine flexure take place? 2. Where does the cephalic flexure take place? 3. Where does the cervical flexure take place?

Take a look at the photo

What is holoprosencephaly?

Telencephalon fails to split into right and left hemispheres (may also involve diencephalon). Tremendous range in severity.

If you see a tongue deviating to the right, what should you do to see if the problem is LMN or in the cortex?

Test the facial muscles. They are close so if you have a problem in the cortex it will likely also be a problem at the facial lower muscles.

What are the derivatives of the diencephalon? What structures make up the forebrain again?

Thalamus Hypothalamus Epithalamus (pineal) Optic cup 3rd ventricle The telencephalon and diencephalon

Push the "2 "Key

Thank you

Where are the cell bodies of the SVA and GVA fibers of CN VII housed?

The Sensory Ganglion (Geniculate) of CN VII

Let's do that again!

The answers are hidden down there ↓ Bonus: What is with the "(???)" ? A: Buccinator B: Pterygomandibular Raphe C: Superior Constrictor D: Retropharyngeal Space E: Oral Cavity F: Pharynx Bonus: Apparently a bunch of atlases say it connects the pterygoid to the mandible, but Dr. Buck doesn't believe it's a real thing; and we all know that Buck is the authority on everything. After all, if he hasn't broken it on himself, then it doesn't exist.

*Cervical Fascias:* 1. cervical fascia bind deeper structures thereby giving them strength and continuity while at the same time allowing what? 2. They allow movement of visceral components during what? 3. They help isolate the spread of what? 4. although infection can spread by what 2 paths that communicate inferiorly with compartments withing the thorax

The importance of the cervical fascia! layers is several fold. 1. They bind deeper structures thereby giving them strength and continuity while at the same time allowing movement to take place. 2. They also allow movement of visceral components during swallowing independent of movements of the neck 3. and help to isolate the spread of infection, 4. although we will see later that infection can penetrate these fascia! layers following the paths of *blood and lymph vessels* and communicate inferiorly with compartments located within the thorax.

*KEY POINT* Learn the pathways, overlap them, then when evaluating lesions in the brain/spinal cord look for common nuclei throughout the brainstem and spinal cord as well as common ascending pathways.

The key to acing Neuro...

*Bones of the Nasal Cavity:* 1. What are Choanae?

The posterior nasal apertures or internal nostrils are found at the posterior (back part) of the nasal passage between the nasal cavity and the throat *The exit of air that has been inhaled*

When you think you've been taught everything for the test

Then the teacher asks a question that was only mentioned in the book

What is the highly influential Melzack and Wall's "*Gate Control Theory of Pain*"?

Theory that there is a gate you have to pass through when going from the PNS to the CNS and whatever type of sensation is going through this gate can eliminate the other. I.E. Pain will come into the gate and synapse before going to the CNS if you get another sensory coming in such as fine touch it will block the pain and have the fine touch go to the CNS not the pain. His example is when he has a headache he pushes on the superficial portions of the trigeminal nerve and the foramina it goes through to modulate the pain so he doesn't feel it.

In what way is the spinal nucleus like an onion?

There is an onion skin distribution of the spinal nucleus, with a rosto-caudal representation of the mouth to the back of the head

The post-ganglionic fibers from the internal carotid nerve will go where?

These fibers or GRAY RAMI COMMUNICANTES will go to the spinal nerves C1-C4

*NAME THE TRACT* Which tract would have the following identifying information? -Unconscious proprioception -Info from muscle spindle, golgi tendon organs from muscles and joints. -Primary cell bodies are in the DRG -First synapse is in Accessory cuneate nucleus in the caudal medulla. -Travels in the posterior funiculi.

This is describing the cuneocerebellar tract.

What is the Chiasmatic groove?

This is the groove on the sphenoid bone which contributes to the formation of the optic canal.

The cavernous plexus provides fibers to what? What forms as a result?

This plexus provides fibers to CN III which forms the SYMPATHETIC ROOT of the CILIARY GANGLION.

What covers the cupola of the lung?

This region extend superior to the anterior border of the 1st rib where it is covered by PARIETAL PLEURA & the SUPRPLEURAL MEMBRANE (Sibson's Fascia)

Mesolimbic pathway Works on which system?

This will be covered later in neuro!! *LImbic* Projections form Ventral Tegmental Area to the nucleus accumbens

Where is the first synapse in the Ventral trigeminothamic tract?

This will be the *spinal trigeminal nucleus* (spinal nucleus of V) this has somatotopic organization.

What is the dermatome level for the following: --Thumb --Index Finger --Nipples --Umbilicus --Pelvic rim --Big toe --Little toe & heel --Posterior thigh

Thumb = C6 Index Finger = C7 (??) Nipples = T4 Umbilicus = T10 Pelvic rim = L1 Big toe = L5 Little toe & heel = S1 Posterior thigh = S2

Question: would you like to see arterial blood supply on a fancy angiogram?

Too BAD...

What type of lesion would you have if.... Fluency is: absent Repetition is: intact Comprehension is: intact

Transcortical Motor

What type of lesion would you have if.... Fluency is: Intact Repetition is: Intact Comprehension is: absent

Transcortical sensory

What is transmitted through the condyloid canal? Where is this canal located?

Transmits CONDYLOID EMISSARY v. -- condyloid cana is found in the Occiptial bone (posterior cranial fossa)

Short term memory check What innvervated supratentorial dura?

Trigeminal V1, V2 and V3

All the sensory neurons within the Trigeminal n. (CN V) will have cell bodies in what structure?

Trigeminal Ganglion

GSA input from the face will have to travel through what?

Trigeminal Sensory Nuclear Complex

Where are the primary afferent cells bodies within the ventral trigeminothalamic tract?

Trigeminal ganglion (also called semilunar or gasserian ganglion)

Where will the LMNs from the Trigeminal n. pass through?

Trigeminal motor nucleus

What passes through the Tympanic canaliculus?

Tympanic branch of CN IX (glossopharyngeal n.)

He goes through a lot of the where the neuron is and what not.... i made all of the cards and then he said to mostly focus on the ones with trigeminal.... so focus on that

UMBC is down by 1 to Kansas State.... let's see if they can upset another team

Push number 2

UNC was a 2 seed... that didn't help them much

What forms the jugulovenous angles? Why are these junctions important (clinically)?

Union of subclavian & internal jugular vv. will form R and L jugulovenous angles. **These angles receive the RIGHT LYMPHATIC DUCT and THORACIC DUCT

What are 4 characteristics that make the human brain unique?

Unique in: Size Shape Patterns of connections Patterns of development

Which branches innervate some dura?

V1 V2 V3

What is the cutaneous distribution of the trigeminal n. (CN V) trunks?: V1 V2 V3

V1 ---> Frontonasal process V2 ---> Arch 1 maxillary process V3 ---> Arch 1 Mandibular process

Which branch innervates the somatic sensory of: Inf. Nasal cavity and maxillary sinus?

V2

Which branch innervates the somatic sensory of: palate upper teeth /gingiva

V2

Which branch innervates somatic sensory of: oral mucosa lower teeth/gingiva Floor of mouth Ant. 2/3 of tongue

V3

Which trigeminal branch innervates somatic sensory of the: Temporal region upper auditory canal tympanic membrane

V3

Which branch of trigeminal has a somatic motor part? Can you list the muscles it innervates? (5)

V3 2. Mm of mastication Digastric (ant. Belly) Tensor veli palatini mylohyoid Tensor tympani m.

What is the somatopic map of the VPM and VPL? Senses from what part of the body will be medial/lateral?

VPM: tongue--> face--> back of head VPL: Upper --> lower

Where is the 2nd synapse in the ventral trigeminothalamic tract?

Ventral posterior medial nucleus (*VPM of the Thalamus*)

7. Where is the second synapse in the MSN/ML & Dorsal Trigeminothalamic tracts?

Ventral posterior medial nucleus (VPM of the thalamus)

What is the innervation of the Posterior scalene m.?

Ventral rami from Brachial plexus (C7-C8)

What is the innervation of the Anterior scalene m.?

Ventral rami of cervical spinal nerves (says don't have to be specific)

What is the innervation of the Longus Colli m.?

Ventral rami of cervical spinal nn. (C2 - C7 don't worry about specific level)

What is the innervation of the Rectus capitis lateralis m.?

Ventral rami of spinal n. C1

What is the innervation of the Longus Capitis m.?

Ventral rami, spinal nerves C1 - C4

Where is the Vertebral ganglion located? Fibers from this ganglion will participate in what?

Vertebral Ganglion = Base of the vertebral artery. **Participates w/ INFERIOR CERVICAL GANGLION in providing post-ganglionic fibers to form the Vertebral plexus which courses superiorly on the vertebral artery. **May also provide the Ansa Subclavia.

What is the insertion of the *Omohyoid m.*?

Via fascial sling of infrahyoid fascia to clavicle & 1st rib & sheath to subclavian vein.

How does huntington's disease typically begin?

W/ depression.

That card was a long one... might as well take a bit of a gif break...

We are right in the thick of it...

In terms of 7 layer bean dip, explain the process of how the cerebral cortex is developed. Where are the youngest cells going to be?

We have our first wave of neurons (i..e the refried beans) that climbs up their own radial glial cells to differentiate at the cortical plate. The next wave of cells comes along, climbs their own set of radial glial cells (which has put projections through the previous cell layer) and lays themselves on top of the previous layers of cells (just like putting some guac on the beans, if you will). This continues to happen 4 more times to make the 6 layers. This is known as a "inside-out" layering with the younger neurons migrating *through* layers of older neurons.

even better photo

We will talk about the deep lymphatic nodes later so that is why I did not mention them

We are now officially finished....

Well done mates...

What type of lesion would you have if.... Fluency is: Intact Repetition is: absent Comprehension is: absent

Wernicke's

Answer questions on the back.

What is 1-4? 1. Gracile nucleus 2. Cuneate nuclues 3. Internal arcuate fibers 4. Medial lemniscus

Look on the back of this card

What is 1-6? 1. Fasciculus gracilis 2. Fasciculus cuneatus 3. Dorsolateral tract of Lissauer 4. Dorsal spinocerebellar tract 5. Ventral spinocerebellar tract 6. Anterolateral system

Question on back

What is the blue line pointing at? Arachnoid granulation

Here is a sweet pic showing the growth of all telencephalon and diencephalon...

What is the green portion going to create? What are the empty spaces going to become?(scroll down for the answer) 1. Future basal ganglia 2. The ventricles of the brain

Flip the card and name the vein

What type of vein is the blue arrow pointing at?

Flip to the back

Which of the following people have had a cleft lip/palate repair?

Did UMBC make history tonight?

Yes.... they were the first #16 seed to ever lose in the second round

Welcome to the wonderful world of imagination...

You'll regret every second you spend here.

Check out Neurulation via SEM!!

[Garrett]: OMG woooooooooooow

What are the other 3 branches of the recurrent larygneal n?

a) Cardiac branches to the deep cardiac plexus b) Branches to muscles and glands of the trachea and esophagus c) Pharyngeal branches to the inferior constrictor muscle

Emissary veins receive blood directly from where? (6)

a. Face b. Orbit c. Nasal cavity d. Parietal e. Mastoid f. Occiput

get outta here

are we done? yes

knock knock, Who's there, Arch, Arch who

bless you....

*Corticospinal tract*: Spinal cord

check 'em off your list ladies

look on the other side for dope pic

cool picture of arch 2 about to go through foramen cecum

The 5 paired muscles in the *Soft Palate*... (flip the card for a naming romp)

das answers ↓ A: Tensor Veli Palatini B: Levator Veli Palatini C: *Palatopharyngeus* D: *Palatoglossus* (oral cavity | pharynx) E: Musculus Uvulae

check out this sick summary

dope right

Aqueduct vestibuli is the opening of what?

endolymphatic duct

Straight sinus is found at the site of fusion of _____________ to ___________. (both are dural reflections) Straight sinus opens posteriorly into what?

falx cerebri to tentorium Confluence of sinuses (when present)

Summary of the buck book, focus on the purple, all clinical stuff

file:///C:/Users/Jake%20McRae/Downloads/Neuro%20Exam%20One%20Study%20Guide(2)%20(1).pdf

FLIP IT

flip it 2.0

thank you

flip it back

....

flip it back yo!!

Great overview

great overview

donzo now go relax this is the hardest stuff you'll have to know

haha jk.

we lost Colorado

help help help

OMG WOOOOOOOOOW!

here is a photo of everything we talked about on the last slide.

Practical two 2nd order stuff (15 pages... )

https://docs.google.com/document/d/1-12zOuW49WSTZmcyfyUFRVEaBBpaBAjlk4zK8eWKZs8

Muscle worksheet

https://docs.google.com/document/d/1irVRLx8GKZ-tdisKdySZvHKvKTjZTv1jL3Wq-SwubKo/edit

Neck lab with 2nd order questions

https://docs.google.com/document/d/1n-TWqLJe1dCmJUtWWQUV8T9Iyo26DNNCIJ-Zo4NPAXs/edit

tutor review class of 2019

https://www.facebook.com/groups/586365828130904/757902534310565/

Lexi's test review

https://www.facebook.com/groups/rvucom2020/397835553907090/

"Here's the "things to know" powerpoint. Again, use it as you will. As a reminder, these are good supplementary resources"

https://www.facebook.com/groups/rvucom2020/397946830562629/

drawing tracks out template

https://www.facebook.com/groups/rvucom2020/search/?query=neuro

ALSO! before we get started...

https://youtu.be/4glEasCJDYM Just a little something to nourish and strengthen our testimonies....

What are the 3 *Suprahyoid mm.* of the *Anterior neck Δ*? - All these muscles are found superior to what?

i. Digastric m. ii. Stylohyoid m. iii. Mylohyoid m. (all are superior to Hyoid bone)

What are the functional categories (4) of neurons found in the spinal cord?

i: *Afferent Tract Neurons* ii: *Interneurons* iii: *Motor Neurons* iv: *Propriospinal Neurons*

*Middle Constrictor* What are it's 2 attachments?

i: *Hyoid Bone* (Greater & Lesser Horns) ii: *Stylohyoid Ligament* (lower bit)

What are the 3 subdivisions of the pharynx & with what do each communicate?

i: *Nasopharynx*: Nasal Cavity (ant) & Auditory (eustachian) tubes (lat) ii: *Oropharynx*: Oral Cavity (ant) -located @ C2 -C3 iii: *Laryngopharynx*: Larynx (ant) & Esophagus (inf) - located @ C4 - C6 (aka: Hypopharynx)

5 Typical signs of LMN damage

i: *Paralysis or paresis* ii: *Areflexia*: Loss of muscle tone iii: *Atrophy*: Due to denervation & disuse iv: *Fibrillations*: Rapid twitching due to change in muscle fiber excitability (pathology) v: *Fasciculations*: Local, small twitch due to α-MN damage (like a sparking wire)

2 (1 general, 1 specific) branches of segmental arteries (eg intercostals, etc) *&* what they supply?

i: *Radicular arteries* (R & L, A & P): nerve roots, DRGs ii: *Artery of Adamkiewicz* (joins ASA): much of lower spinal cord

2 reasons your scalp bleeds like a mother when you cut it open?

i: *Robust blood supply* (to feed all those luscious locks [hair]) - make's healing fast ii: All that *dense CT holds blood vessels open* (normal vessels spasm is ineffective)

*Inferior Constrictor* 2 attachments for this muscle?

i: *Thyroid Cartilage* (oblique line) ii: *Cricoid Cartilage*

Lets start histology off right

instead of demons its neuro now.....

freaking giraffes

just to be cool

This is a tough one...

los answers ↓ A: Nasal Septum B: Soft Palate C: Torus Tubarius D: Pharyngeal Recess E: Pharyngeal Tonsil

What goes through lacerum? What bones?

meningeal branch of ascending pharyngeal a. sphenoid, occipital and temporal bones (looking through the internal opening of the carotid canal)

What passes through foramen spinosum? What bone is it on?

middle meningeal a., recurrent meningeal n. (Vs) Sphenoid

Also check out this excellent photo

most excellent

1. optic recess 2. Infundibular recess 3. pineal recess 4. suprapineal recess 5. silver stain

name the recesses brahs #5 What stain is this? 1. optic recess 2. Infundibular recess 3. pineal recess 4. suprapineal recess 5. silver stain

Name those foramina

no really... name them... (Scroll for answer) =these CN V exit points= A: Supraorbital Foramen/Notch B: Zygomaticofacial Foramen C: Infraorbital Foramen D: Mental Foramen

What sinus does the falx cerebelli contain?

occipital sinus

FLIP IT

pat yourself on the back

uoy knaht

reverse that flip

So, that was external carotid... Where do branches of the *Internal Carotid* go?

right dere

Where in the spinal cord would you expect to find each of the below: - Fasciculus Cuneatus - Fasciculus Proprius - Dorsal Spinocerebellar Tract - Fasciculus Gracilis - Ventral Spinocerebellar Tract - Anterolateral System (Spinothalamic)

see image for answer

What passes through foramen magnum? bone?

spinal cord, spinal roots of CN XI, vertebral aa., anterior and posterior spinal aa., dural vv. with vertebral venous plexus Occipital

What type of cells would we see in the external granular zone?

stellate (granule) cell cell of martinotti pyramidal cell

What type of cells would we see in the internal granular zone?

stellate (granule) cell cell of martinotti pyramidal cell

What type of cells would we see in the internal pyrimadal zone?

stellate (granule) cell cell of martinotti pyramidal cell

What type of cells would we see in the external pyramidal zone?

stellate cell cell of martinotti pyramidal cell chandelier cell

What type of cells would we see in the multiform zone?

stellate cell cell of martinotti pyramidal cell fusiform cell

summary

summary

If there is no confluence of sinuses what is the continuation of the superior saggital sinuse? What is the continuation of the straight sinus?

superior sagittal sinus forms the *right transverse sinus* straight sinus forms the *left transverse sinus.*

Confluens of sinuses is present 30-40% of the time. It joins which sinuses? (4, pairs count as 1)

superior sagittal, straight, transverse occipital sinuses

Falx cerebri follows contour of sagittal suture posteriorly to the internal occipital protuberance to become continuous with what structure?

the *tentorium cerebelli*

Settle in for an hour of...

this gorgeous mug.

Now we are going to go through the tracts more specifically...

this shoud be fun

Whoa... you have to see this...

told you

Check out this dope review picture

told you it was dope Note: arachnoid granulations draining CSF from subarachnoid area to the venous system via the superior sagittal sinus

During rapid deceleration, what can the tentorial notch do to the midbrain?

transect the midbrain

I put the next ones in for help in review, we don't have to do them together if you don't want to. Also She said that she will test more anomaly's we need to know the info in the coming cards for her questions and for practical questions

ur welcome

Broad questions for the win Veins in the skull often drain directly to what?

venous dural sinuses

What circuit helps us make our movements smooth, linked, & repeating?

via the ACCESSORY MOTOR CIRCUIT which involves the basal ganglia.

Here is a picture of that process taking place

well... kinda

"check out my backside" -this card - Michael Scott

which one is hooman? scroll down even more even more almost there C

Pharyngeal Arch Nerves & Muscles *Overview CHART*

would you look at that

are you excited to learn about the larynx?

you should be

Pharyngeal Arch Nerves & Muscles *Overview PICTURE AND CHART*

you've out done yourself this time

Vestibulospinal tracts: Spinal cord

✓ That's 4 of 8 tracts reviewed (you're doing so well!)

Tectospinal tract: Spinal cord

✓ That's 5 of 8 tracts reviewed (you're doing swell!)

Rubrospinal tract: Spinal cord

✓ That's 6 of 8 tracts reviewed (that's neat!)

You guys...

✓ That's 8 of 8 tracts reviewed ... that must mean...

Explain what plasticity of the cortical representation is. For example, if i lost my 2nd and 3rd digit, what would most likely take place?

"If there is anytime of catastrophic damage like amputation or some sort of loss, the part of the cortext that is usually devoted to those areas will be abosrbed by the cortex just next to it. The cortex on either side of it will take over." So for example, you would have a larger thumb and 4th/5th digit area in the cortex.

*Superior Thyroid a.* 1. What is it the first branch of? 2. What is its course? 3. What are the 3 major branches?

(1) 1st branch of the external carotid artery (2) Courses along the superior medial margin of the thyroid gland (3) a. Superior laryngeal a. b. anterior branch c. posterior branch

.... This is getting old

(Cam did scroll dancing in high school) A: Parotid Gland & Duct B: Zygomatic/Buccal Branch C: Mandibular Branch D: Cervical Branch E: Temporal Branch

Major arteries that perfuse the scalp... (flip it for a pictorial answering experience)

(I am seriously on a scroll) A: Superficial Temporal A B: Supraorbital A C: Supratrochlear A D: Occipital A E: Posterior Auricular A F: Superficial Temporal A G: Supraorbital A H: Supratrochlear A

But wait, there's more

(I did scroll vaulting in high school) A: CN VII (Facial) Main Trunk B: Posterior Auricular N C: Temporal Branch D: Zygomatic Branch E: Buccal Branch F: Mandibular Branch G: Cervical Branch

Let's drain this sucka...

(I like a bit of hot butter on my scroll?) A: Supraorbital V B: Supratrochlear V C: Angular V D: Superior Labial V E: Inferior Labial V F: Facial V G: Common Facial V H: Maxillary V I: Superficial Temporal V J: Posterior Auricular V K: External Jugular V L: Internal Jugular V M: Retromandibular V

Name the structures on the back

(Scroll down for answers) -What is found in #5? 1. Fasciculus gracilis 2. Fasiculus cuneatus 3. Dorsal spinocerebellar tract 4. Ventral spinocerebellar tract 5. Anterolateral system: holds all the ascending fibers of the spinathalamic tract.

In cases of Brain Hypoxia...

(idk)

SVE - Cranial and Peripheral components

**BRANCHIOMERICS** CN's: V, VII, IX, X NO SPINAL NERVES = NO PERIPHERAL Components

What is so special about Special Efferent Fibers, and what 2 categories are they broken into?

**Special Efferent Fibers are found Only in CRANIAL Nerves which innervate a specialized area of skeletal musculature** 1. SVE (Special Visceral Efferent) - Nerves innervate SKM derived from Visceral (Branchiomeric/Pharyngeal) arch MESODERM a) Include muscles of mastication, facial expression, Pharynx, Palate, and Larynx. b) Visceral has NOTHING to do w/ ANS 2. SSE (Special Somatic Efferents) - Nerve fibers can Reflexively influence Sensory input into Ear

What is the innervation of the *Sternohyoid m.*?

*Ansa cervicalis* (C1-C3) of cervical plexus

What is the innervation of the *Sternothyroid m.*?

*Ansa cervicalis* (C1-C3) of cervical plexus

What is the origin of the *Digastric m.* (2)?

*Anterior Belly* = Digastric fossa of mandible *Posterior Belly* = Mastoid notch of temporal bone.

Which artery is responsible for supplying blood to the Gray matter & adjacent white matter of the spinal cord?

*Anterior Spinal a. (ASA)*

1. What type of fibers are found w/in *Rexed lamina VIII*?

*Interneurons & propriospinal* neurons that receive *input from UMN's*

look at the other side plz

*Spinoreticular and spinomesencephalic tracts:* 1. What is the top arrow? 2. What section of the medulla is this? 3. How does the spino-bulbar-spinal pathway use this, is it the Spinoreticular or Spinomesencephalic tract that uses #1? scroll for the answers keep going 1. Raphe Nuclei 2. Rostral Medulla 3. Spinoreticular tract have 2nd synapse on #1. then 3rd neuron descends spinal cord

Which branch of the subclavian a. will branch superiorly & ascend between the longus colli m. & anterior scalene mm? Where does this artery go and what does it supply?

*VERTEBRAL a.* (Part 1 of subclavian a.) **Enters transverse cervical foramen of CV6 and ascends through all remaining cervical vertebrae. **Courses posterior over atlas, grooving posterior arch and piercing atlanto-occipital membrane posteriorly **Ascends through foramen magnum where it fuses w/ its opposite counterpart inferior to the pons to form Basilar a. IN the NECK --Supplies muscular branches & spinal branches to vertebrae & spinal cord.

Which 1st neuron fibers from the Glossopharyngeal n. (CN IX) will be found in the Inferior Ganglion of IX? Where are the 2nd neurons found in this path?

*VISCERAL SENSORY:* 1st neuron -- Inferior ganglion of CN IX 2nd neuron -- *Solitary nucleus*

*Clinical correlation* What can result in a paralysis of the lateral gaze? Which nerve is affected? and what is that nerve responsible for?

*carotid arterial aneurysm* or *infection occurring within the cavernous sinus* affecting *CN VI* which is solely responsible for controlling abduction of the eye

What 2 facial layers are directly apposed across the floor of the posterior Δ?

- *Cervical investing* & *Prevertebral* fascial layers

What are the *boundaries* (5) of the *Posterior Δ*... - *Roof* ? - *Anterior*? - *Posterior*? - *Inferior*? - *Floor* (5ish)?

- *Roof*: Cervical Investing Fascia - *Anterior*: Posterior border of SCM m. - *Posterior*: Anterior border of Trapezius - *Inferior*: Middle 1/3 of superior margin of clavicle - *Floor*: i: Pre-vertebral fascia covering neck musculature (post., mid., & ant. scalene) ii: levator scapulae iii: splenius capitis iv: sometimes semispinalis capitis v: infrahyoid fascia following omohyoid

Can you tell me the 4 pairs of tonsils in *Waldeyer's Tonsillar Ring* + where each are found?

- Pharyngeal & Tubal Tonsils (Nasopharynx) - Palatine & Lingual Tonsils (Oropharynx)

What is another name for the Thalamic fasciculus? What is carries within this pathway and where does it go?

---FOREL's Field *carries fibers from the basal ganglia (globus pallidus internal) and from cerebellum. *fibers will travel back to the cortex.

What are the foramen found in the Orbit? (8)

---Supraorbital notch ---Infraorbital foramen ---Optic canal ---Superior Orbital fissure ---Inferior Orbital fissure ---Anterior ethmoidal foramen ---Posterior ethmoidal foramen ---Nasolacrimal canal

Which structures are found in the frontoethmoidal suture?

--> ANTERIOR ethmoidal foramen --> POSTERIOR ethmoidal foramen

What structure is transmitted through the stylomastoid foramen?

--> Facial n. (CN VII): SVE fibers --> Stylomastoid a.

What are the parts of the Spinal nucleus of V?

--> NUCLEUS ORALIS (most superior) --> NUCLEUS INTERPOLARIS (middle) --> NUCLEUS CAUDALIS (most inferior)

What are common symptoms of Thoracic Outlet Syndrome?

--> Pain, numbness, or tingling in the neck --> Pain, numbness or tingling in medial forearm & 4th/5th fingers. --> Paresis of intrinsic mm of the hand --> Poor circulation (cold fingers or swollen upper limb)

What are the branches of the subclavian artery which come off in Part 1?

--> Vertebral a. (superior branch) --> Thyrocervical trunk (anterior-superior branch) --> Internal Thoracic a. (descending branch)

What are the structures (5) that pass through the superior orbital fissure?

--CN III (oculomotor n.) --CN IV (trochlear n.) --CN V (1st branch of trigeminal n.) --CN VI (abducens n.) --Superior ophthalmic vein

What is transmitted through the greater palatine canal?

-Greater palatine a. & n.

What is transmitted through the lesser palatine canal?

-Lesser palatine a. & n.

Hey, remember this...

-Red circle: The internal capsule has somatotopical organization (legs posterior/lateral → arms/face medial/anterior) -Green circle: look at those ipsilateral fibers... so cute

I get really freaked out when I look at the Pharynx...

...and I think it's freaked out to look at me too

*Lymphatics: superficial cervical lymph nodes* 1. Nodes of this system drain to WHAT? 2. #1 runs parallel to what vein?

1&2. *nodes of this system drain to the deep cervical lymph nodes that parallel the internal jugular vein*

*Subclavian a. (3rd bit)* 5. 3 Possible Branches off Subclavian a. in Posterior Δ (2 old, 1 new)? 6. The new one: i. passes dorsalward thru what structure? ii. to gain ventral surface of what muscle? iii. descends parallel to what nerve? iv. ventral to what muscle? v. along medial border of what bone??

1) *Transverse cervical a.* 2) *Suprascapular a.* 3) *Dorsal scapular a.* 6. i. thru brachial plexus (near middle trunk) ii. levator scapulae iii. dorsal scapular n. iv. ventral to rhomboids v. scapula

Where is the internal carotid nerve located? What fibers (3) leave this nerve?

1) Caroticotympanic plexus 2) Deep petrosal n. 3) Cavernous plexus

What are the Visceral structures (5)found within the root of the neck?

1) Cupola of lung 2) Esophagus 3) Trachea 4) Thoracic duct 5) Right lymphatic duct

*Vagus Nerve Origin and Course* 1. Where does it exit the brainstem? 2. Where does it exit the skull? 3. How does it make its way inferiorly? What is its orientation to the other structures with which it travels? 4. Where does it enter the thorax (differentiate between R and L side)?

1) Exits brainstem at medulla 2)Exits skull via jugular foramen 3) Courses in the carotid sheath posteriorly between the carotids (internal and common) and internal jugular vein 4) Enters thorax on the right side between the subclavian artery and the right brachiocephalic vein; on the left between the junction of the left common carotid with the left subclavian artery and the left brachiocephalic vein

*Jugular Lymph Trunks* 1. What are they formed by? 2. On the left side, what to they drain to? 3. On the right side, what do they join with? That joining forms what structure? Where does this then enter the venous system?

1) Formed by efferents of the superior and inferior deep cervical nodes 2) On the left side, drain to the thoracic duct 3) On the right side, joins with the subclavian and right broncho-mediastinal lymph 'trunks to form the right lymphatic duct which enters the venous system at the right jugulovenous angle formed by the subclavian and internal jugular veins

flip for question

1-4 identify 5. #3 pierces what membrane? 1. Superior thyroid artery 2. Inferior thyroid artery 3. Superior laryngeal artery 4. She called this the superior thyroid artery still but buck called this the inferior laryngeal artery 5. the thyrohyoid membrane

Flip de card fur de question

1-5 identify veins 6. What membrane does #4 pierce? scroll down for answers 1. Superior thyroid vein 2. Middle thyroid vein 3. Inferior thyroid vein 4. Superior laryngeal vein 5. Inferior laryngeal vein 6. Thyrohyoid membrane

1. Superficial layer, cervical fascia 2. fascia of infrahyoid ms 3. carotid sheath 4. alar fascia 5. prevertebral fascia 6. platysma 7. buccopharyngeal fascia

1-7 identify

1. Deep cervical fascias 2. infrahyoid fascia #2 3. Investing fascia #1 4. Pretracheal fascia #3 5. Buccopharyngeal fascia #4 6. Alar Fascia #6 7. Prevertebral Fascia #5 8. spaces we will get into them later

1-8. name the facial layer and what number layer they are plz

*Arch 6* 1. Fuses with which arch? skeletal derivatives 2. because of this what does it become?

1. (fuse with Arch 4) Skeletal Derivatives: 2. Laryngeal cartilages: Thyroid; cricoid; arytenoid; corniculate; cuneiform

1. What fascia invests the roots of the brachial plexus? 2. What artery is also covered by this fascia?

1. *Axillary Sheath* composed of Pre-vertebral Fascia 2. Subclavian artery *This is the fascia layer of the neck that covers the scalene muscle*

*lateral ventricles:* 1. *In the intact brain, What is the septum that separates the two ventricles?? 2. Lateral ventricles shape mimic growth of what?

1. *In the intact brain, the septum pellucidum separates the two ventricles 2. telencephalon, because that is what makes the this space....

1. What types of neurons exist as short processes within the spinal cord? 2. What do these neurons talk to (2)?

1. *Interneurons* - part of many central pattern generators & reflexes 2. Thalamus or Ventral horn (from dorsal horn)

*Cervical Fascias: pre-vertebral fascia* specializations: 1. Continuation of prevertebral fascia reflected from the scalene muscles [medially or laterally?] forms WHAT sheath along the subclavian and axillary vessels and brachial plexus as they pass through WHAT triangle?

1. *LATERALLY* forms the *Axillary sheath* through the scalene triangle

1. What area is found within *Rexed lamina I*? 2. What's found within this layer (group)?

1. *Marginal Zone* 2. *Pain & Temp* 1° afferent terminals (location of synapse w/2nd order cell bodies)

Arachnoid mater 1. Compared to pia, does it have more or less elastic and collagen fibers? 2. On which side or the arachnoid mater is it trabeculated? (deep or superficial side? 3. The trabeculae form what space? 4. What does #3 contain? (3)

1. *More*, it is somewhat denser than pia 2. *Deep side*, between pia and arachnoid 3. *Subarachnoid space* 4. CSF, cerebral aa., cerebral vv

Review: 1. Superior, Anterior & Inferior borders of *Nasopharynx* 2. Superior, Anterior & Inferior borders of *Oproharynx* 3. Superior, Anterior & Inferior borders of *Larngopharynx* (hypopharynx)

1. *Nasopharynx*: Base o'skull (sup); Choanae o'nasal cavity (ant); superior margin o'soft palate (inf) 2. *Oproharynx*: Inferior margin o'soft palate (sup); palatoglossal arch (ant); superior margin o'epiglottis (inf) 3. *Larngopharynx*: Inferior margin o'epiglottis (sup); larynx (ant); esophagus (inf)

Main venous patterns of drainage for the spinal cord... 1. Veins are found within what space (hint: think similar to brain)? 2. What specific veins are found in this space (3)?

1. *Subarachnoid space* (similar to arterial supply) 2. Anterior & Posterior Spinal & Radicular vv.

*Facial Artery* 1. 1st branch & what it supplies? 2. Next 2 branches & what they supply? 3. Next Branch & what it supplies? 4. Continues where to become what artery?

1. *Submental A*: chin 2. i: *Inferior Labial A*: Lower lip ii: *Superior Labial A*: Upper lip & Nasal Cavity 3. *Lateral Nasal A*: Nose & Nasal Cavity 4. Cont. to angle of eye to become *Angular A*

1. What area is found within *Rexed lamina II*? 2. What's found within this layer (group)?

1. *Substantia Gelatinosa* 2. *Interneurons* that modulate activity of *Pain & Temp Fibers*

*Thyroid Gland*- Veins What *Veins* (3) will drain the thyroid gland?

1. *Superior thyroid vv.* 2. *Middle thyroid vv.* 3. *Inferior thyroid vv.*

1. *Bulbar* refers to anything in the ______? 2. However, in common language, *bulbar* is used for _______ synapses of cranial nerve motor nuclei

1. *medulla* 2. *cortico-medullary*

*Paranasal Sinuses:* 1. What percentage of the air is conditioned in the paranasal sinuses? 2. what 2 things are less in the respiratory mucosal lining in the paranasal sinuses? 3. What thing in the mucosa is more concentrated near the ostium?

1. 0%! Paranasal sinuses do NOT participate in conditioning air during respiration 2. less vascular and goblet cells are sparse throughout epithelium. 3. Seromucus glands are concentrated near the Ostium

*thyroid cartilage:* Posteriorly 1. The thyroid cartilages makes up how many horns? 2. What are their names?

1. 2 pairs. 2. Superior and inferior horns

(EVERYONE TAKE ONE QUESTION) Couple of quick questions to check for understanding: 1. If a baby were to have a developmental issues with the 3rd ventricle, what portion of the primitive brain did not develop properly? 2. If a baby were to have a developmental issues with the 4rd ventricle, what portion of the primitive brain did not develop properly? 3. If a baby were to have a developmental issues with the Cerebral aqueduct, what portion of the primitive brain did not develop properly? 4. If a baby were to have a developmental issues with the lateral ventricle, what portion of the primitive brain did not develop properly? 5. What portions of the primitive brain, when matured, contain Choroid plexus?

1. 3rd ventricle --> Diencephalon --> Prosencephalon 2. 4th ventricle --> met- and myelencephalon --> Rhombencephalon 3. Cerebral aqueduct --> Mesencephalon --> Mesencephalon 4. Lateral ventricle --> Telencephalon --> Prosencephalon 5. a. Telencephalon and Diencephalon --> Prosencephalon b. Met- & myelencephalon --> Rhombencephalon

*Cervical Fascial Spaces:* 1. How many spaces are there? 2. What is the name of Space 1? 3. What fascia forms this space? 4. What is it filled with and what does it contain? 5. the vein communicates with the inferior portion of what jugular viens?

1. 4 spaces 2. Suprasternal space 3. The investing fascia 4. normally filled with fat and contains a vein 5. the vein communicates with the inferior portion of the anterior jugular veins

*Cervical Fascias: pre-vertebral fascia* 1. What layer # of deep fascia is this? 2. Continuous with what posteriorly? 3. pre-vertebral fascia and #2 then encircle what and its associated musculature?

1. 5th layer of deep fascia 2. Nuchal fascia 3. both then encircle the vertebral column and its associated musculature

*Nasal Cycle:* 1. about what percentage of people experience the nasal cycle? 2. The time varies between 50 minutes and how > many hours? 3. is it under autonomic control? is it sympathetic or parasympathetic inputs that cause drainage of the erectile tissue? 4. OTC nasal spray (e.g. Afrin) are parasympathomimetics or sympathomimetics?

1. 80% 2. > 4 hours 3. YUP, sympathetics 4. sympathomimetics

1. How many cartilages are in the larynx? 2. How many are paired? 3. How many are unpaired?

1. 9 2. 3 are paired 3. 3 unpaired

*Arytenoid (oblique and transverse):* 1. These both do what to the glottis? 2. What is the difference b/w the oblique and transverse arytenoids in their function of closing the glottis? 3. Why are they important?

1. Adduct 2. The Oblique arytenoid closes the glottis completing living little or no space the Transverse arytenoid keeps a small space between the two focal ligaments 3. important for speaking gives you more control over what sounds you make.

*Congenital Anomalies: Neural Crest Disorders* 1. Goldenhar syndrome is caused from which arch(s)? 2. What are the 5 symptoms/structural defects?

1. Arches 1 & 2 Structures 2. - Underdeveloped facial bones -Ear anomalies -Eye anomalies -hemivertebrae -spina bifida note: 1/3500-1/5600 Male:female ratio of 3:2

*Congenital Anomalies: Neural Crest Disorders* 1. DiGeorge Anomaly is caused from which arch(s)? 2. What is the mnemonic to remember this? 3. Which chromosome is the problem? 4. What are the 5 symptoms/structural defects?

1. Arches 3 & 4 Structures 2. CATCH-22 3. Chromosome 22 4. Cardiac defects -Abnormal facies -Thymic aplasia -Cleft palate -Hypocalcemia (parathyroid deficiency) note: -1/4000 live births

*Peter Dinklage* 1. What is achondroplasia? 2. Where is the primary effect of this condition? 3. Will you see a normal sized skull and ribs in this condition? 4. What are two narrowings that take place in this condition?

1. Autosomal dominant premature closure of primary growth plates. 2. In long bones specifically in endochondral ossification (again in the growth plates). 3. Yes, skull and ribs and such will not be effect as much. 4. Narrowing of the cervical spinal canal and the foramen magnum.

1. Why does the stegosaurus have a brain in it's butt? (this is a real question)

1. B/c the shape & size of the spinal cord (incl. white & gray matter) mirror the needs of the body in that area (i.e. big legs for walking around need extra cord)

*Cervical Fascial Spaces:* Space 4: 1. it extends from the base of the skull to the diaphragm b/w what 2 structures?

1. B/w the vertebral column and the esophagus

*Spinoreticular and spinomesencephalic tracts:* 1. Major descending pathways from the PAG (periaquiductal grey) signal through the Raphe nuclei of the RVM (Rostral ventromedial medulla) to either [inhibit or excite?] the spinal cord nociceptive signals 2. What 2 neurotransmitters excite pain? 3. What 2 neurotransmitters inhibit pain? 4. Whats up with serotonin and depression?

1. BOTH inhibit or Excite 2. excite = Endorphins and Enkephalins 3. inhibit = Norepinephrine - inhibit *Serotonin* - inhibits 4. serotonin is giving to help depression and it also helps to inhibit the excess pain they have. so its like a win win dawg

1. What info in the main *ascending + descending* PWs of spinal cord? 2. Where are they found (2)?

1. Balance (vestibular) 2. Cerebellar & Vestibulospinal pathways

*V2: Maxillary Division* 1. What region of the head does this innervate? 2. 3 named branches we need to know

1. Below eyes & some temple bit 2. i: Zygomaticotemporal ii: Zygomaticofacial iii: Infraorbital (pay attention to locations, you will be quizzed later) {ZIZ

what are the 3 cisterns?

1. Cisterna magna - (medullary cerebeller) 2. Pontine cistern 3. lumbar cistern - (down around caudia equina) Note: these are places with a CSF pool w/no trabeculae so its easy to get access to CSF here

*Pharyngeal Cleft Derivatives:* 1. Cleft one forms what meatus? and contributes to what membrane? 2. Which cleft(s) form the cervical sinus? (what layer of epithelium?) which is later obliterated with overgrowth of which arch? 3. If the cervical sinus isn't obliterated what can happen? what tissue layer/type would it be?

1. Cleft 1 forms external acoustic meatus and contributes to tympanic membrane. 2. Clefts 2-4 form the cervical sinus (ectodermal epithelium) which is later obliterated with overgrowth of Arch 2. 3. a cyst can form, which is apparently a bad thing/ectodermal tissue

*Corticospinal tract* 1. Role (2)? 2. UMN body found where? 3. Pyramidal cells in which layer? 4. LMN body where?

1. Complex voluntary behavior & Fine motor control 2. Cerebral cortex 3. Layer V 4. Ventral horn in spinal cord

*Posterior Column - Medial Lemniscal Pathway* 1. Conscious or unconscious level? 2. Fine or course touch? 3. 3D shape sense or pain? 4. Vibration or temperature? 5. 2-point discrimination or itch? 6. Joint position & movement or whole limb movement?

1. Conscious 2. Fine touch 3. 3D shape (stereognosis) 4. Vibration 5. Texture discrimination (2-point discrimination) 6. Joint position & movement (proprioception)

*Generalized Descending PW* 1. Location of UMN cell body? 2. Decussation: yes or no? 3. Synapse/LMN cell body location? 4. Final synapse?

1. Cortex or Brainstem 2. Yes (most) 3. Spinal cord or Brainstem 4. Muscle fiber(s)

*Esophagus* 1. Cervical portion extends inferiorly from the inferior border of what structure? 2. Located midline, but inclines to {right or left} as it descends? 3. Muscle of cervical portion is {smooth or striated}?

1. Cricoid cartilage (opposite CV6) 2. to *left* 3. striated

1. Bone is very [basophilic or eosinophilic?]? 2. Respiratory epithelium lines what in the nasal cavity? 3. What type of epithelium is in each of the paranasal sinuses? 4. Is the nasal septum or lateral wall of the nasal cavity more key in the process of warming the air? 5. Again the cilia move the mucus towards the mouth or the pharynx?

1. Eosinophilic 2. lines the vast majority of the nasal cavity 3. ALL of the paranasal sinuses have respiratory epithelium 4. Lateral wall, Chonchas. 5. PHARYNX

1. The crista galli is part of which bone? 2. What does it attach?

1. Ethmoid 2. Falx cerebri

1. Cribiform plate is on which bone? 2. What does it allow to pass?

1. Ethmoid 2. olfactory fibers (CN I)

*Bones of the Nasal Cavity:* 1. What bone is very complex and forms majority of the roof of the nasal cavity and contributes to lateral walls and septum?

1. Ethmoid bone!

*Gag Reflex* 1. Sensory via what nerve? 2. Motor via what nerve? 3. What are the motor responses?

1. Sensory: CN IX 2. Motor: CN X 3. Elevate Palate & Contract Pharyngeal constrictors (to expel noxious substance)

*Long thoracic n. (C5, C6, C7 twigs)* 1. Descend into axilla on the lateral surface of what muscle? 2. Innervates what muscle?

1. Serratus anterior 2. Serratus anterior

*CN VII (Facial Nerve)* 1. From what foramen does it emerge? 2. Wait, when does it branch again?

1. Stylomastoid foramen 2. After getting to the face

1. b/w pia and arachnoid is what layer? what happens here? *2. In some areas subarachnoid space is enlarged and there are no trabeculae what are these called?*

1. Subarachnoid layer =CSF flow 2. Cisterns - larger more visible

*Structure of the Eye:* 6. The inner sphere forms what? 7. #5 also forms the Posterior Epithelium of the what?

6. *Neural retina* 7. Posterior Epithelium of the Iris

What does sensory and motor for muscles of the face?

CN V= Sensory CN VII= Motor (facial migrates into trigeminals territory which is why you see both in that area)

What other nerves will have fibers that are carried in the ventral trigeminal tract (NOT trigeminal n.)?

CN VII (facial n.) ---> ear (small portion) CN IX (glossopharyngeal n.) ---> external auditory meatus, back of ear CN X (vagus n.) ---> External ear

What type of lesion would you have if.... Fluency is: Intact Repetition is: absent Comprehension is:Intact

Conduction (this would be an example of white matter interruption between areas like Wernicke's and Brocas

1. A corticobulbar tract lesion in the cortex going to the Bhronchiometic mm. ABOVE the eyes will have what presentation?

Cortical lesion will cause: -BILATERAL deficiency (minor)

1. Where does the nasal cavity end? 2. Again, what's the name of the oval space b/w nasal cavity & nasopharynx? 3. What's the name of the border b/w hard & soft palate (which also connects soft palate to tongue)? 4. What's the name of the structure that connects the soft palate to the nasopharynx? 5. What sit's b/w these two structures (Q3 & Q4)? 6. Again, what is the anterior border of the oropharynx?

1. Cavity ends where the nasal septum ends 2. choana(e) 3. *Palatoglossal arch* 4. *Palatopharyngeal arch* 5. Palatine *tonsil* 6. Palatoglossal arch (so, tonsils & palatopharyngeal arch are in oropharynx)

*Spinothalamic Pathway REVIEW* 1. Where are the cell bodies? 2. Where do they enter spinal cord? 3. Do they ascend? 4. Where do they synapse?

1. Cell bodies in DRG 2. Enter spinal cord via Lissauer's (posterolateral) tract 3. Ascend ~1-3 levels 4. Synapse with dorsal horn neurons(Substantia gelatinosa) (2nd order)

*REVIEW* Alright, here is another big card. Lets quickly review the route of the Spinothalamic tract.

1. Cell body is in the DRG, goes in through the dorsal horn. 2. Can travel up 1-3 segments through Lissauer's Fasciculus, will then synapse

*Optic nerve:* 1. What artery and what vein gain access to the retina in the optic disc? 2. What is their relation to the optic nerve there? why?

1. Central Retinal artery and vein 2. the central retinal artery and vein travel within the optic nerve, it is the only available passageway

1. The cerebrum grows in what type of fashion? (hint: its in the alphabet) 2. What structures expand rostrally as the brain grows? What expands caudally? 3. What fissure forms the deep lateral groove?

1. Cerebrum grows in a "C" shape 2. Frontal & temporal lobes expand rostrally, Occipital lobe caudally 3. Sylvian fissure forms deep lateral groove

1. What do you call a modified capiliary tuft located in ventricles of the brain? 2. What does #1 do? 3. CSF is circulated to the fourth ventricle where it opens up and communicates with what space?

1. Choroid plexus 2. Make CSF 3. Subarachnoid space

Cavernous sinus 1. Extends from what anteriorly 2. To what posteriorly?

1. Extends from the *superior orbital fissure* anteriorly 2. to the *petrous portion of the temporal bone* posteriorly

*Bones of the Nasal Cavity:* 1. What is the most superior bone in the Nasal Cavity? 2. The Frontal, Sphenoid, Ethmoid and Maxillary bones house WHAT that are continuous with the nasal cavity and intimately related to the nasal cavity?

1. Frontal Bone 2. *Paranasal Sinuses*

1. What muscle(s) do you need to contract to close the eye? 2. What muscle(s) do you need to contract to open the eye? 3. Why do your eye lids droop when you're tired?

1. Orbicularis Oculi 2. *Upper lid*- i: Levator Palpebre Superioris (SKM) ii: Superior Tarsal (SMC -Symp) *Lower lid* - Inferior Tarsal (SMC -Symp) 3. You've lost sympathetic tone in your tarsal msucles

*Eyelid:* 1. They Eyelid is a component of what muscle? 2. What are the 2 portions of #1? 3. Which portion of #2 makes up the eyelid?

1. Orbicularis Oculi 2. Orbital portion and Palpebral portion 3. Palpebral portion

*Platysma* 1. Origin? 2. Insertion? 3. Our lives are in your hands...

1. O: Fascia covering Pec Major & Deltoid 2. I: Mandible & Skin of lower face 3. And you've got butterfingers

*Paleospinothalamic tract:* 1. Is it phylogenetically older or younger then the neospinothalamic tract? 2. 1st synapse happens where? 3. Does it ascend on one side or bilaterally? 4. what does it ascend through?

1. OLDER 2. 1st synapse in Lamina I - VI 3. Ascend bilaterally 4. in the ALS

*REVIEW* 1. What Lobe is vision coming from? 2. What is the cortical area for sight? 3. Gyrus? 4. Broadmann's area? 5. What afferent area is helping? 6. Efferent? 7. What Broadmann's area is the efferent in?

1. Occipital 2. Primary visual cortex (V1) 3. Cuneus/Lingual gyrus 4. 17 5. LGN Thalamus 6. V2 7. 18

1. The Larynx, Trachea, and Lungs are derived from? 2. At the level of what structure does Q2 form?

1. Out-pocketing of Endodermal gut tube. 2. Level of Pharynx

*Retina:* 1. What is the name of the synapses layer b/w the inner and outer nuclear layers? 2. What is the name of the synapses layer b/w the Retinal Ganglion cells (RGC's) and the inner nuclear layer? 3. What is the layer on top of the retinal ganglion cells (RGC's)?

1. Outer Plexiform Layer (Synapses) 2. Inner Plexiform layer (synapses) 3. Nerve Fiber Layer

*Arch 2:* nerve 1. What nerve does it become?

Nerve: 1. Facial nerve (CN VII)

*Arch 1* Nerve 1. What nerve? 2. Which branch of that nerve? 3. which is what number?

Nerve: 1. trigeminal n. 2. Mandibular branch of trigeminal n. (CN V3) 3. 3 woowwah it matched up with the question number cool

*Arch 6* Nerve 1. Has what nerve and specifically what branch of this nerve?

Nerve: 1.Recurrent laryngeal branch of vagus (CN X)

Just a little exercise to finish things off...

Please identify the following structures: 1. Carotid bifurcation 2. Internal jugular v. 3. CN X 4. CN XII 5. Ansa cervicalis 6. Sympathetic trunk (deep)

Case Study: An 18 y/o male presents to the urgent care clinic with a severe sore throat of two days duration. The patient has a fever of 102.4 F and complains of difficulty swallowing. Past medical history is negative for any medical conditions. The patient is on no meds and has no allergies. Physical exam: The patient appears to be in some mild distress. Upon oral exam, tonsils are enlarged and exudative. The pharynx is red with some mild swelling.

Tests: Rapid strep test is positive. Treatment: The patient was started on antibiotics, given general care instructions and discharged that day. The patient fell asleep on the couch that evening. The next morning, his mother tried to wake the him, but the patient had died during the night.

1. What is a common nerve block performed in dental procedures? 2. What nerve specifically is blocked?

Trigeminal n. Block Inferior alveolar nerve

What passes through condyloid canal? Bone?

condyloid emissary v. Occipital

*Functional Cornea:* 1. Which membrane of the Cornea is a tough and unusually thick Basement Membrane that supports the Endothelium? 2. Is #1 capable of regeneration when damaged?

1. Descemet's Membrane 2. YES capable of regeneration when damaged unlike bowman's layer

*Spinoreticular and spinomesencephalic tracts:* 1. After second synapse does it Ascend or Descend? 2. in what tract? 3. Where is the 3rd synapse? 4. is it ipsilateral or contrilateral from 2nd synapse and is it bilaterally or laterally?

1. Descend 2. DLF (dorsolateral funiculus) 3. Ipsilateral dorsal horn 4. ipsilateral, one side laterally not bilaterally

Direct or indirect? 1. In parkinson's you are taking out wich pathway? 2. Huntington's?

1. Direct 2. Indirect

*Vestibulospinal tracts* 11. *Lateral* vestibulospinal: UMN projects where? Travels where? 12. *Medial* vestibulospinal: UMN projects where? Travels where?

11. Projects *ipsilaterally* the *full length* of spinal cord 12. Projects to *medial longitudinal fasiculus (MLF)* on both sides & travels *bilaterally* in cervical spinal cord

Describe the path of the parasympathetic fibers form the Glossopharyngeal n. (IX). Where is the first and where is the 2nd neuron?

1st neuron ---> INFERIOR SALIVARY NUCLEUS 2nd neuron ---> OTIC GANGLION

1. Accessory nucleus 2. Rexed lamina IX 3. Spinal Accessory Nerve

*Special Nuclei* 1. What's in Red? 2. What Rexed lamina? 3. Nerve this is associated with?

1. Phrenic Nucleus 2. Rexed lamina IX 3. Phrenic Nerve

*Special Nuclei* 1. What's marked? 2. What Rexed lamina? 3. Nerve this is associated with?

You will be quizzed now...

(scroll dammit) A: External (dorsal) Nasal (V1) B: Supratrochlear (V1) C: Supraorbital (V1) D: Lacrimal (V1) E: Infratrochlear (V1) F: Zygomaticofacial (V2) G: Infraorbital (V2) H: Buccal (V3) I: Mental (V3) BONUS: What 2 nerves are missing? (scroll) Zygomaticotemporal (V2) & Auriculotemporal (V3)

*Branches of the Superior Thyroid a.* 1. What membrane does the superior laryngeal a. pierce? What comes with it (think nerve)? 2. What is the course of the anterior branch and what does it anastomose with? 3. What is the course of the posterior branch and what does it anastomose with?

(1) Superior laryngeal a. - pierces the thyrohyoid membrane with the internal laryngeal n. (vagus) to provide branches to the interior of the larynx (2) Anterior branch - branches to the anterior portion of the thyroid gland; anastomoses with opposite counterpart (3) Posterior branch - branches to the posterior portion of gland; anastomoses with branches of the inferior thyroid artery

That wasn't good enough. AGAIN!

(Let's go scrolling!) A: Supratrochlear (V1) B: Supraorbital (V1) C: Lacrimal (V1) D: Infratrochlear (V1) E: External (dorsal) Nasal (V1) F: Zygomaticotemporal (V2) G: Zygomaticofacial (V2) H: Infraorbital (V2) I: Auriculotemporal (V3) J: Buccal (V3) K: Mental (V3) L: Cervical Nerves (Supplement on Mandible)

*Neural Proliferation and Migration* 1. Where is the layered cortex at (i.e in what layer)? 2. As neurogenesis is taking place, is the cortical plate the only level that grows, or do all the zones grow as well? 3. Where does asymmetric mitotic division take place? Where do they migrate to? 4. After layer in #3 is established, where do later neurons go? 5. What do new neurons being made do to the neurons that migrate from #4?

(SORRY! THIS ONE WAS KINDA CONFUSING!) 1. In the cortical plate zone 2. All of the zones grow, no just the cortical plate. 3. Takes place in the ventricular zone and these cells migrate to the preplate (known later as the marginal zone). (this layer will stay superficial) 4. Later neurons settle below the preplate, then displaced to subplate. 5. New cortical plate neurons migrate up through the subplate and push down the older neurons (inside-out development).

Had enough yet?

(Scroll in One!!) A: V1 B: V2 C: V3 D: C2 E: C2/C3 F: C3 G: Greater Auricular N. H: C2/C3 I: C3/C4

Major arteries that perfuse the scalp (again tho)...

(Where did I put that remote conscroll?) A: Superficial Temporal A B: Occipital A C: Transverse Facial A D: Angular A E: Supratrochlear A F: Supraorbital A G: Superficial Temporal A H: Occipital A

Ah yes, but what about the scalp...

(You're my scrollmate) A: Supratrochlear (V1) B: Supraorbital (V1) C: Zygomaticotemporal (V2) D: Auriculotemporal (V3) E: Lesser Occipital (Cervical N) F: Greater Occipital (Cervical) G: 3rd Occipital (Cervical)

Last one, I promise

(You've got to pay the scroll toll) A: Supratrochlear (V1) B: Infratrochlear (V1) C: External Nasal (V1) D: Supraorbital (V1) Blue E: Lacrimal (V1) Green E: Infraorbital (V2) F: Zygomaticofacial (V2) G: Zygomaticotemporal (V2) H: Auriculotemporal (V3) I: Buccal (V3) J: Mental (V3) K: Lesser Occipital (Cervical N) L: Greater Occipital (Cervical) M: 3rd Occipital (Cervical) N: Greater Auricular N. O: C4 P: C5 Q: C3/C4 Supraclavicular R: C2/C3 Transverse Cervical

A fine time to test your knowledge...

(You've got to pay the troll scroll) A: CN VII (Facial) Main Trunk B: Posterior Auricular N C: Temporofacial Division D: Cervicofacial Division E: Temporal Branch F: Zygomatic Branch G: Buccal Branch H: Mandibular Branch I: Cervical Branch

**ID the CN's which possess Sensory ganglia and ID their receptive Fields**

**I am not sure if this is correct, so please feel free to add/change this card b/c I cannot for the life of me find a complete answer to this question. This is one of bucks objectives that he keeps telling us to know for the test** CN's: V, VII, IX, X Receptive Fields????

What forms the Pharyngeal plexus? What does this plexus innervate?

**Pharyngeal branches of Superior Cervical ganglia, CN IX and CN X. --The pharyngeal plexus innervates the mucosa & blood vessels of the pharynx & larynx.

What is so special about Special Afferent Fibers, and what 2 categories are they broken into?

**Special Afferent Fibers are found ONLY in Cranial Nerves** SSA (Special Somatic Afferents) - Eye and Ear (vision, hearing, equilibrium) SVA (Special Visceral Afferents) - Olfactory and Gustatory receptors - "visceral" b/c of fxnal assoc. of sensation w/ digestive tract

What is the innervation of the *Digastric m.* (2)?

*Anterior Belly* = Mylohyoid n. (CN V) *Posterior Belly* = digastric branch of facial n. (CN VII)

What's the name of the muscles that let me wiggle my ears?

*Auricularis* (Anterior, Superior, Posterior)

What is the innervation of the *Thyrohyoid m.*?

*C1 via Hypoglossal n.* (CN XII)

What is the only branch of the trigeminal nerve which will be involved in a Corticobulbospinal tract?

*CN V3* *this branch is the only one that carries motor fibers.

What is the anterior attachement of falx cerebri?

*Crista galli* of ethmoid bone

What is the action of the *Sternohyoid m.*?

*Depresses* hyoid & larynx

What is the action of the *Thyrohyoid m. (2)*?

*Depresses* hyoid & tongue when larynx is fixed from below. *Elevates* larynx when hyoid is fixed from above.

What is the action of the *Sternothyroid m.*?

*Depresses* larynx

What does trigeminocardiac reflex mimic?

*Diving reflex* diving reflex of mammals produces the same response when the face is submerged in cold water

What is the action of the *Stylohyoid m.*?

*Elevates & Retracts* hyoid & base of tongue

What is the action of the *Mylohyoid m. (2)*?

*Elevates hyoid & floor of mouth* When hyoid is fixed it *Depresses mandible*

What is the action of the Digastric m. (2)?

*Elevates* hyoid & base of tongue. -If hyoid is fixed via infrahyoid musculature this will *Assist in Opening Mouth*

What receptors are involved in the Ventral Trigeminothalamic tract?

*Free Nerve Endings* (TRP channels) in skin, visceral, mm. *this tract will carry pain and temperature

Easy one...

*Gag Reflex* A: CN IX (afferent limb) B: CN X (efferent limb)

Where does the Facial n. (CN VII) leave the skull?

*INTERNAL ACOUSTIC MEATUS* Then then *stylomastoid foramen* or *petrotympanic fissure*

What are the foramen (6) associated with the Posterior Cranial Fossa?

*Internal acoustic meatus *Jugular foramen *Mastoid foramen *Condyloid canal *Foramen magnum *Hypoglossal canal

What can be clinically used to assess the trigeminal n. (CN V)? Both its nucleus & corticobulbar pathway.

*JAW JERK REFLEX*

Through which foramen does the Vagus n. pass through the skull?

*JUGULAR FORAMEN*

1. What type of fibers are found w/in *Rexed lamina IX*?

*LMN pools* that receive *input from UMN's*

ID some things...

*Laryngopharynx* (what is special about C?) A: Laryngeal Aditus B: Posterior Larynx C: *Piriform Recess* (path food takes to traverse Laryngopharynx)

Projections from the substantia Nigra (pars compacta) to the caudate or putamen are called what? What is this pathway used for?

*NIGROSTRIATAL pathway* used by Dopamine (DA) to *turn the basal ganglia "ON"*

What portion of the Trigeminal nerve contributes to the frontonasal process?

*Ophthalmic* Remember Trigeminal is the OMM nerve Opthalmic branch (V1) Maxillary branch (V2) Mandibular branch (V3)

I sure hope I don't have this one...

*Oropharynx* A: Palatoglossal Arch B: Palatopharyngeal Arch C: Uvula D: Palatopharyngeal Arch E: Palatopharyngeus Muscle F: Palatine Tonsil G: Palatoglossus Muscle H: Palatoglossal Arch I: *Vallecula* (retains saliva - help keep stuff out of larynx) J: Epiglottis K: Lateral Glossoepiglottic Folds (connects tongue to epiglottis) L: Median Glossoepiglottic Folds M: in Oropharynx N: in Oral Cavity O: Root of the Tongue P: *Lymphoid Tissue* (Lingual Tonsil) Q: *Sulcus Terminalis*

6. Where will decussation occur in the MSN/ML & Dorsal Trigeminothalamic tracts?

*PONS* --- then *ascends WITH the medial lemniscus*

*Inferior Thyroid Artery* Branches of the inferior thyroid artery will go to what structures (5)?

*Pharynx* *Larynx* *Trachea* *Esophagus* *Posterior/Inferior bit'o Thyroid*

After the thalamus where does the Ventral Trigeminothalamic tract go?

*Primary somatosensory cortex* (via internal capsule & corona radiate)

What forms the Lentiform nucleus?

*Putamen (part of striatum) *Globus pallidus (both external & internal)

1. Onuf's nucleus 2. Rexed lamina IX

*Special Nuclei* 1. What's in Blue? 2. What Rexed lamina?

1. Clarke's Nucleus 2. Rexed lamina VII

*Special Nuclei* 1. What's in Green? 2. What Rexed lamina?

1. IML 2. Rexed lamina VII

*Special Nuclei* 1. What's in Red? 2. What Rexed lamina?

1. Nucleus Caudalis 2. Rexed lamina I

*Special Nuclei* 1. What's in Red? 2. What Rexed lamina?

Which nucleus in the brainstem will sense pain and temperature modalities?

*Spinal trigemina nucleus* which spans many levels (or spinal nucleus of V) This is a trigeminal nerve thing but stuff from Facial, vestibulochochlear, vagus... all the nerves tapping in to trigeminal system will be doing it at that brainstem level

other side the question is on

*Spinoreticular and spinomesencephalic tracts:* OVERVIEW SUMMARY STUFF YEAH

? on other side

*Spinoreticular and spinomesencephalic tracts:* 1. Ascends levels of cord via what tract? 2. synapses where? 1. Ascends levels of cord in lissauer's tract 2. Dorsal horn neurons

question and answer on flip side y'all

*Spinoreticular and spinomesencephalic tracts:* 1. What is the top arrow? 2. What is the upper left arrows? 3. What is the bottom left arrows? 4. What is the lower arrow? 5. What is the lower right arrows? 6. What section of the spinal cord is this? 7. How does the Spino-bulbo-spinal pathway use #1-5? (scroll down for the answers) 1. Lissauer's Fasciculus 2. Lamina I-II 3. Anterolateral spinothalamic tract 4. Ant. White Commissure 5. Anterolateral spinothalamic tract 6. Spinal cord (upper cervical) 7. They enter #1 and synapse on #2 then either ascend via #3 and/or cross over via #4 and ascend via #5

again check out my backside

*Spinoreticular and spinomesencephalic tracts:* 1. What part of the brainstem is this? 2. What are the arrows pointing to? (its one thing) 3. Is this for the spinoreticular or spinomesencephalic tracts and what is it used for? (scrooooolll down for answers) 1. Midbrain 2. Periaqueductal grey 3. spinomesencephalic tract have 2nd synapse on #1. then 3rd neuron descends spinal cord

question other side

*Spinoreticular and spinomesencephalic tracts:* 1. both ascend the spinal cord via what tract? 2. Spinoreticular's (left side of pic) second synapse is on where? 3. Spinomesencephalic's (right side of pic) second synapse is where? 4. Both are bilateral, and cross at what? 5. They both end by synapsing on what? 6. What tract does it descend through? 1. ALS 2. Reticular formation 3. Periaqedcucatal 4. Both bilateral, cross at ventral white commisure 5. Dorsal Horn 6. Dorsolateral Funiculus (DIIIILLLFFFF)

What is the action of the *Omohyoid m.*?

*Stabilizes, Retracts & Depresses* hyoid & larynx

What is the origin of the *Omohyoid m.*?

*Superior Belly*: Inferior margin of greater horn of hyoid. *Inferior Belly*: Superior margin of scapula near notch & suprascapular ligament

1. What condition is communicated through the ventral trigeminal pathway and is a severe stabbing pain in the face? 2. what region of the face is most commonly affected? 3. Ususally due to what?

*TRIGEMINAL NEURALGIA* "tic douloureux" 2. most common in the *maxillary division* Right side is more often affected 3. due to *vascular compression*

*Thyroid Gland* 15. What can form if ectopic glandular (thyroid) tissue remains, but does not form an additional lobe on the gland?

*Thyroglossal Duct· Cysts* (can be found anywhere along migratory path of glandular tissue during development)

Which branches of the thyrocervical trunk will branch laterally - describe path?

*Transverse cervical a. *Suprascapular a. --crosses the posterior triangle inferiorly, medial (deep) to the inferior belly of the omohyoid m.) --Suprascapular branches inferior to transverse cervical a.

Explain the indirect excitation model

*disinhibition* constant hyperpolarization prevents action potentials in an otherwise active circuit Removing inhibitory action allows system to go "riding the brakes"

*Wallenberg's Syndrome.* 1. Due to? 2. what happens to pain/temp of face? 3. What happens to pain/temp in body?

*lateral medullary SYndrome* 1. Due to a *Stroke of PICA* which leads to: 2. *Ipsilateral loss* of pain/temp in the FACE 3. *Contralateral loss of pain/temp in the BODY

What are the 5 boundaries of the *Anterior neck Δ*? - *Roof* ? - *Anterior*? - *Posterior*? - *Inferior*? - *Floor*?

- *Roof*: Investing cervical fascia - *Anterior*: Line from symphysis menti to Sternal notch - *Posterior*: Anterior border of SCM - *Inferior*: Inferior margin of Mandible - *Floor*: Structural components of visceral compartment of neck

What transmits through the Hiatus for Greater Petrosal n.?

--Greater Petrosal n. (from CN VII) --Petrosal branch of Middle Meningeal a.

What will transmit through the hiatus for Lesser Petrosal n.?

--Lesser Petrosal n. (from CN IX)

What are the general steps of a pathway found in the basal ganglia?

--Movement will by initiated by the Primary Motor Cortex in the precentral gyrus. *this will initiate actions in the different components of the basal ganglia which will then stimulate the THALAMUS to either excite or inhibit the primary motor pathway.

What are the foramen (7) found at the base of the skull? (with a basal view)

--Petrotympanic fissure --Stylomastoid foramen --Carotid canal --Mastoid canaliculus --Tympanic canaliculus --Foramen lucerum

What are the foramen found in the pterygopalatine fossa?

--Sphenomaxillary fissure --Sphenopalatine foramen --Pterygopalatine fossa --Pterygopalatine canal --Greater palatine canal --Lesser palatine canal --Pterygoid canal --Pharyngeal canal

What are the 4 main components of the basal ganglia?

--Striatum (caudate nucleus, nucleus accumbens & putamen) --Globus Pallidus (external and internal) --Subthalamic nucleus ( --Substantia nigra (pars compacta & reticulata) *These components have both MOTOR & NON-MOTOR functions which are integral to carrying out stereotyped & adaptive behaviors.

What passes through the supraorbital notch? What bone is this found in?

--Supraorbital a. v. n. will pass through this notch. *Found in the frontal bone (just superior to the orbit)

What veins typically drains into the external jugular vein (which then drains to subclavian v.)

--transverse cervical v. --dorsal scapular v. --suprascapular v.

*Eyelid:* 1. What 2 muscles help Elevate the eyelid? 2. Of the 2 muscles of #1 which one is skeletal muscle and which one is smooth muscle (sympathetic) 3. What will be on the external surface of the eyelid accompanying the skin? 4. What is the Tarsal Plate, where is it found, and what type of tissue is it?

1&2. -Levator Palpebrae Superioris (Skeletal) -Superior Tarsal Muscle (Mueller's) Smooth muscle sympathetic 3. hair follicles 4. The tarsal plate is a dense connective tissue that gives structure to the eyelid

*Common Carotid Artery* 1. Which side is longer than the other? Where does the right one originate? where does the left originate? 2. Where does the common carotid artery end and the internal and external carotid's begin? (hint: structures in that region) 3. Does it (common carotid) have any more branches after that? What can it sometimes give off?

1) *Left side* longer than right; right originates from brachiocephalic split, left from the arch of the aorta 2) Extends approximately to the *superior horn of thyroid cartilage* *opposite CV3* where it terminates as internal and external carotid arteries 3) *Usually has no branches* although sometimes the *superior thyroid artery*, during development, will "slide" down onto the common carotid (16%)

*Branches of the Vagus N* 1. What does the menigneal branch of the vagus innervate? 2. What does the auricular branch of the vagus innervate? 3. What does the pharyngeal branch of the vagus innervate? 4. What does the nerve to the carotid body branch of the vagus innervate?

1) *Meningeal* - to dura of posterior cranial fossa (GSA) 2) *Auricular* - to posterior surface of pinna, auditory canal and external surface of tympanic membrane (GSA) 3) *Pharyngeal* - component of the pharyngeal plexus; provides branches to majority of the muscles of the pharynx and soft palate (SVE) 4) Nerve to the carotid body - from pharyngeal branch; afferent limb from 02 chemoreceptors in carotid bifurcation (GVA)

What at the fibers (4) which branch from the Inferior Cervical Ganglion?

1) Gray Rami to spinal nn. (C7 - T1) & post-ganglionic fibers to the vertebral plexus 2) Inferior cardiac n. to cardiac plexus 3) Vasomotor fiber to the subclavian & inferior thyroid aa. via the thyrocervical trunk 4) Fiber which join the recurrent laryngeal nerve.

What fibers (3) will leave the Middle Cervical Ganglion?

1) Gray rami to spinal nerves C5 - C6 2) Middle cervical cardiac n. 3) Ansa Subclavia

*Superior Deep Cervical Lymph Nodes* 1. Where are they located? 2. What composes this set of lymph node (4 different sets)? 3. From what does it receive efferent lymph from (hint: there are superficial and deep structures)? 4. Where do the lymph nodes from the superior deep nodes drain to?

1) Located in the carotid triangle superior to the superior belly of the omohyoid 2) Composed of retropharyngeal, deep parotid, *jugulodigastric* and jugulo- omohyoid nodes 3) Receive efferent lymph channels from superficial lymph nodes of the face and neck, as well as drainage from deeper areas of the head via direct efferents to the nodes listed in #2 above 4) Lymph from superior deep nodes drains to inferior deep nodes

*Inferior Deep Cervical Lymph Nodes* 1. Where are they located? 2. What nodes are they composed of? 3. Where do they receive lymph from?

1)Located inferior to the superior belly of the omohyoid muscle 2) Composed of only a few nodes located in a supraclavicular position; may extend into the omoclavicular triangle 3) Receive lymph from: a. Superficial cervical lymph nodes b. Superior deep cervical nodes c. occipital lymph nodes d. accessory chain of the posterior triangle. e. transverse cervical nodes of the posterior triangle f. juxtavisceral nodes of the anterior triangle (nodes parallel to the larynx and trachea: infrahyoid, pre-layrngeal, pre-tracheal, paratracheal).

*Branches of the Vagus N* 1. What are the 2 branches of the cervical cardiac branches of the vagus n.? 2. Where do they each arise from?

1-2. a) *Superior Cardiac Nerves* - arise near the origin of the superior laryngeal nerve and descend medial to the carotid sheath b) *Inferior Cardiac Nerves* - arise from the vagus in the root of the neck near the first rib

questiona on the flippity flop

1-3 identify scroll down for the answers 1. Vestibular folds 2. Laryngeal ventricle/ vestibule space 3. Vocal Folds

1. #2 pretracheal space 2. #3 retrovisceral retroesophageal space 3. retropharyngeal space #4

1-3. name the space and what number space it is. note there is not space #1 in this pic

1. What system in the brain helps move cellular waste into venous drainage system of deep brain parenchyma 2. is #1 more active in an asleep or awake brain? 3. How many times more active is #1 when you are asleep?

1. "Glymphatic System" Helps move cellular waste into venous drainage system of deep brain parenchyma 2. Asleep- deep cleans the brain while you are alseep 3. The brain doesn't stop consuming energy when asleep. The glymphatic system is 10X more active asleep than when we're awake note: Very high metabolic rate, but no lymphatics

*Congenital Anomalies: Neural Crest Disorders* 1. What are these also called? 2. What are the main 4 disorders?

1. (neurocristopathy) 2. treacher collins, robin sequence, DiGeorge anomaly, and Goldenhar syndrome

*Cervical Fascias:* 1. Which deep fascias of the neck blend laterally with the *carotid sheath*? 2. Because of this care must be exercised during dissection b/c these interwoven fascias are tough yet structures embedded within these i.e. ansa cervicalis, are very WHAT and can be easily WHAT?

1. *ALLL* deep fascias of the neck! 2. Very delicate and can be easily excised

Review: 1. What nerve innervates almost all of the infrahyoid mm.? 2. What is the exception to this?

1. *Ansa cervicalis* (C1-C3) of cervical plexus. 2. Thyrohyoid m. is innervated by *C1 via Hypoglossal nerve (CN XII)*

Which branches (2) of the vertebral artery will contribute to the blood supply of the spinal cord?

1. *Anterior spinal artery (ASA)* 2. *Posterior spinal arteries (PSAs)* - R & L

*Is all pain the same?:* 1. Visceral pain info is ONLY carried by what fibers? 2. Does visceral pain "feel like" the damage/disruption responsible for the pain 3. Males or Females will report more pain for the same stimulus? 4. Psychological intervention improves "well-being," Is this by improving painful symptoms every time?

1. *C-Fibers* 2. NO it does NOT! visceral is not localized and usually has referred pain 3. Female predominance - they have a higher threshold and report pain differently then males 4. Psychological intervention improves "well-being," *not necessarily* painful symptoms. I.E. serotonin helping depression and causing more inhibition on pain

*Cervical Fascial Spaces:* space 3: 1. it extends from the base of the skull above to a point approximately opposite of what vertebra range? 2. that range is where WHAT fascia blends with the esophagus in the neck or as far inferior as the superior mediastinum

1. *CV7-TV3* 2. *Alar fascia*

*Corticospinal tract*: Cerebrum 1. UMN cell bodies where again? 2. Axons descend as what brain structure? 3. Q2 become part of? 4. Q3 becomes what in midbrain?

1. *Cerebral motor cortex* 2. *Corona radiata* 3. *Internal capsule* 4. *Cerebral peduncles*

Tell me... 1. What is the name for the opening from nasopharynx to the nasal cavity? 2. What is the name for the opening from oropharynx to the oral cavity? 3. What is the name for the opening from Laryngopharynx to the Larynx?

1. *Choana(e)*:(nasopharynx to nasal cavity) 2. *Fauces*: (oropharynx to oral cavity) 3. *Aditus*: (Laryngopharynx to Larynx)

*Important* 1. What connects the *dense CT* of hypodermis to the *Galea*? 2. What does this accomplish? 3. But, what about the area under the scalp? 4. What does this accomplish?

1. *Connective Tissue Bridges* 2. Allows entire scalp (epi/dermis/hypo/gaela) to move together 3. Galea is barely attached to the underlying loose CT (Sub-apo tissue) 4. Scalp slides over the skull

Ventral Trigeminothalamic tract 1. Does it ascend or descend before it's first synapse? 2. First synapse is where? 3. After it decussates does it ascend or descend?

1. *Descends* 2. *spinal nucleus* 3. Ascends

1. An area of *white* matter in the spinal cord is called? 2. 3 types of Q1 in the spinal cord? 3. What is a tract?

1. *Funiculus* 2. Posterior (dorsal) *&* Lateral *&* Anterior (ventral) 3. Functionally-related axons traveling a specific path (Multiple tracts found in each funiculus in white matter)

1. What areas (2) are found within *Rexed lamina VII* & What's found within these layers (group)? 2. Spinal levels of each group?

1. *IML/Lateral horn*: Cell bodies of preganglionic autonomic cell bodies *Nucleus Dorsalis of Clarke*: Terminals of proprioceptive afferents on 2nd order cell bodies 2. *IML/Lateral horn* (T1-L2, S2-S4) *Nucleus Dorsalis of Clarke* (C8-L3)

*Forming the Neural Tube* 1. What cells proliferate faster than the rest of the surface ectoderm and what structure is formed? 2. Where does the structure from #1 form? What direction do the lateral edges fold? What are they called? 3. What then meets on the dorsal midline? Ectoderm then covers the dorsal surface over what structure? 4. When the neural folds bind dorsally, when migrates away after the binding? Where were they located prior to the binding?

1. *Neural plate* cells proliferate faster than the rest of the embryo, this goes on to form the neural groove. 2. *Neural groove* forms on the midline; lateral edges fold dorsally (neural folds) 3. Neural folds meet on dorsal midline. Ectoderm covers the dorsal surface over the *neural tube* 4. Meanwhile, neural crest migrate away from neural folds. They were found at the crest of the neural folds.

What are the basic eras of CNS development in humans? (5)

1. *Neurulation*: Neural tube formation 2. *Neuronal Proliferation*: Mitotic division and fate determination 3. *Neural Migration*: Axonal growth cones navigate to target synapses 4. *Synaptogenesis and apoptosis*: Synaptic machinery is formed at synapses, unused synapses die off 5. *Myelination*: Mature neurons are myelinated by oligodendrocytes

1. What area is formed by *Rexed laminae III & IV*? 2. What's found within this layer (group)?

1. *Nucleus Proprius* 2. *Interneurons* that receive input from *non-nociceptive fibers* (eg. position of body)

What are the arteries (4) which are found in the posterior Δ of the neck?

1. *Occipital a.* 2. *Transverse cervical a.* 3. *Suprascapular a.* 4. *Subclavian a. (3rd bit)*

1. What are the ovoid bodies which can be found on the dorsal surface [*w/in capsule*] of thyroid gland? 2. On which portion of the thyroid gland 3. What is their purpose?

1. *Parathyroid Glands* (2-6 of em) 2. Found both Superior (at level of cricoid cartilage) & Inferior (at inferior pole of thyroid gland) 3. Secrete parathormone (PTH) when there's decreased serum Ca2+ levels. (increase Ca2+ uptake & mobilization of stored calcium)

*Lymphatics* 1. Nasopharynx drain posteriorly to what nodes? 2. What node would be enlarged if you had *tonsillitis*? 3. These nodes drain to what type of nodes? 4. Lymph joins which tube? 5. Lymph ultimately joins circulation via?

1. *Retropharyngeal* Nodes (bidirectionally - bad for cancer spreading) 2. *Jugulodigastric* Node 3. *Deep Cervical* Nodes 4. *Jugular Lymphatic Trunk* 5. *Right Lymphatic Duct* or *Thoracic Duct*

*Radiculopathy* 1. What is damaged? 2. Example of a cause? 3. Symptoms?

1. *Spinal* nerve is damaged 2. intervertebral disc disease 3. Numbness, tingling, weakening (*beginning near spine & radiating distally along spinal nerve*)

*Spino-bulbo-spinal pathways:* 1. What are the 2 tracts in the Spino-Bulbo-Signal pathways? 2. What type of information is in these pathways? 3. What receptors are involved? 4. What is the point of origin?

1. *Spinoreticular and spinomesencephalic tracts* 2. Pain 3. Free nerve endings (TRP channels) 4. in Skin, viscera, muscles

*Pain Modulatory Pathways:* 1. What 2 tracts are acting upon the anterolateral system and Spino-Bulbo-Spinal pathways?

1. *Spinoreticular tract* *Spinomesencephalic tracts*

Lymphatics of posterior Δ - *Accessory nodes* 1. Receive lymph from which nodes (generally)? (located {superficial or deep} to investing fascia) 2. Receive lymph from which nodes (2 specifically)?

1. *Superficial lymph nodes of head* (*superficial* to investing fascia) 2. i. *Occipital nodes* (drain occipital area) ii. *Retroauricular nodes* (drain posterior parietal area)

*Thyroid Gland* - Innervation 1. What portion of the ANS will innervate the thyroid gland?

1. *Sympathetic* innervation

1. What structure separates cerebellum from posterior portion of cerebral hemispheres? 2. #1 forms a tent over what fossa?

1. *Tentorium cerebelli* 2. *posterior cranial fossa*

1. If i stab your tounge with a knife in the anterior 2/3rds... what nerve will carry the sense of pain? 2. If I put lemon juice on your anterior 2/3 of tongue what nerve carries that sensation?

1. *Trigeminal nerve* 2. Facial N.

Innervations 1. What provides pain fibers to the *floor of the cranial vault* and to areas of the *dural sinuses*?

1. *Trigeminal nerve* (anterior and middle fossae and supratentorial dura)

*Cervical Fascias: pre-vertebral fascia* specializations: 1. The prevertebral layer of fascia is continued onto the [topside or underside?] of what muscles? 2. with the thickened cupolar endothoracic fascial layer, it reinforces the dome of what pleura? 3. this forms what membrane? 4. what is another name for this membrane? (________ fascia)

1. *Underside* of the scalene muscles 2. Reinforces the dome of cervical pleura 3. thereby forming the *suprapleural membrane* 4. Sibson's fascia

*Localization* related to neural control of *movement* 1. LMN cell bodies located where (2)? 2. What 2 types of LMNs innervate skeletal muscle? 3. UMN cell bodies located where (6 specific neural PWs)?

1. *Ventral* horn of spinal cord (RL IX) *&* Brainstem motor nuclei 2. Alpha (α) & Gamma (γ) motor neurons 3. i: Cortex (Corticospinal & Corticobulbar) ii: Vestibular nuclei (Vestibulospinal) - balance iii: Superior colliculus (Tectospinal) - vision + head iv: Red nucleus (Rubrospinal) v: Reticular formation (Reticulospinal)

1. Anterior meningeal aa branch off of what arteries? (2) 2. What does the anterior meningeal aa pass through? 3. What does it supply?

1. *anterior & posterior ethmoidal aa.* - from ophthalmic a. via internal carotid 2. Pass through the cribriform plate 3. supply the floor of *anterior cranial fossa*

1. The larynx is in the [anterior or posterior?] portion of the neck. 2. It is b/w what cervical vertebrae?

1. *anterior* 2. C3-C6

*Anterior Jugular Veins (L&R):* NOTE: 1. The union of the retromandibular and facial veins also forms a _____________ vein which follows the anterior border of what muscle to communicate with the anterior jugular system 2. A portion of the superficial cervical lymph nodes lie along the path of what vein?

1. *communicating vein* which follows the anterior border of the SCM to communicate with the anterior jugular system 2. External jugular vein

*Cervical Fascias: Infrahyoid fascia* 1. the deep and superficial fascial layers of the infrahyoid fascia eventually fuse [anteriorly, posteriorly, inferiorly, superiorly?] with the adventitia of what 2 things? 2. It fuses with #1 via what ligament? 3. They also fuse *laterally* with what?

1. *inferiorly* with the adventitia of the *brachicephalic veins, fibrous pericardium* 2. via the *superior sternopericardial ligament* 3. *laterally* with the *carotid sheath*

*Cutaneous nerves: Ventral Rami* Transverse cervical n. (C2, 3) 1. Crosses the [medial or lateral?] surface of the SCM [superior or inferior?] to the great auricular nerve and [superficial or deep?] to the external jugular vein? 2. within what triangle does it travel deep to platysma where it does what? 3. these branches pierce what muscle to innervate the skin and subcutaneous tissue of the anterior triangle from the mandible down to the what? 4. Often, the transverse cervical nerve and the cervical branch of the facial nerve unite to form what? and what is its function?

1. *medial*, *inferior*, *deep*, 2. *anterior triangle* divides into two branches (superior and inferior). 3. Platysma. Down to the sternum 4. *Ansa cervicalis superficialis* (function unknown)

*Cutaneous nerves: Ventral Rami* Great auricular n. (C2, 3) 1. Ascends the [medial or lateral?] surface of the [upper or lower?] half of the SCM toward the angle of the mandible paralleling what vein? 2. enroute it provides branches to the skin cover what process? 3. it also provides branches to the [upper or lower?] portion of both surfaces of the ear and the [superior or inferior?] portion of the angle of the mandible and WHAT region?

1. *medial*, *upper* paralleling the external jugular vein 2. Mastoid process 3. *lower*, *inferior*, parotid region

1. Where do you find the periosteal layer of dura? 2. What is the meningeal layer of dura? 3. What does the meningeal layer form? 4. What is created between the periosteal and meningeal layers?

1. *periosteum of cranial vault* adherent to meningeal dura 2. *duplications of dura* which are prolonged *between major portions of the brain* 3. *Dural reflections* 4. Dural venous sinuses

1. What bone does the tentorium cerebelli attach to anteriorly? 2. And which processes of those bones specifically?

1. *sphenoid bone* 2. *anterior & posterior clinoid* processes of the sphenoid bone

1. How are neurons arranged in the Ventral horn? 2. Organization in ventral horn based on what 3 aspects of muscle target?

1. *topographically* 2. i: Primary *action* of muscle → ie: Flexors (dorsal) vs Extensors (ventral) ii: Relative *location* w/in body → ie: Proximal (medial) vs Distal (lateral) iii: *α-MNs & γ-MNs* scattered in diff LMN pools

The tentorium cerebelli houses two sinuses... 1. What sinus is formed by grooves in the occipital bone where it attaches? 2. Which sinus is created where it attaches to the petrous ridge?

1. *transverse sinus* 2. *superior petrosal sinus*

*α-MNs & γ-MNs* are scattered in different LMN pools... 1. γ-motor neurons are found in which part of the ventral horn? 2. α-motor neurons (somatic) are found in which part of the ventral horn?

1. *γ*-MNs: lateral portion 2. *α*-MNs: Medial

How many nuclei are found in the brainstem associated with the trigeminal ganglion and name them? Include where in the brainstem the nuclei are located.

1. --Mesencephalic nucleus (midbrain) 2. --Main sensory nucleus (Pons) 3. --Spinal nucleus of V (medulla)

*Ciliary body:* 1. What are the 2 major functions of the Ciliary Body? 2. Where do the zonule fibers insert into the lens?

1. -Function 1: Controls shpae of the lens via Ciliary Muscle and Zonule Fibers -Function 2: Produces Aqueous Humor that fills the anterior and posterior chambers of the anterior segment 2. insert into the equator of the lens capsule

*Glaucoma:* 1. What is the difference b/w an Open angle and Closed Angle Glaucoma 2. Which one has a slow onset of optic nerve damage and which one has a rapid onset and acute loss of vision?

1. -Open angle: Fluid has unimpeded access to the angle but reabsorption is reduced - Closed angle: Fluid can't get to the angle often blocked by lens at pupil which anteriorly displaces iris at the angle 2. Open angle = Slow onset Closed angle= rapid onset

*Glaucoma:* 1. What are the 2 options for treatment?

1. -Pharmacologically - mechanically: insert a stent in the anterior chamber and reinforce connection to the canal of schlemm, currently only an option if having cataract removed otherwise pharmaceuticals are the standard treatment.

*Iris:* 1. The iris is made up of 2 opposing muscle groups that regulate pupil diameter. What are the names of the 2 muscles? 2. Which muscle in #1 pulls on the other muscle in #1 3. Which muscle receives parasympathetic innervation? 4. Which muscle receives sympathetic innervation?

1. -Sphincter pupillae on the inside -Dilator Pupillae around the outside 2. Dilator Pupillae pulls on the sphincter muscle 3. Sphincter receives parasympathetic innervation 4. Dilator receives Sympathetic innervation

*Tongue Development:* 1. the anterior 2/3 of the tongue comes from what arch? 2. posterior 1/3 is from what arch? 3. what foremen in the tongue should not persist in adulthood?

1. 1st arch 2. 3rd arch (remember 2nd arch goes to form the thyroid) 3. Foramen cecum, still called foramen cecum in adults but it shouldn't be an opening just an impression she didn't talk about the other boxed items so idk I bet they are not tested on

*Congenital Anomalies: Neural Crest Disorders* 1. Robin sequence is caused from which arch? 2. What are the 3 symptoms/structural defects?

1. 1st arch structures 2. -Micrognathia -Cleft palate -Glossoptosis note: -1/8500-1/10000

WHat is the two different paths for the SOMATIC Sensory fibers within the trigeminal n.?

1. 1st neuron --TRIGEMINAL GANGLION 2nd neuron --Principal (Main) Sensory nuscleus 2. 'same 1st neuron' 2nd neuron -- Spinal trigeminal nucleus

Describe the two paths of the parasympathetic fibers from the Facial n. (CNVII).

1. 1st neuron is from *SUPERIOR SALIVARY NUCLEUS*. 2nd neuron is from *PTERYGOPALATINE GANGLION* 2. "same 1st neuron" 2nd neuron is from *OTIC GANGLION*

*Spinoreticular and spinomesencephalic tracts:* 1. 1st synapse where? 2. Does it first ascend or descend; laterally or bilaterally? 3. #2 through what tract?

1. 1st synapse in Lamina I & II 2. Ascend bilaterally 3. in ALS

*Retina:* 1. The early retina has how many discrete layers? 2. the outer layer (furthest from the pupil) becomes what? Is it a neural layer?

1. 2 1. Retinal Pigmented Epithelium (RPE) *NOT* a neural layer

*Eye Development:* 1. How many layers is the retina initially?? 2. What does the lens come from?

1. 2 layers it becomes more complex later on 2. comes from the overlying ectoderm and becomes separate from that

1. What is the general purpose of the Corticobulbar tract? 2. What CNs are involved in these tracts?

1. 2-neuron white matter MOTOR pathway which connects the primary motor cortex to the MEDULLARY PYRAMIDS. 2. CN V, VII, IX, X & XII

1. What gestation age do the arches show up? 2. what do they form?

1. 28-32days 2. a lot of different things we are going to talk about. #2 is so dumb I'm sorry

*Cervical Fascias: Infrahyoid fascia* 1. what # layer of deep fascia is this? 2. where does it begin? 3. how many definite layers does this form and what are their names? 4. What muscles does those layers invest?

1. 2nd layer 2. beginning at the hyoid bone and thyroid cartilage 3. 2 definite layers - superficial and deep layers 4. infrahyoid muscles

*Retina:* 1. The inner layer differentiates into how many distinct neural sub-layers? 2. What happens to the space b/w the layers? 3. All ___ layers of the retina become intimately associated

1. 3 2. it is OBLITERATED! 3. 4 (3 from inner neural layers, 1 from outer non-neural layer) Adult retina has a layer of pigment epithelium (nuclei hard to discern) and 3 discrete layers of nuclei (neural cells)

*Eye Formation: Sclera and Choroid* 6th step. 1. How many layers is the adult eye comprised of? 2. What is each layer called?

1. 3 2. outer - sclera middle - uvea innermost - Neural retina

*Structure of the Eye:* 1. The eye is composed of how many spheres lying one inside of the other? 2. The tough outer layer is complete and comprised of what 2 things?

1. 3 (these are the layers) 2. *Sclera* and *Cornea*

1. How many *cortical* PWs? 2. *cortical* {pyramidal or extrapyramidal}? 3. Which *cortical* PWs? 4. How many *brainstem* PWs? 5. *brainstem* {pyramidal or extrapyramidal}? 6. Which *brainstem* PWs?

1. 3 cortical PWs 2. Pyramidal 3. Lateral & Ventral corticospinal, Corticobulbar 4. 4 brainstem PWs 5. Extrapyramidal 6. i: Vestibular (vestibulospinal) ii: Red nucleus (rubrospinal) iii: Superior colliculus (tectospinal) iv: Reticular formation (reticulospinal)

*Olfactory Epithelium:* Cells in different layers perform different functions. 1. How many layers are there? 2. What do the cells in layer 1 do and what is their name? 3. What do the cells in layer 2 do and what do we call them? 4. What do the cells in layer 3 do and what do we call them? 5. Is the epithelium considered layered?

1. 3 layers 2. support cells called *sustentacular cells* 3. *Olfactory Neurons* help us smell 4. *Basal Cells* these are the stem cells 5. keep in mind that although the nuclei are found in layers, the epithelium itself is not considered layered. every cell contacts the BM, so only one layer of cells is present that is why it is *Pseudostratified*!!!!!!!!

*General Considerations:* 1. What does the system of muscles and associated fascias that exist due in the neck?(4)

1. A system of muscles and associated fascias exist which control skull and neck movements, strengthen skeletal support and protect, while at the same time, mobilize the visceral compartment.

1. How many muscles in the pharynx? 2. What is the function & names of the *constrictors*? 3. What is the function & names of the rest? 4. Ok, I lied, there are a few more... what do they do?

1. 6 (3 constrictors & 3 others (paired)) 2. Superior/Middle/Inferior Constrictors constrict & make peristaltic waves to move food down) 3. Stylopharyngeus, Salpingopharyngeus, Palatopharyngeus elevate & dilate the Pharynx. 4. A few more elevate & tense the soft palate

*Pharyngeal Apparatus:* 1. How many pairs of arches are there and what are their numbers? 2. Which one disappears? 3. Which 2 fuse? 4. Bars of Lateral plate and paraxial mesoderm are lined externally w/ [ectoderm or endoderm?] and lined internally w/ [ectoderm or endoderm?]

1. 6 pairs 2. 5th disappears, 3. 4 + 6 fuse 4. bars of lateral plate and paraxial mesoderm lined externally with ectoderm, internally with endoderm

*Ethmoid Bone:* 1. How many Concha are there? How many concha are on the ethmoid bone? 2. Concha is also called What? 3. Concha tells you its shape which is what? 4. #2 tells you what it does which is what?

1. 6, 4 2. Turbinate 3. Conch 4. Turbinate tells you what it does (creates turbulence)

*Cervical Fascias: Alar fascia* 1. what layer # of deep fascia is this? 2. Anteriorly what fascia bifurcates to form the alar fascia? 3. Alar fascia attaches to the midline of what fascia? 4. Vilaterally alar fascia blends with what sheath? 5. inferiorly it blends with the adventitia of WHAT in what part of the mediastinum b/w what vertebra?

1. 6th layer of deep fascia 2. Anteriorly the pre-vertebral fascia 3. alar fascia attaches to the midline of the buccopharyngeal fascia 4. Carotid sheath 5. inferiorly blends with the adventitia of the esophagus in the superior mediastinum between *CV7 and TV3*.

*Cerebral palsy (spastic-type)* 1. What % of all CP cases are spastic? 2. _____ per 1,000 live births 3. Symptoms? 4. Multiple causes? 5. Actual affects on CNS? 6. So is this an UMN or LMN lesion?

1. 70-80% of all CP cases 2. ≈2.1/1000 3. Hypertonia is most pronounced symptom, developmental delay, visual & auditory impairments 4. prenatal hypoxia, perinatal asphyxia, infection 5. damage to white matter lateral/dorsal to lateral ventricles 6. UMN lesion (Cortex, Internal capsule, CST)

*Lens:* 1. The entire lens is surrounded by what? 2. #1 causes the lens to do WHAT, unless it is overcome by Zonule Fibers? 3. Does the lens grow throughout life? 4. What happens to flexibility and transparency of the lens with age? 5. what happens if you get a large lens?

1. A Lens Capsule 2. "Round Up" 3. yes it continues to grow slowly throughout life 4. flexibility and transparency of the lens is compromised with age 5. large lens can compromise aqueous humor flow in the anterior chamber as it occupies more space

*Congenital Anomalies:* 1. What are Lateral Cervical Cysts and Branchial Fistula? 2. What causes them? 3. Branchial fistulas occur when WHAT arch fails to overgrow WHAT 2 arhes? 4. The cervical cyst retains a connections with the surface so it is a [internal or external?] fistula 5. In rare cases, the lateral cervical cyst can open into the pharynx causes a [internal or external?] fistula? 6. Whats the difference b/w a cyst and a fistula?

1. A branchial cleft cyst is a cyst in the skin of the lateral part of the neck. A lateral Cervical Cyst is a cyst in the branchial area 2. Cause: cervical sinus fails to degenerate; found along the anterior border of the SCM. 3. Branchial fistulas occur when second arch fails to overgrow the third and fourth arches. 4. The cervical cyst retains a connection with the surface (external fistula). 5. In rare cases, the lateral cervical cyst can open into the pharynx (internal fistula). 6. fistulas make an abnormal connection cysts are just sacs of fluid where they shouldn't be

*Congenital Anomalies:* 1. What is a Thyroglossal cyst? 2. What causes this? where is it usually found? 3. What is the big difference b/w thyroglossal cyst and ectopic glanduar tissue?

1. A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct. 2. Cause: cyst formed in remnant of thyroglossal duct; found along midline 3. The ectopic glandular tissue will have glandular tissue (thyroid tissue) and the thyroglossal cyst will not have glandular tissue

*General Considerations:* 1. what does the visceral compartment of the neck provide? (2)

1. A visceral compartment exists which provides communication between nasal and oral cavities and the thoracic components of the digestive and respiratory systems.

From the tracts on the previous slide, match the tract with the type of information that its conveying (1-4 have two of the 4 options): a. Carry fine, detailed proprioceptive information b. Carry broad integrated information c. Entire limb d. Single muscle cells or portions of muscle-tendon complex 1. Posterior spinocerebellar tract 2. Cuneocerebellar tract 3. Anterior spinocerebellar tract 4. Rostral spinocerebellar tract

1. A, D 2. A, D 3. B, C 4. B, C

1. What two pores are important for CSF flow and regulating fluid homeostasis? 2. What cells are they on?

1. AQP1 and AQP4 2. ependymal cells and astrocytes that make up the BBB AQP4 really important for that

1. What is the name of CN VI? 2. What component/s does it contain? 3. What single muscle does it innervate, and what is that sole muscle responsible for?

1. Abducens 2. GSE 3. Lateral Rectus m. (Extraocular) Responsible for turning eye LATERALLY, named for ability to abduct the eye.

*Posterior CricoArytenoid*: 1. The posterior CricoArytenoid is the only intrinsic muscle to do what? 2. this opens or closes the glottis?

1. Abducts 2. Opens the glottis nice and wide

1. What is alexia without agraphia? 2. What about speech? 3. What is it caused by? 4. Where does the issue lie?

1. Able to write but unable to read 2. Production of language and comprehension of speech intact 3. Caused by left PCA stroke 4. It is in the corpus callosum. "you are not getting the visual output out to the L side of the brain to go and do the motor actions".

1. Afferent tract neurons are segregated in the spinal cord based on [modality/color] and axonal [diameter/radius]. 2. Large diameter neurons will [ascend/descend] with in what? 3. What are the two portions of #2? 4. Where do they then synapse?

1. Afferent tract neurons are segregated in the spinal cord based on modality and axonal diameter 2-3. Ascend within the Posterior Funiculus in the Fasciculus Cuneatus or Fasciculus Gracilis (aka Dorsal Column) 4. Synapse on interneurons or LMNs in the gray matter

1. What is characteristic of agranular areas of the brain? 2. What are characteristics of granular areas of the brain?

1. Agranular Large pyramidal neurons Motor cortex 2. Granular Small pyramidal neurons Sensory cortices (look at last FC image if you're confused)

1. The Nasal Cavity Takes in [Water or Air?] that is almost always [warmer or cooler?] and [drier or moister?] than what is optimal for the lungs. 2. Rapidly and efficiently the nasal cavity [elevates or depresses?] humidity levels and temperature to avoid lung what?

1. Air, Cooler, Drier 2. Elevates, to avoid lung damage

1. Define myotome 2. Most muscles receive motor fibers from {multiple or just one spinal cord segment} 3. Implications of this on muscle, if you have spinal segment damage?

1. All muscles that receive innervation from a single spinal cord segment (somite) 2. Multiple (this was written 3 times on the same card) 3. If 1 segment gets damaged, you would expect weakness in a muscle, not necessarily paralysis

Match the following axonal types to the type of pain; Alpha-alpha, Alpha-beta, Alpha-delta, C-Fibers: 1. Lowest intensity of pain 2. Higher intensity of pain 3. Highest intensity of pain

1. Alpha-alpha, Alpha-beta 2. Alpha-delta 3. C-Fibers

Match the following axonal types to the type of myleination of the axon; Alpha-alpha, Alpha-beta, Alpha-delta, C-Fibers: 1. lightly myelinated 2. Unmyelinated 3. Myelinated

1. Alpha-delta 2. C-Fibers 3. Alpha-alpha, Alpha-beta

Match the following axonal types to the type of receptors of the axon; Alpha-alpha, Alpha-beta, Alpha-delta, C-Fibers: 1. Nociception ( Mechanical, thermal, chemical) 2. Proprioception, light touch

1. Alpha-delta, C-Fibers 2. Alpha-alpha, Alpha-beta

Another Clinical Correlation 1. How can the middle meningeal artery relate to trigeminal neuralgia? 2. What flavor of cell bodies are stimulated (GVA, SVA..?)

1. An *aberrant branch of the middle meningeal artery* occurring within the middle cranial fossa has been implicated in Trigeminal Neuralgia (Tic Doulouruex). It is thought that *pulsations of the artery located deep to the trigeminal ganglion irritate it* 2. causing mechanical stimulation of the *GSA* cell bodies located there.

1. Supraorbital V + Supratrochlear V = ? 2. Angular V + Superior Labial V = ? 3. Superficial Temporal V + Maxillary V = ? 4. Bifurcation of Retromandibular V: - Posterior branch + Posterior Auricular V = ? - Anterior branch + Facial V = ? 5. Common Facial V empties into?

1. Angular V 2. Facial V 3. Retromandibular V 4. - EJV -Common Facial V 5. Internal Jugular V

*Subclavian a. (3rd bit)* 1. Portion lateral to what muscle? 2. Passes b/w what muscles? 3. Accompanied here by what nerves? 4. Invested here w/what fascia?

1. Anterior Scalene (In extreme ant/inf extent of posterior Δ) 2. Anterior & Middle scalenes 3. Trunks of Brachial Plexus 4. Prevertebral Fascia (axillary sheath)

*Structure of the Eye: Fluid-filled segments* The anterior segment is subdivided into 2 chambers. 1. What are the 2 chambers named? 2. What divides them? 3. Are they continuous? if so thru what?

1. Anterior and Posterior Chambers 2. The Iris. Anterior chamber is in front of the iris and the Posterior Chamber is behind the iris 3. YES continuous thru the pupil

Related to the sphenoid bone 1. What is the attachment of the tentorium cerebelli? 2. what is the groove on roof of sphenoid formed by optic chiasm ? 3. What goes through the optic foramina? 4. What is the saddle shaped body of sphenoid?

1. Anterior clinoid process 2. Prechiastmatic groove 3. traversed by the optic nn. & ophthalmic aa. 4. Sella Turcica

*Glaucoma:* 1. Where is the initiating pathology in glaucoma? 2. Where is the damage? 3. Why is it this way

1. Anterior portion of the eye 2. damage occurs in the posterior region of the eye 3. Pressure increases in the anterior segment, the sclera is unyielding so the pressure is transmitted to the posterior segment which then compresses the optic nerve and compromises the axons because it is the weakest spot.

*Aqueous humor:* 1. what segment is this in? [anterior or posterior?] 2. #1 contains about how many ml of aqueous humor? 3. Aqueous humor is produced constitutively by cells of what?

1. Anterior segment 2. 0.2 ml 3. Ciliary body

*Boundaries and subdivisions of the neck:* 1. what is the general anterior border of the neck? 2. What is the general posterior border of the neck? 3. What is the general superior border of the neck? 4. What is the general inferior border of the neck?

1. Anterior: line drawn from the symphysis menti to the sternal notch 2. Posterior: Trapezius (anterior) border 3. Superior: indefinite line that connects the superior nuchal line, mastoid process and inferior margin of the mandible to the symphysis menti 4. Inferior: Superior margin of the clavicle, sternoclavicular joint and sternal notch

*Spinothalamic Pathway* 1. What is another name for this pathway? 2. What type of information does this pathway carry? 3. What type of receptors are found in this pathway? 4. Are there large or small receptive fields?

1. Anterolateral System (ALS); ALSO! The NEOspinothalamic pathway 2. Non-discriminative touch (crude touch), itch, temperature, pain 3. free nerve endings 4. large

1. Pia mater is what type of connective tissue that is directly applied to the surface of the brain? 2. Pia mater follow the contors of the brain but does it invest its vessels?

1. Areolar c.t. 2. yes, it cannot be dissected from the brain

*Ascending Pharyngeal a.* 1. Where does this artery arise from? 2. What does it travel in and next to? 3. Does it course straight to the base of the skull? 4. What are its branches (4)?

1. Arises from the medial aspect of the external carotid usually near the bifurcation. 2. It travels in the connective tissue lateral to the pharyngeal wall just medial to the internal carotid artery 3. Courses *straight* to the base of the skull. 4. Its branches include: (1) Pharyngeal a. (2) Palatine a. (tonsillar branch) (3) Inferior tympanic a (4) Meningeal a.

1. As the portions of the brain develops, what happens with the ventricles that are apart of them? 2. What would we expect of the lateral ventricles (what does it derive from?)? 3. What about the 3rd ventricle (what does it derive from?)? Where would we find it? 4. Where would the aqueduct be (what does it derive from?)? 5. Where is the 4th ventricle (what does it derive from?)?

1. As the brain develops, the portions of the brain drag the ventricles with them. 2. Lateral ventricles match the "C" shape of the cerebrum 3. 3rd ventricle on the midline where the diencephalon would be (mimicking its movement) 4. Cerebral aqueduct on midline (which is where we find the mesencephalon) 5. 4th ventricle on midline (Met- & Myelencephalon, which are derived from the Rhombencephalon)

*DEEP CERVICAL LYMPH NODES* 1. What are they associated with in the neck? 2. What are the two groups and how are they differentiated?

1. Associated with the carotid sheath along the course of the internal jugular vein 2. Divided into two groups by the passage of the omohyoid muscle: superior above, inferior below

1. Where are most synapses forming postnatally? (associative/commissural/projection) 2. Where does most of the myelination take place postnatally?

1. Association corticies 2. Association corticies and reticular formation (i.e. poorly dispersed nuceli down the brain stem).

1. Where does the pain pathway decussate? 2. Where does the touch pathway decussate? 3. At what point do the pain and basic touch pathways converge? In terns of afferent neurons, what level of nerves synapse here? 4. Damage to the spinal cord of the pain pathway will cause symptoms on what side? What about the basic touch pathway?

1. At the level of the spinal cord 2. At the level of the brainstem 3. At the thalamus. this is where the 2nd degree and the 3rd degree neurons will synapse 4. contralateral; ipsilateral

1. Generally speaking, what happens to a muscle with denervation? 2. In what 2 ways is Q1 accomplished? 3. As Q1 happens, what is it replaced by? 4. What sort of proteins are lost? 5. What makes the tissue even more restricted in size?

1. Atrophy (Muscle mass & capillaries decrease) 2. Apoptosis & Autophagy PWs activated 3. fatty & fibrous tissue 4. Contractile proteins lost 5. Fibrous tissue can cause contracture (static scrunch)

*Nasopharynx:* 1. Respiratory Epithelium continues into the nasopaharynx and lines what tube? 2. The hard and soft palates separate the nasal cavity and nasopharynx from what 2 things 3. Their respiratory surfaces are lined with Respiratory Epithelium while the answer in #2 are lined with what type of epithelium?

1. Auditory tube 2. Oral cavity and oropharynx 3. Stratified Squamous epithelium

1. What 2 structures enter through Gap 1 again? 2. What is the name of the horshoe-shaped swelling around the the orifice to the auditory tube? 3. What's the name of the mucosa overlaying the Levator Veli Palatini? 4. What's the name of the mucosa overlaying the Salpingopharyngeus muscle?

1. Auditory tube & Levator Veli Palatini 2. *Torus Tubarius* 3. *Torus Levatorius* 4. *Salpingo-pharyngeal Fold*

1. Beginning [4th/5th/6th] week, ectoderm thickens locally forming nasal _______1_____. Middle of ____(same as 1)______ begin to invaginate while mesenchyme at margin of placodes [dies/proliferates], creating medial and lateral nasal prominences. The invaginations proliferate to form what? 2. What are the mandibular and maxillary arches associated with?

1. Beginning 5th week, ectoderm thickens locally forming nasal placode. Middle of (1)placodes begin to invaginate while mesenchyme at margin of placodes proliferates, creating medial and lateral nasal prominences. Invagination proliferates deep to form nasal cavity. (The nasal prominence is associated with the nose) 2. The lips

1. Where does the superior saggital sinus begin? (anteriorly) 2. Where does it end? (posteriorly) 3. When patent what does the the superior sagital sinus transmit anteriorly?

1. Begins anteriorly at the *foramen cecum* 2. Ends at *confluens of sinuses* 3. transmits *emissary vein from the nasal cavity*; variable and not always patent

*Trachea* 1. Cervical portion is a continuation of the airway below what structure? 2. Cervical portion accounts for what fraction of total length? 3. What hard structures surround the trachea (incl. size)?

1. Below cricoid cartilage of larynx 2. ≈ 1/2 3. Incomplete cartilaginous rings (≈2.5 cm)

*Lens:* 1. The lens is a [concave, convex, biconvex, or biconcave] disc that sits just [in front of, or behind?] the pupil 2. The lens forms a boundary b/w what 2 things?

1. Biconvex, that sits just behind the pupil. 2. Forms the boundary b/w the anterior segment and the posterior segment?

Review: Vestibulospinal pathways 1. Medial: Ipsilateral, Contralateral or Bilateral? 2. Medial: Full spinal cord? 3. Lateral: Ipsilateral, Contralateral or Bilateral? 4. Lateral: Full spinal cord?

1. Bilateral 2. Cervical cord only 3. "Same side" 4. Full length of spinal cord (maybe you should draw this or something)

Answer bilateral, ipsilateral or contralateral for each one nuclei in the corticobulbar pathway 1. CNV motor 2. CN VII motor upper face 3. CN VII motor lower face 4. CN XII 5. Nucleus ambiguus

1. Bilateral (V3) 2. Bilateral 3. Contralateral 4. Contralaterals 5. Bilateral

1. What is CSF derived from? 2. From serum to CSF Cl- concentration is being [increased or decreased?] 3. From serum to CSF K+ concentration is being [increased or decreased?] 4. From serum to CSF water content is being [increased or decreased?] 5. From serum to CSF protein content is being [increased or decreased?] 6. Atpase keeps intracellular Na+ [high or low?] (in the ependymal cells) 7. Why?

1. Blood 2. Cl- increased 3. K+ Decreased 4. H20 Increased 5. Protein content is obliterated to basically zero 6. low. 7. Keeps concentrations of ions that the neuron will need to function. like synapse, which is its job.

1. Air humidification and temperature raising is accomplished in the nasal cavity through interplay b/w complex architecture of the ________/_____________ foundation of the Nasal Cavity and the unique attributes of the associated nasal ____________ 2. The anterior regions of the nasal cavity have a [bone or cartilage?] base?

1. Bony/cartilaginous, Nasal mucosa 2. Anterior regions of the nasal cavity have a cartilage base

1. On what bone is the: Hiatus for the greater petrosal N. Hiatus for the lesser petrosal N. 2. What cranial nerve does each come from?

1. Both on Temporal bone 2. Hiatus for the greater petrosal N. *(VII)* Hiatus for the lesser petrosal N. *(IX)*

*Clinical Note* 1. What are the carotid triangle? 2. Surgical approach through this triangle gives access to what structures (think carotid)? 3. Manipulation of two specific structures found in #2 can lead to protracted changes int he voice as these innervate the muscles of the larynx. What are they?

1. Boundaries: anterior border of SCM, posterior border of sup. belly of omohyoid, inferior border of post. belly digastric 2. Provides access to the carotid bifurcation, internal jugular v., vagus and hypoglossal nn, and the sympathetic trunk. 3. Manipulation of the *vagus* and *recurrent laryngeal nn.* during this approach can lead to protracted changes in the voice as these nerves innervate the muscles of the larynx.

*Olfactory Mucosa:* 1. What glands secrete a watery fluid that dissolves odorants. Constantly produced to wash away old odorants and keep the olfactory system 'live 2. #1 secretions are delivered to the apical surface of the epithelium (where the odorant receptors are) by a duct system. what is the name of these ducts and what is prominent on them that helps you identify them? 3. Olfactory nerve: Axons from the Olfactory neurons begin to cluster and will ultimately make their way to the brain and pass through a region of the ethmoid bone called what?

1. Bowman's Glands- respiratory epithelium has more mucusy mucus 2. Bowman's ducts, identified by a prominent lumen 3. *Cribiform Plate*

*N. to subclavius (C5-C6, upper trunk)* 1. Descends anterior to what structures (nerves & vessels)? 2. Descends posterior to what bone? 3. Enters deep surface of what muscle?

1. Brachial plexus & subclavian vessels 2. Clavicle 3. Subclavius

*Thyroid Ima Artery (≈10%)* 1. Branch of what artery (2)? 2. Ascends ventral surface of what structure to gain thyroid isthmus? 3. Anastamoses with?

1. Branch of *Brachiocephalic* (or directly off Aortic Arch) 2. Ventral surface of trachea 3. Branches of *Inferior Thyroid Arteries*

What are the Larynx's 3 main jobs?

1. Breathing: pathway of airflow/ protection of airway 2. Eating: swallowing (prevention of aspiration) 3. Vocal apparatus: communication

*CN V (Trigeminal)* 1. How does it get onto the face? 2. What are the branches?

1. Buncha foramina/Sneaking around bones 2. V1: Ophthalmic V2: Maxillary V3: Mandibular

1. At what week of development is the majority of things the in body are organized? 2. What does alcohol and acutaine effect in a developing fetus? 3. What are things that accutane effect in a developing fetus?

1. By week 8 2. They cell death in Neural crest cells. 3. Ear abnormalities, thymus gland, hormone deficiencies, cardiovascular abnormalities, and an elongation of the skull (check it)

Match the following axonal types to the diameter of the axon; Alpha-alpha, Alpha-beta, Alpha-delta, C-Fibers: 1. Smallest diameter 2. medium diameter 3. Largest diameter

1. C-Fibers 2. Alpha-delta 3. Alpha-alpha, Alpha-beta

Match the following axonal types to the speed of the axon; Alpha-delta, C-Fibers: 1. 2 m/sec 2. 20 m/sec

1. C-Fibers 2. Alpha-delta fibers

*Cutaneous nerves: Ventral Rami* 1. What spinal levels have nerves have Ventral rami cutaneous nerves here? 2. C1-C4 ventral rami from what?

1. C1-C4 2. *C1 - C4 ventral rami form the cervical plexus*

*Cutaneous nerves: Dorsal Rami* 1. What spinal levels have nerves have dorsal rami cutaneous nerves here? 2. how often does C1 spinal nerve have a dorsal root in individuals? 3. When C1 is present, it has a much [reduced or increased] dorsal root ganglion 4. its cutaneous distribution has been taken over by what nerve? 5. Small amounts of GSA innervation that remain comes from what in the posterior cranial fossa?

1. C1-C6 2. *C1 spinal nerve has no dorsal root in 50% of individuals*; 3. when present, it has a much *reduced* dorsal root ganglion. 4. Its cutaneous distribution has been taken over by the greater occipital n. (C2). 5. What small amount of GSA innervation that remains comes from the dura lining the posterior cranial fossa.

Review: 1. How many Cervical spinal nerves? 2. How many Thoracic spinal nerves? 3. How many Lumbar spinal nerves? 4. How many Sacral spinal nerves?

1. C1-C8 2. T1-T12 3. L1-L5 4. S1-S5 + (Co)

He has repeated this point a few times.... so it gets a card. ID the CN and Component associated with: 1. Motor innervation to SKM derived from the 1st pharyngeal arch. 2. Motor innervation to SKM derived from the 2nd pharyngeal arch. 3. Motor innervation to SKM derived from the 3rd pharyngeal arch. 4. Motor innervation to SKM derived from arches 4 and 6.

1. CN V (SVE, only in V3) 2. CN VII (SVE) 3. CN IX (SVE) 4. CN X (SVE) Patterns.... It's always about the patterns.

1. Which 2ish nerves do sensory innervation of the head?

1. CN V + Cervical nerve (ventral & dorsal rami) *HEY!* while your here... name the labels (scroll for answers) A: V1: Ophthalmic Division B: V2: Maxillary Division C: V3: Mandibular Division D: Cervical Nerves

1. CSF is contained in what layer around the brain again? 2. Arachnoid is connected to the pia via what? 3. what does #2 do?

1. CSF is contained in the subarachnoid layer around the brain 2. Trabeculae 3. Keeps the brain suspended

1. What do the Cajal-Retzius cells organize? *What type of signaling?* 2. What happens as a result of mutations in the signaling pathway? 3. What happens for women? men?

1. Cajal-Retzius cells organize cortical migration and lamination through *Reelin signals* 2. Smooth brain or "lissencephaly" results when there are mutations in the reelin signaling pathways 3. In women they get two layers of cortex forming (see picture top right) in men lissencephaly results (smooth brain, lack of gyrification).

1. Chronic pain arises from [central or peripheral?] sensitization? 2. #1 is Spinal cord and brain-based sensitization in [presence or absence?] of nociceptive stimuli?

1. Chronic pain arises from *central* sensitization 2. Spinal cord and brain-based sensitization in the *absence* of nociceptive stimuli

*Ciliary body:* 1. What muscle is in the ciliary body? 2. What processes come off of the ciliary body? 3. What connects the ciliary body to the lens?

1. Ciliary Muscle 2. Ciliary Processes 3. Zonule Fibers (Suspenory Ligaments of the Lens)

1. Aqueous humor is produced by what? 2. It then fills the anterior and posterior chambers and flow is toward the junction b/w what 2 things? 3. Aqueous humor collects in what canal to return to the venous system?

1. Ciliary body 2. Uvea and the Sclera 3. Canal of Schlemm

*Zonule Fibers:* 1. The Zonule fibers connect to the ciliary body via what? 2. The Zonule fibers connect to the lens to help do what to the lens??

1. Ciliary process 2. change the shape of the lens

*Respiratory Epithelium:* 1. This is what type of epithelium (be very specific)

1. Ciliated Pseudostratified Columnar Epithelium with Goblet cells

*Olfactory Epithelium:* 1. What type of epithelium is it? 2. does the olfactory epithelium have goblet cells like the respiratory epithelium? 3. Is the olfactory epithelium taller or shorter then respiratory epithelium? 4. Is it more or less cellular? 5. does it have cells organized into more or less discrete layers? 6. does it have more or less prominent subepithelial glands and ducts? 7. does the olfactory or respiratory epithelium have the olfactory nerve often visible?

1. Ciliated Pseudostratified Columnar Epithelium- beyond that classification it has nothing in common w/ Respiratory Epithelium 2. *HAS NO GOBLET CELLS 3. TALLER 4. MORE cellular 5. MORE discrete layers 6. MORE Prominent subepithelial glands and ducts 7. olfactory epithelium. the olfactory nerve is often visable

*CERVICAL PLEXUS* 1. What is this composed of? 2. What motor innervation does this give? 3. What sensory innervation does this give? 4. Does it supply sympathetic innervation?

1. Composed of ventral rami of C1 - C4 2. Innervates the deep cervical muscles of the vertebral column, infrahyoid musculature and the diaphragm 3. Provides innervation to sensory dermatomes of the lateral head, neck, superolateral shoulder and upper anterior thorax 4. Distributes postganglionic sympathetic innervation to all areas supplied by the cervical plexus

Conditions affecting vestibular pathways... 1. How might you get trauma to anterior spinal cord? 2. Which 3 arteries might be involved & what would be jacked there? 3. Where on the medulla would damage affect vestibular PWs?

1. Compromised vasculature 2. Anterior spinal artery: tracts Posterior inferior cerebellar artery: nuclei or cerebellum Vertebral arteries: affects ASA, PSAs, cerebellar arteries 3. Disease/damage to posterior medulla

1. Ophthalmic Veins connect what to what? 2. Infraorbital Veins connect what to what? 3. Deep Facial Vein connects what to what? 4. Why might these connections pose a problem?

1. Connect Angular V *directly* → Cavernous Sinus (around brain) 2. Connect Angular V *directly* → Pterygoid V Plexus → Cavernous Sinus (around brain) 3. Connect Facial V → Pterygoid V Plexus 4. These can all take superficial infections to the brain zone

1. The name of the caudal end of the Spinal Cord? 2. At what level is this located in an Adult? 3. The name of the structure caudal to Q1? 4. In a fetus, where would Q1 be located?

1. Conus Medullaris 2. ≈ L1 - L2 vertebrae. 3. Cauda Equina 4. Sacral vertebrae

*Referred pain:* 1. Visceral pain is referred due to what?

1. Convergence Below is what he had written in the notes of the slide but he never talked about it he was running out of time tho so it may be important. Left arm/shoulder is referred pain. Heart burn is chest hurting. Because it joins fibers in the PCML on its way up: Relative sparsenss of visceral sensory innervation, travels along with the PC/ML. Recognize the pain will be slower, duller, less localized, sometimes a side preference, often unresponsive to opiates.

1. What is the function of the posterior eye?

1. Converging light image to a neural signal

*Epiglottis* 1. Has a core of what? 2. What type of epithelium is on the epiglottis on the oral surface side? 3. What type of epithelium is on the epiglottis on the laryngeal surface side? 4. Hard palate has a core of what?

1. Core of elastic cartilage 2. Stratified Squamous 3. Respiratory Epithelium 4. bone

*Cornea:* 1. What is the name of the innermost layer that lays on top of descemet's membrane? 2. What type of endothelium does #1 have? 3. Why is the Corneal *Epi*thelium Stratified squamous and #1 has #2? 4. What type of fluid lies deep to #1?

1. Corneal *Endo*thelium 2. Simple Squamous 3. Corneal *epi*thelium needs to be stratified because it needs to protect the eye and it gets scratched every time you blink. Corneal *endo*thelium needs to get nutrients to the corena so that is why it is simple squamous. 4. Aqueous Humor

*Functional Cornea:* 1. Which cornea layer is most crucial to cornea function? 2. Which cornea layer is where almost all nutrient exchange for cornea happens? 3. What does #1 due to help the Substantia Propria maintain transparency? 4. When what cells fail will the Cornea fail?

1. Corneal Endothelium 2. Corneal Endothelium 3. actively removes water from Substantia propria 4. *When Corneal Endothelium cells fail the Cornea fails*

*Surface Anatomy:* 1. opposite of what cervical vetebrae is the cricoid carilage locate? 2. What type of ring shaped carilages is cricoid cartilage? 3. it is palpated directly inferior to what?

1. Cricoid cartilage - located anterior to the sixth cervical vertebra 2. this "signet" ring shaped cartilage 3. is palpable directly inferior to the thyroid cartilage

1. What is the upper limb equivalent to the PST? 2. Where do these nerve fibers enter? 3. Through which column will these fibers ascend? 4. Where will these fibers then synapse? Through which peduncle will it ascend? 5. What is their final destination?

1. Cuneocerebellar tract 2. Enther through posterior root 3. Ascend within posterior column (cuneate fasciulus). 4. Synapse on lateral cuneate nucleus (also known as the accessory cuneate nucleus). This is where the second order neuron is found. Through the inferior cerebellar peduncle. 5. Ascend to cerebellum.

1. Which of the tracts enter the cerebellum through the inferior cerebellar peduncle? 2. Which of the tracts enter the cerebellum through the superior cerebellar peduncle?

1. Cuneocerebellar tract Posterior spinocerebellar tract Rostral spinocerebellar tract 2. Anterior spinocerebellar tract

1. What is secreted by the substantia nigra? 2. What is the effect of this secretion? (trick question, answer along with #3) 3. What receptors?

1. DOPAMINE 2. *depends* on the targets receptor. 3. D1 is excitatory D2 is inhibitory

*Lymphatics of posterior Δ* 1. Located deep to what fascia? 2. Composed of nodes of {superficial or deep} cervical system? 3. Spinal accessory n. (CN XI) has what accompanying nodes? 4. Transverse cervical a. has what accompanying nodes?

1. Deep to investing fascia 2. *Deep* cervical system 3. *Accessory* nodes 4. *Transverse Cervical* nodes

*Generalized Relationships* 1. Where is the carotid sheath in reference to the SCM? What boarder? 2. Within the sheath, the artery lies [lateral/medial] and [anterior/posterior] while the vein is [lateral/medial] and somewhat [anterior/posterior]. 3. What groove does CN X descend in within the carotid sheath?

1. Deep to the sternocleidomastoid (SCM); approximately follows its anterior border 2. Within the sheath, the artery lies medial and anterior while the vein is lateral and somewhat posterior 3. The vagus nerve descends in the posterior groove between the two vessels.

1. What kind of connective tissue is dura mater? 2. Dura mater of brain is continuous with spinal dura, where does it transition? 3. What are the two portions of Dura?

1. Dense fibrous c.t. layer enclosing brain; 2. Foramen magnum 3. periosteal and meningeal

1. Where do you find the alar plate? What type of nuclei do they have? 2. Where do you find the basal plate? What type of nuclei do they have? 3. What is the sulcus limitans?

1. Dorsal (alar)plate Sensory nuclei 2. Ventral (basal) plate Motor nuclei 3. It is the suclus that separates the dorsal sensory and ventral motor cell bodies.

*PCML in Spinal Cord* 1. Where are the cell bodies for sensory information? 2. What do the processes of the DRG form? 3. Where do the rootlets go from there? 4. How would rootlets from the sacral region differ in their location in the spinal cord than those found in the cervical region? 5. What fasiculus do lower body sensory fibers use? What about upper body?

1. Dorsal Root Ganglia (DRG) 2. they form dorsal rootlets 3. Enters the posterior columns. 4. Rootlets from the lower body will be found more medial in the spinal column, as opposed to those found in the higher levels of the body (i.e. cervical area) would be found more lateral. 5. Lower body --> Fasiculus gracilis Upper body --> fasiculus cuneatus.

What are the 5 branches of the Brachial plexus found in posterior Δ? (Include cord levels of these nerves)

1. Dorsal Scapular n. (C5) 2. Accessory phrenic n. (usually C5) 3. Nerve to Subclavius (C5-C6, upper trunk) 4. Suprascapular n. (C5-C6, upper trunk) 5. Long thoracic n. (C5, C6, C7)

*Spinal Cord Pain Mechanisms:* 1. Where in the body is the Wide dynamic range neuron? 2. What synapses on the Wide dynamic range neuron?

1. Dorsal horn of the spinal cord 2. Alpha-beta, Alpha-delta, and c-fibers, and descending brain stem fibers

Information enters & exits spinal cord via spinal nerves 1. PW of *Sensory* information (*both* somatic & visceral afferent) from *peripheral to spinal cord*? 2. PW of *Motor* information (*both* somatic & visceral efferent) from *spinal cord to periphery*?

1. Dorsal/Ventral ramus → Spinal nerve → Dorsal roots → Dorsal rootlets → Dorsal Horn 2. Ventral Horn → Ventral rootlets → Ventral roots → Spinal nerve → Dorsal/Ventral ramus

Review... but with a pic

1. Dorsal/Ventral ramus → Spinal nerve → Dorsal roots → Dorsal rootlets → Dorsal Horn 2. Ventral Horn → Ventral rootlets → Ventral roots → Spinal nerve → Dorsal/Ventral ramus

1. What is the role of DLPFC? 2. What is the role of VMPFC?

1. Dorsolateral prefontal cortex (DLPFC): Planning, solving problems, paying attention 2. Ventromedial prefontal cortex (vmPFC): Impulse control, processing of risk and fear, decision making

*Paranasal Sinuses:* 1. The Maxillary sinus drains to what? through what? 2. What is bad about #1? what is it dependent on?

1. Drains to the middle meatus through the Ostium (opening) of the maxillary sinus 2. Drains 'uphill'. Not aided by gravity most of the time. Dependent of ciliary action to move mucus into nasal cavity

1. When does early dorsal-ventral patterning of the nervous system begin? 2. What are the two flavors of signaling patters and where do they come from?

1. Early dorsal ventral patterning starts while the nervous system is still a flat structure (I.e. the neural tube hasn't even formed yet). 2. The patterning signals come in two flavors - lateral signaling from the BMPs in the ectoderm and planar signaling from sonic hedgehog in the notochord.

*Nasal Cavities* 1. What is the nasal cavity's origin of tissue? 2. How is the nasal sac created? 3. What makes up the floor of the nasal pit? What does this floor separate? 4. What happens to #3? 5. What happens with the lateral shelves?

1. Ectoderm 2. Starts out with the nasal prominence, it starts to invaginate in, forms the nasal pit, continues to invaginate with the lateral nasal prominence growing over it. 3. Oronasal membrane 4 - 5 Regresses and replaced by lateral shelves of secondary palate, which fuse at midline (normally) creating complete separation b/t nasal and oral cavities. (here is a pic of it)

*Lens:* 1. Embryonic Nucleus comes from what tissue? Where is it found in the lens? 2. What connects to the equator of the lens? 3. What type of epithelium covers the lens, but only on the [posterior or anterior?] surface of the lens?

1. Ectoderm, forms the core of the lens 2. zonule fibers 3. Simple cuboidal lens epithelium covers only the ANTERIOR surface of the lens

*Arch 1* 1. Stomodeum is an invagination of what tissue layer that will form what cavity? 2. memory check, are pouches on the outside or the inside? this makes clefts on the outside or inside?

1. Ectoderm, that will form the oral cavity 2. pouches =inside, clefts =outside dope pic

*Physiological Basis of the EEG* 1. What is the electrical field of the brain generated by? In what layer? 2. What are the 3 characteristics of these cells? 3. What do they do to signals?

1. Electrical field generated by similarly oriented pyramidal cells in cortex (layer 5) and detected by scalp electrode 2. Pyramid cells: -same relative orientation -polarity -synchronously activated 3. Amplifying signal

1. What are the two conditions that occur when the rostral neuropore does not close? 2. What is the condition that occurs when the caudal neuropore does not close? What are the 3 different types?

1. Encephalocele and anencephaly 2. Spindabifida a. occulta b. meningocele c. myelomengocele (dura and arachnoid mater and portions of the spinal nerves out in the cele) most dangerous

*Thyroid Gland* 1. Endocrine or Exocrine? 2. 2 Cell types? Each secrete what?

1. Endocrine gland 2. i: Follicular cells: secrete thyroxin ii: Parafollicular (C) cells: secrete calcitonin

*Occipital a.* 1. 5th branch of which artery? 2. Passes from behind which muscle @ apex of posterior Δ 3. Ascends to supply what structure?

1. External Carotid 2. SCM 3. Posterior scalp (along w/greater occipital n.)

What are the *general contents* of *Posterior Δ*... 1. 1 vein? 2. 4 Cutaneous nn. of the Cervical Plexus? 3. CN? 4. Plexus? 5. Muscle? 6. 5 arteries? 7. Lymph Nodes?

1. External Jugular v. & tributaries (4) 2. Cutaneous nn. of the Cervical Plexus (lesser occipital, great auricular, transverse cervical, supraclavicular) 3. Spinal accessory n. (CN XI) 4. Brachial Plexus 5. Inferior belly of omohyoid m 6. 3rd bit'o subclavian a., transverse cervical a., suprascapular a., dorsal scapular a., & occipital aa. 7. Deep cervical lymph nodes.

*Face Scanning* ... it's what we spend most of our interaction time doing. 1. What do we primarily focus on? 2. Why?

1. Eyes & Mouth 2. This is where our muscles of facial expression have their greatest effect (also, to make sure Rob is not going to hurt you... or seduce you)

*CERVICAL PLEXUS - Clinical Note* 1. T or F: each phrenic n. innervates the contralateral diaphragm. 2. Where can accessory phrenic n. arise from? Most common? 3. In surgical procedures where the diaphragm needs to be paralyzed for weeks, what needs to be done? What about if structures from #2 are present?

1. FALSE! 2. Accessory phrenic nerves often occur from other branches of C3,4,s sometimes arising from supraclavicular nerves or from the nerve to subclavius. *The most frequent one*, however, arises somewhere along the course of the C5 spinal nerve and courses lateral to the phrenic n. 3. In surgical cases where the diaphragm needs to be paralyzed for weeks, i.e., diaphragmatic hernia repair, *the phrenic n. is crushed between forceps. If an accessory phrenic n. is present, it must also be crushed to achieve complete paralysis.*

1. What is the name of CN VII? 2. What component/s does it contain? (5)

1. Facial 2. SVE, GSA, SVA, GVA, GVE-P

1. What can happen during birthing if clamps are used improperly? 2. What anatomical artifacts make this more likely to happen in infants? 3. Where should the forceps NOT be placed when birthing a child?

1. Facial N paralysis 2. Mastoid process is undeveloped in infants. Stylomastoid foramen (CN VII motor to face) lies lateral and is unprotected. 3. Avoid placing forceps immediately behind ear.

1. What causes an oblique cleft? 2. What is the most common cleft issue? 3. What is the difference between a cleft lip and cleft primary palate? 3. Do cleft lip happen bilaterally? 4. Which type of cleft happens when the tongue doesnt move out of the way properly?

1. Failure of maxillary prominence to fuse with lateral nasal prominence. 2. Cleft lip. Also the easiest to repair. 3. The cleft lip only has the lip involved where the cleft palate has the lip and primary palate involved. 3. Yes they can 4. An isolated cleft palate (cleft of the secondary palate)

*Larynx:* 1. histologically what is the difference b/w the true and false vocal folds? 2. what space is b/w the true and false vocal folds?

1. False vocal folds have alot more glands then the true folds 2. ventricle (vestibule space)

1. T or F: most of the growth of the skull occurs after birth. 2. T or F: most of the growth of the face takes place after birth.

1. False, most of the growth of the skull takes place in the womb. 2. This is true, check out this chart.

1. T or F: proprioceptive infromation being sent to the cerebellum is conscious level proprioception. 2. What type of proprioceptive information will be sent to the cerebellum? 3. How many neurons are in this chain? 4. At what point does the decussation happen? 5. If there is damage along this pathway, would it present with ipsilateral or contralateral symptoms?

1. False; unconscious 2. Information regarding the positioning of muscles, bones and joints feeds into the cerebellum 3. 2 neuron chain 4. Decussation does not take place in this pathway (but there is one exception, we'll talk about it soon). 5. Presents with ipsilateral symptoms.

What are the four dural reflections?

1. Falx cerebri 2. Tentorium cerebelli 3. Falx cerebelli 4. Diaphragma sellae

*CERVICAL PLEXUS - Motor* 1. Fibers from what cervical level are "disguised" in the hypoglossal n. to innervate the geniohyoid and thyrohyoid muscles? 2. Where are direct muscular branches coming from to innervate pre-vertebral muscles? What are the muscles?

1. Fibers from C1 continue "disguised" within the hypoglossal nerve and diverge from it to innervate the geniohyoid and thyrohyoid muscles. 2. Direct muscular branches from C1 - C4 are provided to pre-vertebral muscles (longus capitis, longus colli, middle scalene).

1. What's the pharynx made of? 2. Extend from where to where? 3. What happens at it's distal end? 4. How long would that make this thing?

1. Fibromuscular tube 2. Base of skull to CV6 3. Esophagus 4. 12-14cm long

*Posterior Column Tract PW* (the basics for now) 1. What type of info? 2. Where does it enter spinal cord & what happens there? 3. In which part of cord does it ascend 4. Where does it cross over? 5. What does it synapse? 6. Where does it end up?

1. Fine touch, vibration, conscious proprioception 2. Enters *dorsal root* (eg on R) & *no synapse* here 3. Ascends in *Posterior Funiculus* on *same side* (eg on R) 4. Cross over in *Medulla* (eg to L) 5. Synapse in *Thalamus* (eg on L) 6. Ends in primary somatosensory cortex [*R body → R spinal cord → L cortex*]

1. Which fibers are refereed to as the first pain and which are refereed to as the second pain?

1. First pain = alpha-delta fibers second pain= C-fibers

For the following... Is this a sign of *UMN damage* OR *LMN damage* OR *Both* OR *Neither*: 1. Initially flaccid paralysis → spasticity 2. Flaccid paralysis → atrophy 3. ↑ strength 4. ↓ strength 5. ↓ muscle tone (hypotonia) 6. ↑ muscle tone (hypertonia) 7. Weak/lost stretch reflex (hypo/areflexia) 8. ↑ deep tendon reflex (hyperreflexia) 9. Clonus, Babinski's sign 10. Fasciculations 11. Usually affects groups of muscles 12. Usually affects myotome (muscles sharing common spinal segment innervation)

1. Flaccid paralysis → spasticity: *UMN* 2. Flaccid paralysis → atrophy: *LMN* 3. ↑ strength: *Neither* 4. ↓ strength: *Both* 5. ↓ muscle tone: *LMN* 6. ↑ muscle tone: *UMN* 7. Weak/lost stretch reflex: *LMN* 8. ↑ deep tendon reflex: *UMN* 9. Clonus, Babinski's sign: *UMN* 10. Fasciculations: *LMN* 11. Usually affects groups of muscles: *UMN* 12. Usually affects myotome: *LMN*

*Clinical Note* 1. For diagnostic purposes, where can the *right* internal jugular vein be accessed? At what angle should it be accessed?

1. For diagnostic purposes, the right internal jugular vein can be accessed by inserting a needle/catheter inferiorly at the apex of the triangle between the clavicular and sternal heads of the SCM with the needle inserted approximately a finger's breadth lateral to the common carotid pulse at a 30° angle aimed inferiorly toward the ipsilateral nipple.

*Thyroid Gland Development:* 1. Invaginates through what foramen? 2. Mostly comprised of what tissue layer/type from what arch? 3. arch from #2 goes through #1 and travels down what to be where the thyroid is?

1. Foramen Cecum (four men see cum) 2. Endoderm from 2nd arch 3. migrate down the front of the throat (*Thyroglossal duct*). you can get remnants from it anywhere along this pathway

*Retina:* Retina has the same general design with exception to 2 spots. 1. Which exception spot has the best vision? 2. Which exception spot has NO vision? 3. #1 is the central part of what?

1. Fovea 2. Optic disc (blind spot) 3. The Macula

1. Which fibers detect pain? 2. Which fibers detect temperature? 3. The other receptors (like Meissner's and raffinies corpuscle) are just modified what?

1. Free nerve endings. 2. Free nerve endings. 3. Free nerve endings.

*Epliglottic cartilage:* 1. The epliglottis is What type of cartilage? *2.* it is connected to the inside thyroid cartilage by what? 3. What muscle pulls the epiglottis down over the trachea to make it so food doesn't go down the wind pipe?

1. Free wedge of elastic cartilage 2. thyroepiglottal ligament 3. NONE!! the epiglottis doesn't move! the larynx moves up and covers itself by moving into the epiglottis

*Posterior Spinocerebellar Tract* 1. What region of the body is information coming from in the posterior spinocerebellar tract? 2. What are the particular fibers that are sending their information? 3. Where do they enter? 4. Where do they synapse? 5. Where do they ascend?

1. From trunk & lower limb 2. Fibers from muscle spindles, Golgi tendon organs 3. Enter through posterior root 4. Synapse on Clarke's nucleus (2nd order) 4. Ascend in PST to cerebellum

*Lateral Ventricles:* Match these 5 parts of the lateral ventricles to what they are : Central part/ body, Atrium, Occipital horn, Frontal horn, and Temporal horn: 1. In frontal lobe 2. In frontal and parietal lobes, extends to *splenium* 3. into occipital lobe 4. into temporal lobe 5. around splenium

1. Frontal Horn: In frontal lobe 2. Central part/body: In frontal and parietal lobes, extends to *splenium* 3. Occipital horn: into occipital lobe 4. Temporal horn: into temporal lobe 5. Atrium: around splenium

*Motor Cortex* 1. Found entirely in which lobe? 2. Primary motor cortex found where? 3. Premotor cortex found where? 4. Supplementary motor found where?

1. Frontal Lobe 2. In Precentral gyrus 3. Anterior to primary motor 4. Medial to premotor

*REVIEW* 1. What is the cortical area for motor? Lobe? 2. Gyrus? 3. Broadmann's area? 4. What afferent area is helping?

1. Frontal, Primary motor cortex (M1) 2. Pre-central gyrus 3. 4 4. Supplementary/Pre-Motor Area

1. What are the 3 main prominences of the face through development? 2. What is the nerve that innervates these 3 areas? 3. Which arch does CN V "come from"?

1. Frontonasal Maxillary Mandibular 2. Trigeminal (V1 with frontonasal, V2 with maxillary, V3 with mandibular). 3. The first arch. Buuuuut..... do the cranial nerves come from the arches? or do they just innervate the arches? idk, thats what she said so suck it Toby....

*Spinal Cord Pain Mechanisms:* 1. What are the 3 pain theories that may all work together? 2. Explain how they work together to accomplished our prized pain.

1. Gate-theory intensity based theory (additive theory) labeled line theory. 2. Look at the picture. but labeled line theory is how the fibers travel to the spinal cord. Gate theory is all the nociceptive and non-nociceptive signals come in and synapse in the dorsal horn. Intensity based theory is then you perceive different pain depending on what neurons are synapse on the WDR which includes all the nociceptive and non-nociceptive and brainstem signals.

1. What Afferent functional components are found in both Cranial and Peripheral nerves? 2. What types of fibers are associated w/ afferents, and where their cells of origin? 3. What is #1 broken down into? (2 things)

1. General Afferent Fibers 2. Sensory fibers; Cells of origin located in CranioSpinal Ganglia. (Dorsal root ganglia; ganglia of specific cranial nerves) 3. GVA (General Visceral Afferents) and GSA (General Somatic Afferents)

1. What Efferent functional components are found in both Cranial and Peripheral nerves? 2. What types of fibers are associated w/ Efferents and what do they innervate? 3. What is #1 broken down into? (2 things)

1. General Efferent Fibers 2. Motor Fibers; innervate musculature of body. (Except Branchiomeric muscles) 3. GSE (General Somatic Efferent) and GVE (General Visceral Efferent)

1. What genetic mutation is associated with Huntington's Disease? 2. What in basal ganglia pathway is targeted in this disease

1. Genetric mutation of polyglutamine (CAG) repeats which causes neuronal death. 2. this disease will target the striatum

ONly going over what is new... 1. Striatum now acts on what target? 2. via what NT?

1. Globus Pallidus externa 2. GABA

Direct Basal Ganglia Pathway 1.. What is Stiatum's target? 2. What neurotransmitter does Striatum use? 3. Besides motor cortex, what else is acting on Stiratum?

1. Globus Pallidus internal (GPi) 2. Gaba (-) 3. Substantia nigra pars compacta

1. What does subthalamic nucleus target? 2. via what NT?

1. Globus pallidus Internal 2. GLUT

1. What is the name of CN IX? 2. What component/s does it contain?

1. Glossopharyngeal 2. SVE, GSA, SVA, GVA, GVE-P

1. What CN innervates the Pharynx? 2. With what muscle does this CN travel? 3. 2 branches of note + how they access their final destination

1. Glossopharyngeal (CN IX) 2. Stylopharyngeus 3. i: *Lingual/Tonsillar* branch enters oropharynx near palatine tonsil b/w Superior & Middle Constictors ii: *Pharyngeal* branch contributes to Pharyngeal Plexus (w/CN X & Symp Chain)

1. What are the 3 receptors that help the transmission of pain? 2. What are the 2 peptides that help the transmission of the second pain or inflammation or tissue damage or long term pain?

1. Glutamate AMPA NMDA 2. *Substance P* (neuropeptide) *Calcitonin gene related peptide* (CGRP)

1. {White or Gray} Matter makes up the dorsal & ventral horns in the spinal cord? 2. What type of cell bodies are found in the dorsal horn? 3. What type of cell bodies are found in the ventral horn?

1. Gray (gray in middle) 2. Sensory *inter*neurons 3. Motor neurons

*Cutaneous nerves: Dorsal Rami* 1. C2 is also called what? 2. It pierces what muscles? 3. after #2 it ascends to innervate the skin over what 2 areas of the skull?

1. Greater occipital nerve 2. semispinalis capitis and trapezius 3. the vertex and posterolateral area of the skull

1. What are *Rexed laminae*? 2. Into how many layers are these separated?

1. Histologically & morphologically similar groups of neurons in gray matter 2. separated into 10 layers (roman numerals)

1. (1) CN I - Olfactory 2. (1) CN II - Optic 3. (2) CN III - Oculomotor & CN IV - Trochlear 4. (2) CN V - Trigemnial & CN VI - Abducens 5. (6) CN VII - Facial CN VIII - Vestibulocochlear CN IX - Glossopharyngeal CN X - Vagus CN XI - Spinal Accessory CN XII - Hypoglossal

1. How Many CNs come off Telencephalon derived structures (cortex)? 2. How Many CNs come off Diencephalon derived structures (thalamus)? 3. How Many CNs come off Mesencephalon derived structures (midbrain)? 4. How Many CNs come off Metencephalon derived structures (Pons)? 5. How Many CNs come off Myencephalon derived structures (Medulla)? [This is helpful because you expect to find the nuclei for these structures found within that region of the brainstem]

1. What is it called when you have a disruption of CSF flow? 2. When CSF flow is obstructed, pressure increases, ventricles get bigger (at expense of surrounding brain), usually at [distal or proximal], [upstream or downstream] site 3. What is the only way to relive the pressure?

1. Hydrocephalus (water on the brain issue) 2. usually at *proximal*, *upstream* site 3. put in a shunt that goes to the parasternal cavity where it can be reabsorbed (better for excessive fluid in abdomen then brain)

*Anterior Jugular Veins (L&R):* Course: 1. descends from the level of what bone? 2. To the medial inferior most extent of what triangle? 3. it then pierces what fascia? 4. it continues inferiorly within what space? 5. in #4 it communicates with its opposite fellow via what? 6. it then turns [medially or laterally?] coursing deep to what muscle? 7. it ends by joining what vein?

1. Hyoid 2. Anterior triangle 3. investing fascia 4. suprasternal space 5. **Jugulovenous arch** 6. laterally coursing deep to the SCM 7. External jugular vein In writing if you want it: Course: descends from the level of the hyoid bone to the medial inferior most extent of the anterior triangle, pierces the investing fascia and continues inferiorly within the suprasternal space where it communicates with its opposite fellow via the jugulovenous arch. It then turns laterally coursing deep to the SCM to join the External jugular vein.

*Surface Anatomy:* 1. Where is the body of the Hyoid bone palpated immediately superior to? this is opposite what cervical vertebra? 2. what part of the hyoid boine are you able to palpate laterally?

1. Hyoid bone - body is palpable anteriorly immediately superior to the prominence of the thyroid cartilage (opposite the third cervical vertebra); 2. laterally its greater horn is palpable

*Epileptic Activity and Behavioral Clues to Cortical Origins* 1. __________________________ discharges that occur during a seizure may begin in a very discrete region of cortex and then spread to neighboring regions. 2. Seizures of M1 follow what type of homunculus movements? What about for S1? Can they have hallucinations? Is it the same for other senses?

1. Hypersynchronous discharges 2. Seizures of M1 follow motor homunculus movements, seizures of S1 follow somatosensory homunculus hallucinations (same for A1, V1, Olfactory, Gustatory, etc.)

1. What is CN XII? 2. What component does it have? 3. What does it do? 4. What does it also carry from the Posterior Cranial Fossa Dura to the DRG of ____________________?

1. Hypoglossal 2. GSE 3. Motor innervation to muscles of Tongue: Styloglossus, Genioglossus, Hyoglossus, and Intrinsic muscles of tongue. 4. GSA fibers of C1 & C2; spinal nerves of C1 & C2

Landmarks related to sphenoid bone 1. What do you call the depression for pituitary gland? 2. What is the origin of posterior clinoid processes? 3. What are the lateral projections of the dorsum sellae which provide attachment sites for the tentorium cerebelli? 4. What is the groove made by the internal carotid a.; located lateral to the sella?

1. Hypophyseal fossa 2. Dorsum sellae 3. Posterior clinoid processes 4. Carotid groove

1. Ansa Cervicalis 2. C1-C2 3. C2-C3 4. Lies in between the common carotid and internal jugular veins. 5. Surrounded by the carotid sheath and it is made up of investing, pretrachial, prevertebral, and visceral cervical fascia (so almost all of them). 6. The strap muscles (?? talk about them later) 7. Should have deep cervical lymph nodes all along this area, from the base of the skull to the root of the neck on lateral side of the sheath.

1. Identify #1 2. What cervical spinal levels are the superior roots from? 3. What cervical spinal levels are the inferior roots from? 4. Where does it lie? 5. What is it surrounded by and what is that made up of? 6. What does it innervate? 7. What is missing from this picture that is important with immune health? And where do they run from and to?

1. Internal jugular vein, CN X, IX, XI, and CN XII. Possibly the internal carotid as well. 2. CN IX, CN X, CN XI, and the jugular bulb (internal jugular vein). 3. the superior cervical ganglion.

1. If and individual fractures the petrous portion of the temporal bone, what structures are at risk for injury? 2. What are the structures that are exiting the jugular foramen? 3. What ganglion are byproducts of the nervous tissue exiting the jugular foramen?

Wallenberg's Syndrome Where in the pathway are the tracts impacted? (2)

1. Impacting *spinal trigeminal tract* of brainstem carrying ipsilateral pain/temp as it is *descending* to get to the spinal trigeminal nucleus 2. This is also the same place that you are getting ascending fibers from contralateral part of body of pain and temp. Horner's syndrome is a result.

Saving our denervating muscle... 1. How might we do the same amount of work with less musculature? 2. Greater discharge rates of α motor neurons can help how? 3. What sort of training makes all this possible? Why?

1. Improve *coordination* b/w activated muscles (↑ efficient innervation of "right" combo of activating agonists & inhibiting antagonists w/PT) 2. ↑ load-bearing w/o ↑ muscle mass 3. Training w/light loads can reduce variability of muscle activation (esp of slow fibers)

*Clinical Note* 1. In cases where metastatic cancer cells have been discovered in the supraclavicular nodes, what might a surgeon do (aim is to remove all traces of cancer). 2. With that aim, what is also removed? What is spared?

1. In cases where metastatic cancer cells have been discovered in supraclavicular nodes, surgeons may perform a radical neck dissection removing en bloc all of the deep cervical lymph nodes and surrounding tissue. 2. Since the aim is the removal of all traces of the cancer, superficial structures, including the cutaneous branches of the cervical plexus are removed, while the deeper more important structures such as the brachia! plexus, vagus and phrenic nerves are spared.

1. In mammals, the [left or right?] recurrent laryngeal nerve avoids the direct route between brain and throat and instead descends into the chest, loops around the aorta near the heart, then returns to the larynx. That makes it much longer than it needs to be. Interestingly, the longer [left or right?] RLN works in perfect harmony with the right laryngeal nerve.

1. In mammals, the *left* recurrent laryngeal nerve avoids the direct route between brain and throat and instead descends into the chest, loops around the aorta near the heart, then returns to the larynx. That makes it much longer than it needs to be. Interestingly, the longer *left* RLN works in perfect harmony with the right laryngeal nerve.

1. If there was a lesion on the ipsilateral side of this pathway, where would the lesion show up in the spinal cord? 2. If there was a lesion on the contralateral side of this pathway, where would the lesion show up in the spinal cord?

1. In the Lissauer's tract (this is where the nerve enters and then ascends 1-3 segments). 2. There would be a lesion in the spinothalamic tract.

*REVIEW* 1. What is the cortical area for gustitory response? 2. Afferent fibers communicating with it?

1. Insula (Frontal Operculum) 2. VPM Thalamus

*Lacrimal Gland:* 1. The Myoepithelial cells squeeze the secretory acini cells to push the secretions into what ducts? 2. What type of epithelium is in #1? 3. Multiple ducts lead to what structure of the conjunctiva? 4. what will the secretions mix with at #3?

1. Interlobular ducts 2. Stratified Cuboidal (which is also rare) 3. The fornix of the conjunctiva 4. secretions from the tarsal glands

1. What is the biggest drive brining the eyes in from the side of the skull at week 6 moving forward? 2. What is the area called where the two medial nasal prominences come together? 3. What are the areas that are associated with a fused medial nasal prominence (hint: #2 is apart of the list)?

1. It is the growth of the maxillary prominance as well as cell death that takes place between the medial nasal prominence (see photo) 2. The philtrum 3. Fused medial nasal prominences = nose ridge, tip, philtrum, and primary palate (she didnt talk about this specifically at this point, but i felt like it might be important. Man this sucks....)

*Extra-cranial Path of the Spinal Accessory Nerve CN XI* 1. Where does it exit the skull? 2. What muscle does it pierce? 3. What branches communicate with it? 4. What is the fiber composition for CN XI? 5. What is the track of CN XI to get to its target? What fibers join in?

1. Jugular foramen 2. SCM 3. C2-C3 for proprioception 4. GSE 5. Passes out from above Erb's point, or at it, runs across the floor of the posterior triangle, is joined by branches of C3 and C4 and then goes under the trapezius to innervate it.

*Tracking the Vagus Nerve Branches* 1. Where does the vagus exit the skull? 2. What is the first branch that is given off the vagus nerve? 3. What is the first ganglion present on the vagus n.? What fibers is it made up of?

1. Jugular formane

1. Where in the spinal cord would you expect to find Lissauer's Fasciculus? 2. What diameter fibers will you find in Lissauer's Fasciculus? 3. What modality cell bodies will you find in the dorsal horn of the spinal cord? 4. What diameter fibers will you find in the Posterior Funiculus?

1. Just lateral to Fasciculus Cuneatus 2. Large 3. Sensory 4. Large (remember, these were those that ascended instead of synapsing in the dorsal horn - flashcard 38)

*Pain Theories:* 1. Descartes (and others) believed pain was carried by specialized receptors (ie. We feel pain because pain receptors tell us that something is painful), what is the name of this theory? 2. How have people debated the theory above?

1. Labeled Line theory (most correct today) 2. Many have debated that pain is a matter of intensity of stimulus using already extant receptors (there is some modulation)

*External Jugular Veins (L&R):* Clinical notes: 1. Laceration of the external jugular vein along the posterior border of the SCM can lead to What? 2. this is do to what? 3. This is evidenced by hearing a _______ upon auscultation of the thoracic wall, 4. What are 3 other symptoms?

1. Laceration of the external jugular vein along the posterior border of the SCM can lead to an *air embolism* 2. This is due to negative intrathoracic pressure which sucks in air through the open vein 3. Bruits 4. cyanosis of mucous membranes, reduced flow of blood through the right atrium due to accumulated air, and dyspnea

*Fast fatigable* muscle fibers 1. {Larger OR Smaller} diameter? 2. Why pale muscle fibers? 3. {Larger OR Smaller} Alpha motor neurons? 4. {Large or Small} force? 5. Easily fatigued? 6. When would you use this type of muscle?

1. Larger 2. few mitochondria 3. Larger 4. Large force 5. Yes 6. Brief exertions that require large forces (eg. jumping)

*Cricoid:* 1. larger [Anteriorly or posteriorly?] and smaller [anteriorly or posteriorly?]? 2. What is the only cartilage in the larynx to form a continuous ring? 3. What cartilage in the larynx is the only immovable cartilage!

1. Larger posteriorly smaller anteriorly 2. You guessed it! its the Cricoid cartilage smarty pants! 3. IIIITTTTT'SSSS Cricoid cartilage how did you know!?!?!?!

*Lacrimal Gland:* 1. Does the lacrimal gland lie in the medial or lateral extent of the orbit? 2. the lacrimal gland is split into 2 parts by the aponeurosis of what muscle? 3. What are the 2 parts from #2?

1. Lateral 2. Levator Palpebrae Superioris 3. Orbital part and Palpebral part

*Ethmoid Bone:* 1. What portion of the ethmoid bone contributes to the lateral walls of the nasal cavity? 2. #1 has a bony portion of it jetting out into the nasal cavity, what is this called? 3. What Plate is midline on the ethmoid bone, it also is the superior part of the nasal septum/

1. Lateral Mass (Labyrinth) 2. Middle Concha 3. Perpendicular plate

Location in the cord tells you type of pathway... 1. Voluntary movement PWs found in what part of the cord? 2. Maintenance of posture & balance PWs found where in cord?

1. Lateral cord (motor) 2. Ventromedial cord (posture/balance)

1. Where would you find portions of the choroid plexus? 2. What does it do and what is it made of?

1. Lateral ventricles, third ventircle, and the fourth ventricle. 2. Makes CSF, vascular tissue + pia mater + ependymal cells

*Cervical Fascias: pre-vertebral fascia* 1. What are the lateral attachements? (1) this forms the floor of what triangle? where it covers what 4 muscles? 2. What are the posterior attachments with the nuchal fascia? (3) 3. posteriorly and inferiorly fuses with what fascia of the deep back?

1. Lateral: attaches to cervical transverse processes and *forms the floor of the* *posterior cervical triangle* where it covers the scalenes, levator scapulae, splenius and semispinalis muscles. 2. Posterior (nuchal fascia): from the nuchal lines and mastoid processes to cervical spinous processes; 3. inferiorly fuses with the thoracolumbar fascia of the deep back

*Layers of the Neocotex* 1. What is the first layer called? 2. What does direct migration mean? 3. Do these cells stay around for a while? 4. What specific type of cell do they contain? 5. What is the importance of horizontal cells?

1. Layer I—Molecular layer 2. They migrated first and dont have cells pushed through them at cortical development. 3. Cells mostly die off 4. Contain Cajal-Retzius (horizontal) cells 5. They are important for the patterning of the cortex)

Problems can depend on what side substantia nigra gets knocked out. Left or right: 1. would cause speech coordinaiton issues?

1. Left

*CERVICAL PLEXUS - Sensory* 1. What nerve gives sensory innervation to scalp above and behind the ear, upper portion of dorsum of ear? 2. What nerve gives cutaneous innervation over the superior portion of the SCM and angle of the mandible and parotid region? 3. What nerve gives sensory innervation to skin over the anterior triangle of the neck? 4. What nerve forms ansa cervicalis superficialis by anastomosing with the cervical branch of the facial n. deep to the platisyma?

1. Lesser occipital n. 2. Great auricular n. 3. Transverse cervical n. 4. Transverse cervical n.

*Structure of the Eye: Sagittal* 1. The non-neural portion of retinal layer continues anteriorly and lines what 2 things?

1. Lines the Ciliary Body and Posterior Iris

Shenoparietal sinus 1. located between dura along the posterior edge of what part of the sphenoid bone? 2. Drains dura to what?

1. Located bilaterally between opposed layers of dura along the posterior edge of the *lesser wing* of the sphenoid bone b. 2. Drains dura to the *cavernous sinus* In pic 11 left sphenoparietal sinus 12 right sphenoparietal sinus 14 cavernous

1. Where are proprioceptive receptors located? 2. What do they detect? 3. What are the fibers that detect muscle length? 4. What are the ones that detect muscle tension?

1. Located within muscles & tendons 2. Detect limb & joint position, movement (kinesthesia) 3. Muscle spindles (muscle length) 4. Golgi tendon organs (muscle tension)

Arachnoid mater 1. Covers the brain but does not dip into the sulci except for what exception? (1)

1. Longitudinal fissure

*Sternocleidomastoid (SCM)* 1. What is the origin of the sternal head? 2. What is the orgin of the Clavicular head? 3. What is the inserstion?

1. Manubrium (anterior surface) 2. Proximal 1/3 of clavicle (superior surface) 3. Mastoid process (lateral surface), superior nuchal line (lateral half)

*extrinsic Laryngeal muscles:* 1. Many of these attache to what bone? 2. They function to do what 3 things to the larynx as a whole? 3. What 3 groups of muscles are these?

1. Many attach to the hyoid bone, 2. function to elevate, depress, or constrict the larynx as a whole 3. (supra/infra hyoid strap muscles, pharyngeal constrictors)

1. What bone makes up the anterior 3/4 of the hard palate? 2. What bone makes up the posterior 1/4 of the hard palate?

1. Maxilla 2. Palatine bones

*Bones of the Nasal Cavity: Maxilla* 1. What is the largest bone making the hard palate? 2. What part of #1 forms anterior 3/4 of Hard Palate and floor of Nasal Cavity? 3. What is buried within #1? 4. #1 forms portion of laterIal walls of what cavity? 5. What on #1 contributes to the nasal septum?

1. Maxilla 2. Palatine Process 3. Maxillary sinus 4. Maxilla helps form portion of lateral walls of nasal cavity 5. Nasal Crest

*Nasal Cavity: Septum* 1. What 2 things make up the hard palate? 2. What are the 2 plates of the Sphenoid bone? 3. What comes off one of the plates in #2? 4. What plate is part of the Ethmoid bone?

1. Maxilla anteriorly and Palatine bones posteriorly 2. Lateral Pterygoid plate and Medial pterygoid plate 3. the Hamulus comes off of the Medial Pterygoid Plate 4. the Perpendicular plate

An accessory meningeal artery is sometimes present.... 1. What does it branch off of? 2. Through what foramen does it enter skull? 3. Supplies dura of which fossa?

1. Maxillary a. 2. Foramen ovale. 3. Middle cranial fossa

Middle Meningeal artery 1. Branches off of what? 2. Through what foramen does it enter middle cranial fossa? 3. Where does it supply blood?

1. Maxillary a. 2. Foramen spinosum 3. provides blood to *all supra-tentorial areas of the dura* except to the floor of the anterior cranial fossa

What are the terminal branches of the external carotid a.? What is the pneumonic for the branches of the carotid artery?

1. Maxillary artery (or artery of the deep face) 2. Superficial temporal a. Sally (superior thyroid) Anne (ascending pharyngeal) Likes (lingual) Flirting (facial) On (occipital) Philidelphias (posterior auricular) Main (maxillary) Streets (superficial temporal)

*Arch 1* 1. The first arch becomes what process and prominence? 2. It also becomes the Stomodeum which will become what?

1. Maxillary process and Mandibular prominence 2. Oropharyngeal membrane that will disintegrate to become the opening of your mouth

*Arch 1* Bones and CT of Face 1. The Maxillary process becomes what 3 things? 2. The maxillary process is [ventral or dorsal?] 3. The mandibular process becomes what? which then becomes what 2 things? 4. the mandibular process is [ventral or dorsal?]

1. Maxillary process: Premaxilla; maxilla; zygomatic; part of temporal 2. dorsal 3. Mandibular process: Meckel's cartilage -> Incus & malleus 4. (ventral) they are all M's just remember meckels becomes incus and malleus

*Lingual a.* 1. Where does it usually arise from? 2. Where does it pass deep? 3. Where does it go and what branches does it provide? (SAYS IN LECTURE THAT WE DONT NEED TO KNOW THE BRANCHES)

1. May arise from a common trunk with the facial artery usually opposite the greater horn of the hyoid. 2. It passes deep to the posterior border of the hyoglossus muscle 3. Enters the tongue where it provides the following branches: (1) Dorsal lingual a. (2) Deep lingual a. (3) Sublingual a.

1. Trunk → Shoulder → Forearm → Hand are located {Lateral → Medial *OR* Medial → Lateral} 2. Where are the neuronal cell bodies to the flexors located? 3. Where are the neuronal cell bodies to the extensors located?

1. Medial → Lateral (more distal = more lateral in horn) - same for leg 2. More dorsal (image) 3. More ventral (image)

*Branches of the Vagus N* What are the branches of the vagus n and what fibers do they give off?

1. Meningeal (GSA) 2. Auricular (GSA) 3. Pharyngeal (SVE) 4. Nerve to the carotid body (GVA) 5. Superior laryngeal n. 6. Cervical Cardiac Branches (GVE-P, GVA) 7. Recurrent larygneal n. (SVE, GVA, GVE-P)

1. What receptors respond to pressure in the skin? 2. Which ones respond to skin stretch? 3. How about fine touch?

1. Merkel disks (pressure) 2. Ruffini's corpuscles (skin stretch) 3. Meissner's corpuscles (fine touch)

(I like the way he split this up in lecture, so i'm going to mimic his approach) 1. What is the brain structure that is derived from the mesencephalon? *2.* What are the brain structures that derive from the metencephalon? 3. What is the brain structure that derives from the myelencephalon?

1. Midbrain *2. Pons + Cerebellum* 3. Medulla

Recall 1. In which fossa is the cavernous sinus? 2. What does it's outer walls house? 3. Waht is located internally?

1. Middle cranial fossa 2. C.N.s Ill, IV, V1 & V2. 3. internal carotid artery and C.N. VI

1. When is the migration of cerebral cortex neurons complete by? 2. How then are the 6 layers of cells in the cerebral cortex produced?

1. Migration of cerebral cortex neurons is complete by ~ 24 weeks 2. The 6 layers are produced via 6 distinct waves of cell migration

*Granule Cells in the Cerebellar Cortex* -We are getting a lecture on these next week, but here is a brief intro 1. What types of fibers are the PST and Cuneocerebellar pathways coming in as? 2. What cells are they synapsing in? 3. What layer are these cells found in that are being synapsed on?

1. Mossy fibers 2. Granule cells 3. In the granule layer of the cerebellar cortex

Pharyngeal plexus - *i: CN IX* 1. Mostly Motor or Sensory? 2. What areas in the pharynx does it not innervate (2)? 3. What motor does it do? 4. What about special sense?

1. Mostly sensory from mucosa 2. Above Auditory tube (CN V or VII) *&* Piriform Recess (CN X) 3. Motor to stylopharyngeus 4. Taste to posterior 1/3 tongue

1. What info in the main *descending* PWs of spinal cord? 2. Where are they found (1)?

1. Motor 2. Lateral Corticospinal tract

Direct Basal Ganglia Pathway 1. Where does it all begin? 2. Where does that project to? (2) 3. What neuro trans is #1 releasing?

1. Motor cortex 2. *Muscle* and *Striatum* (caudate and putamen) 3. Glutamate

Super general pathway of corticobulbar tract 1. Starts in which cortex? 2. Descends down to where? (2 options) 3. What nucleus is target if it goes to spinal cord (in #2)?

1. Motor cortex 2. Brainstem or upper Cervical cord 3. Nucleus of spinal accesory nerve

*Polyneuropathy* 1. What is damaged? 2. Example of a cause? (sorry) 3. Symptoms?

1. Multiple peripheral nerves are damaged 2. Often disease process (diabetes, alcoholism) 3. Numbness/tingling, extreme sensitivity to touch, weakness/loss of proprioception in extremities that radiates proximally

1. What is the resting level of tension in a muscle? 2. Why? 3. With this in mind, what is going on with LMN (esp. in response to UMN)?

1. Muscle tone 2. Allows muscle to make an optimal response to voluntary or reflexive movement by keeping them in a state of *readiness* to resist stretch 3. LMNs often active in reflex PWs w/o any UMN input

1. Do the dural venous sinuses have valves? 2. In which vein does the flow of all sinues eventually end up?

1. No 2. Internal jugular vein

*External Carotid a.* 1. Does it continue in the carotid sheath? 2. Where does it branch from the common carotid? 3. What are the branches of the external carotid a. that are within the carotid triangle? 4. What is it then crossed by before it gives off its 5th and 6th branches (and what are those branches)?

1. NO! 2. Branches from the common carotid in the *carotid triangle near the superior horn of the thyroid cartilage* where it usually gives off its first four branches. 3. *superior thyroid* *ascending pharyngeal* *lingual* *facial*. 4. As it ascends, it is *crossed laterally by the posterior belly of the digastric and stylohyoid muscles* where it gives off its fifth and sixth branches: *occipital* and *posterior auricular branches*.

*INTERNAL JUGULAR VEINS* 1. Are they the largest veins in the leg? 2. Where do they receive blood from? what sinuses are involved when draining one of these structures? 3. What does it begin as? Where is that located? 4. As it courses in the carotid sheath, how does its relationship change in reference to the carotid arteries?

1. NO! They are the largest veins in the head and neck! (main vein that drains the brain) 2. Receives blood from the face, neck and the brain via the dural venous sinuses 3. Begins as a dilatation (superior jugular bulb) at the jugular foramen located at the junction of the temporal and occipital bones 4. As it descends in the carotid sheath, its relationship to the carotid arteries changes, such that superiorly it lays posterolateral, in mid-course lateral and inferiorly lays anterolateral.

1. Is the neocortex uniform throughout each region/lobe of the brain? 2. What are the characteristics we see for motor heavy regions of the brain? What zone will be the largest? 3. What are the characteristics we see for sensory heavy regions of the brain? What zone will be the largest? 4. Which area would be thickest, motor or sensory?

1. NO!! 2. Large amounts of pyramidal neurons, thick layer III zones. Frontal and parietal would be characteristic of this zone (with frontal > parietal). 3. Small pyramidal neurons, lots of sensory cortices. These tend to have a larger layer IV. Parietal is a better example of this. 4. MOTOR > SENSORY!

1. Is the hyoid bone part of the larynx? 2. What does the hyoid bone do in the larynx? 3. The strength of the larynx comes from boney or cartilaginous structures?

1. NOPE 2. (attachment for many extrinsic muscles) 3. Cartilaginous structures

1. Are visceral pain afferents as localized as somatic pain afferents? 2. Why do we get referred pain?

1. NOPE 2. This is because of the pain fibers synapses in the dorsal horn with alot of other things synapsing around it especially the somatic body wall, and it can some crossover. its a mess is what he says.

*(Neo)spinothalamic pathway:* 1. Are neospinothalamic and spinothalamic pathway different? 2. What type of information does it transmit? (3) 3. Where is the point of origin (3) and the receptors involved(1)?

1. NOPE they be the same ting 2. Type of information: *Pain, temperature, poorly localized touch* 3. *Free nerve endings (TRP channels)* in skin, viscera, muscles

*Nares:* 1. What grows in the nares that is super attractive to the opposite sex and helps you get a mate?? 2. What is the function of #1? 3. Are you more or less likely to have asthma if you have more of #1? 4. do Dogs have #1? do Cows have #1? 5. Is there a patent for artificial #1?

1. NOSE HAIRS 2. Filter out large (>20um) particulates from incoming air. Pollen falls in this size range 3. Less likely (stop shaving your nose hairs Andy) 4. nope, nope, 5, YUP

1. Where are the bones of the skull coming from (2)? 2. Where is the cut off for bones of that head that will come from in #1?

1. Neural crest cells and scleretome 2. Check out the image. The line is behind the ear/pituitary fossa.

Quick review: 1. What are the two stages of nervous system development? 2. What is gliogenesis? 3. When does it take place? 4. What specific neural system differentiates from neural crest cells? 5. What is the name of the 6 layer portion of the cerebral cortex?

1. Neurogenesis and glialgenesis. 2. The development of glial cells in the brain. 3. takes place during the second and third trimesters of pregnancy and early postnatal development 4. PNS 5. The Neocortex

*Inferior Constrictor* 1. Do you remember what a Zenker's Diverticulum is? 2. What is it?

1. No 2. When, after a buildup of pressure w/in the pharynx, the mucosa of the pharynx pushes between the 2 parts of the inferior constrictor & you get a diverticulum "and food can accumulate in here, so it's a *very unpleasant* thing"

*CNS Development Major Events* 1. Will we see the same pattern of development across 2 different nervous systems? 2. How much of the protein coding genes are involved in development of the nervous system? 3. Most neuronal production and migration occurs during what months of development? 4. Do the formation of neural connection (what is their name?) and production of myelin sheaths continue after birth?

1. No 2 nervous systems ever develop the same way (also, different parts of the brain are going to grow at different rates during development) 2. *About half* the protein coding genes are also in some way involved in development of the nervous system 3. Most neuronal production and migration occurs during the *third through fifth months* of development 4. The formation of neural connections *(neuropil)* and production of myelin sheaths *continue after birth*

*Palate* 1. Are the lateral palatine shelves fused by week 6 of development? What is in the way? 2. What about by week 7? What has moved by this time? 3. When does fusion of the lateral palatine shelves take place? What descends to fuse with the secondary palate? 4. How is the uvula formed?

1. No, tongue is in the way 2. Nope, not yet. Tongue is out of the way and the palatine shelves are growing medially and more horizontal. 3. Fuse with primary palate and with each other on the midline. Nasal septum descends to fuse with secondary palate. 4. Uvula created by fusion at caudal end of palatine shelves.

*Iris:* 1. Does the anterior Iris have an epithelium? If so, how many layers of epithelium does it have and how are they joined? 2. Does the Posterior Iris have an epithelium? If so, how many layers of epithelium does it have, and how are they joined? 3. what lies on the surface of the Anterior Iris if there is no epithelium?

1. Nope, so zero. 2. YUP, it has 2 apposed layers of epithelium, joined apex to apex 3. Fibroblasts and melanocytes lie on the surface - it is very rare to not have epithelium on top of a tissue. but the iris makes up for it by having 2 epithelial layers on the posterior side. Dr. Woodbury said the only reason it did this was probably because someone told the Iris it couldn't.

*Respiratory Epithelium:* 1. What does psudostartified mean? 2. what 2 things secrete mucus? 3. What is the job of #2 4. What moves #2 and where does it move it?

1. Nuclei occupy multiple levels of the epithelium but all cells contact the basement membrane 2. Goblet cells and Mucosal Glands (not shown in picture) 3. Secrete mucus, humidify air, and pick up particles in air. 4. Cilia on the ciliated cells move it toward the pharynx

*Posterior Triangle:* 1. is the occipital triangle or omoclavicular triangle larger? 2. s the occipital triangle or omoclavicular triangle superior? 3. The Occipital triangle is bounded by what 3 muscles?

1. Occipital triangle is larger 2. Occipital triangle is superior Omoclavicular triangle is inferior 3. bounded by the trapezius, SCM, and inferior belly of the omohyoid.

Review: 1. Only muscle that elevates the brow? 2. What muscle opposes the muscle in Q1? New Muscles: 3. What muscle depresses the medial brow & wrinkles the skin b/w your eyes? 4. What (deeper) muscle draws brow medially & inferiorly? 5. These muscles are the target for what Tx?

1. Occipitofrontalis 2. Obicularis Oculi 3. *Procerus* 4. *Corrugator Supercilii* 5. Botox

1. What muscle defines the scalp? 2. 3 parts to this msucle? Bonus: Do you know another name for this muscle?

1. Occipitofrontalis 2. i: Frontal part ii: Occipital part iii: Aponeurotic part (*Galea Aponeurotica*) Bonus: Epicranius

*Olfactory Epithelium:* 1. It occupies what 3 things in the nasal epithelium on internal surface of the ethmoid bone? 2. Is there alot or minimal amount of olfactory epithelium?

1. Occupies: roof, lateral wall-superior concha (part), and Superior reaches perpendicular plate 2. minimal amount

1. Name for CN III? 2. What are the components? 3. What are each responsible for?

1. Oculomotor 2. GSE and GVE-P 3. GSE: MOTOR; Innervate Extraocular M.'s which assist in ROTATIONAL movement of globe. GVE-P: Parasympathetic innervation of intra-ocular muscles .of the eye responsible for changing the shape of the lens for accommodation (ability to focus on objects both near and far) and for narrowing the pupil (pupillary constriction); via inferior division of CN Ill and the ci/iary ganglion

Look on the back of this card too...

1. Of 1-6, which particpate int he PCML pathway? 2. Which particpate in the spinothalamic pathway? 3. Which participate in the spinocerebellar tract? What is the region called where they are found? 1. 1 and 2 2. 3 and 6 3. 4 and 5; the region is called the lateral faniculus

1. What is the name of CN I? 2. What component/s does it contain? 3. What sense is it responsible for? 4. Why is it designated as (the answer to) #2?

1. Olfactory 2. SVA 3. Sense of Smell 4. Designated as a Visceral Afferent Nerve b/c it assists the body in prep for eating. Causes reflex salivation and increased gastric motility.

*Posterior Triangle:* 1. is the occipital triangle or omoclavicular triangle smaller? 2. s the occipital triangle or omoclavicular triangle inferior? 3. The omoclavicular (subclavian or supraclavicular) triangle is bounded by what 3 things?

1. Omoclavicular triangle is smaller 2. Omoclavicular triangle is inferior 3. bounded by the inferior belly of the omohyoid, clavicle and SCM

1. What is the name of CN II? 2. What component/s does it contain? 3. What sense is it responsible for?

1. Optic 2. SSA 3. Afferent fibers of the retina; primary receptor for the sense of sight

What are all the foramen (7) found in the sphenoid bone?

1. Optic Canal 2. Superior orbital fissure 3. Foramen rotundum 4. Foramen ovale 5. Foramen spinosum 6. Hiatus for Greater petrosal n. 7. Hiatus for Lesser petrosal n.

*Eye Formation: Sclera and Choroid* 4th step. 1. The Outer layer differentiates to what epithelium? 2. The Inner layer becomes what?

1. Outer retinal layer differentiates to *Retinal Pigmented Epithelium* 2. inner layer becomes *Neural Retina*

Cavernous sinus is named for it's trabeculated appearance... 1. And it's outer walls house what? (4) 2. What is located *internally*?

1. Outer wall houses: *C.N.s Ill, IV, V1, V2* 2. *internal carotid a.* and *C.N. VI*

*Skull and Face development:* 1. PA1 becomes what parts of what bones? (2) 2. PA2 becomes what? 3. What 2 arches are part of the Frontonasal prominence?

1. PA1 (mandibular arch and maxillary process) 2. PA2 (hyoid arch) 3. Frontonasal prominence - PA1 and PA2

*Somatic Sensations* Of the following, label whether they will participate in the PCML or Spinothalamic pathways: 1. Vibration 2. Proprioception, conscious (limb & joint position) 3. Nociception 4. Discriminative touch (fine touch, 2-point) 5. Thermal sensation 6. Non-discriminative touch (crude touch) 7. Proprioception, unconscious 8. 3D form (sterogenosis) 9. Itch

1. PC-ML 2. PC-ML 3. Spinothalamic 4. PC-ML 5. Spinothalamic 6. Spinothalamic 7. Spinothalamic 8. PC-ML 9. Spinothalamic

1. What is lost in Parkinson's Disease? 2. What are the characteristic symptoms?

1. PROGRESSIVE loss of *DOPAMINE neurons* (in substantia nigra) 2. Characteristic MOTOR TRIAD phenotype A. resting tremor B. Rigidity (lead pipe) C. Bradykinesia (akinesia) (poor movement contorl)

*Spinothalamic Tract PW* (the basics for now) 1. What type of info? 2. Where does it enter spinal cord & what happens there? 3. What happens after synapse? 4. In which part of cord does it ascend? 5. Where does it end up?

1. Pain, Temp, Crude touch, Itch (ascending) 2. Enters *dorsal root* (eg on R) & synapse in *dorsal horn* 3. Crosses midline here (eg to the L) 4. Ascends w/in ventral part of lateral funiculus (*anterolateral*) on opposite side of the spinal cord 5. Ends in primary somatosensory cortex [*R body → L spinal cord → L cortex*]

*Spinothalamic Pathway REVIEW* 1. What type of information do they carry? 2. What type of receptors are involved? Where are they found? 3. Where are the primary cell bodies for this pathway? 4. Where is the 1st synapse? From a pain management standpoint, what is the difference between the two of them?

1. Pain, temperature, poorly localized touch 2. *Free nerve endings (TRP channels)* in skin, viscera, muscles 3. DRG 4. Lamina I, II; I = pain and temperature information cannot be modulated by input from the brain where information from II can be modulated from the brain to lessen the perception of the pain.

1. The palatine tonsil sits b/w what 2 muscles? 2. What makes up the lateral capsule of the tonsil? 3. If you remove the tonsil, what 3 major things are visible (HINT: they pass through gap 2) 4. Wait... where is gap 2 again?

1. Palatoglossus & Palatopharyngeus (in tonsillar fossa) 2. *Pharyngobasilar Membrane* 3. *Stylohyoid Lig., CN IX (w/tonsillar branches), Robust blood supply* 4. b/w superior & middle constrictors

*Eyelid:* 1. What lines the inner eyelid? 2. What is the name of the cul de sac made from the palpebral conjunctiva being reflected onto the eye? 3. What important even happens in #2? 4. What is the name of #1 when it covers the eye? 5. Does #5 continue onto the cornea?

1. Palpebral Conjunctiva 2. Superior Fornix of Conjunctiva 3. Lacrimal Gland Empties there where it provide tears to coat the eye so it doesn't dry out. 4. Bulbar (Ocular) Conjunctiva 5. no way Jose we want all the light we can get going in there

*REVIEW* 1. What Lobe is touch coming from? 2. What is the cortical area for touch? 3. Gyrus? 4. Broadmann's area? 5. What afferent area is helping? 6. Efferent?

1. Parietal 2. Primary somatosensory cortex (S1) 3. Post-central gyrus 4. 3,1,2 5. VPM/VPL Thalamus 6. S2

1. Within what structure does the Facial Nerve (VII) travel (& even *branch*)? 2. With what does it travel (2)?

1. Parotid Gland 2. External Carotid A & Retromandibular V

*Occipital a.* 1. What is the course of the artery and what does it branch off of? 2. When does it become superficial? When this happens, what fascia does it pierce?

1. Passes posteriorly from the external carotid at the inferior border of the posterior belly of the digastric to pass between the transverse process of the atlas and the mastoid process (which it grooves). 2. It becomes superficial at the superior extent of the posterior triangle (apex) where it pierces the cervical fascia at the point where the trapezius and SCM come together.

*Posterior Auricular a.* 1. Where does it pass from the external carotid? 2. Where does it course from there? 3. What are the branches that it gives off (5)?

1. Passes posteriorly from the external carotid at the superior border of the posterior belly of the digastric 2. It course posterior to the auricle (external ear) posterior to the external acoustic meatus and anterior to the mastoid process. 3. Its branches include: (1) Muscular branches to surrounding musculature (2) Parotid branches (3) Stylomastoid (to middle ear) (4) Auricular (to scalp (5) Occipital (to scalp)

*Branches of the Vagus N* 1. What is the track of the recurrent laryngeal n (R and L specific)? 2. How do they get to the larynx after they "recur"?

1. Passes superiorly from an inferior position or otherwise "recurs" near the root of the neck on the right or from the upper thorax on the left. On the right side, this nerve recurs around the subclavian artery; on the left, around the aortic arch at the ligamentum arteriosum. 2. They both eventually reach the larynx by coursing in the connective tissue interval between the trachea and esophagus posterior to the cricothyroid joint.

*Retina:* 1. What is the difference b/w the Peripheral Retina and Central Retina?

1. Peripheral vision is poor because Peripheral retina is thinner and has fewer cells in all layers. Particularly smaller Retinal ganglion cells (RGC) layer

What are the 7 things that do not line up with the labeled line theory?

1. Phantom limbs 2. Pain on the battlefield 3. Depression and pain 4. Lack of sleep and pain 5. Chronic Pain 6. Placebos and Nocebos 7. Pain Sensitization

1. Which nerve travels with the first pharyngeal arch? 2. What portion of the facial development will this arch and nerve contribute to? (3)

1. Pharyngeal Arch 1 = *Trigeminal n. (CN V)* 2.*Maxillary process* (Arch 1) *Mandibular process.* (Arch 1) *Frontonasal process*

The vagus n. will supply which pharyngeal arch? Be specific with branches of vagus n.

1. Pharyngeal Arch 4 = Superior laryngeal n. (branch of Vagus n.) 2. Pharyngeal Arch 6 = Recurrent laryngeal n. (branch of Vagus n.)

1. What's found on the roof of the *Nasopharynx*? 2. What's found at the posterior portion of the nasopharynx (behind the *Torus Tubarius*) (2)?

1. Pharyngeal Tonsil (adenoid when inflamed) 2. Pharyngeal Recess w/tubal tonsils

1. What are segmental swellings along the head and neck? 2. what week do they appear? 3. What week do they differentiate into terminal structures? 4. What layers does it contain out of the main 3? 5. what are the 5 things it is composed of

1. Pharyngeal arches 2. 4th week 3. by the end of 7th week 4. All of them! endoderm, mesoderm, and ectoderm 5. Composed of endoderm (pharynx), paraxial (muscles) and lateral plate mesoderm (blood vessels; laryngeal cartilages), neural crest (bones/CT), and ectoderm (oropharynx).

1. Venous drainage primarily through what major venous structure? 2. This structure connects to what 5 major veins?

1. Pharyngeal venous Plexus 2. i: Superior Thyroid Vein (to Internal Jugular) ii: Inferior Thyroid Vein (to L Brachiocephalic) iii: Internal Jugular iv: Facial Vein v: Pterygoid Venous Plexus

*Cutaneous nerves: Ventral Rami* Supraclavicular nerves(C3,4) 1. Clinical Note: The cutaneous branches of the cervical plexus are locally anesthetized (cervical nerve block) during the normal course of surgical approaches to superficial ·or deeper areas of the neck, i.e., radical neck dissection of cancerous lymph nodes, etc. Concomitantly, What nerve. shares spinal cord levels of innervation (C3-4) with the spinal cord levels of origin of the cervical plexus? 2. therefore the ipsilateral hemidiaphragm will also be paralyzed. Care must be taken to not utilize this procedure on patients with significant __________________ or _______________ disease.

1. Phrenic nerve 2. respiratory or cardiac disease.

1. Does the cavernous sinus drain anteriorly, laterally, medially or posteriorly? 2. what does it drain into? (2)

1. Posterior 2. superior and inferior petrosal sinuses In pic: 14 Cavernous sinus 15 Superior petrosal sinus 16 Inferior petrosal sinus

*Aqueous humor:* 1. produced in what chamber? 2. Flows thru what to get to the other chamber? 3. Reabsorbed by what to get into the canal of schlemm? 4. #3 is located at what Angle?

1. Posterior Chamber 2. Pupil 3. Trabecular meshwork 4. *IridoCorneal Angle*

1. What are the things that make up the carotid triangle?

1. Posterior belly of the digastric muscle, superior belly of the omohyoid, and the anterior edge of the SCM

*External Jugular Veins (L&R):* What are its 4 tributaries?

1. Posterior external jugular vein (from lateral occiput) 2. Transverse cervical vein 3. Suprascapular vein 4. Anterior jugular vein

1. Where do these tracts enter the spinal cord? What do they hitchhike with (and what particular fibers do the hitchhiking)? 2. Where do the posterior spinocerebellar tract/cuneocerebellar tract decussate? 3. Where is the second synapse for the tracts in #1? How does it get into the cerebellum? 4. What is the final destination of these tracts? Via what type of cells?

1. Posterior funiculi (hitchhikes with dorsal columns; this is more of the cuneocerebellar tract) 2. NONE 3. vermis/paravermis of the cerebellum via inferior cerebellar peduncle 4. Deep cerebellar nuclei (via purkinje cells)

Lymphatics of posterior Δ - *Transverse cervical nodes* 1. Receive lymph from where (3 regions)? 2. Receive lymph from which nodes (2 specific)? 3. Drain into what nodes (specifically)?

1. Posterior thorax (under trap), lateral neck, ant/sup thoracic wall (incl. mammary gland) 2. *Accessory chain of nodes* & sometimes apical nodes of axillary system 3. *Inferior deep cervical nodes* (along internal jugular vein) → jugular lymph trunk or internal jugular or subclavian vein.

*Pharyngeal Pouch Derivatives:* Match each derivative to either Pouch 1, 2, 3, or 4 1. Forms inferior parathyroid glands and thymus 2. Forms auditory tube, middle ear, and contributes to tympanic membrane, mastoid air cells 3. forms superior parathyroid glands and ultimobranchial body (NC) that is incorporated into the thyroid. 4. forms palatine tonsillar fossa.

1. Pouch *3* forms inferior parathyroid glands and thymus 2. Pouch *1* forms auditory tube, middle ear, and contributes to tympanic membrane, mastoid air cells. 3. Pouch *4* forms superior parathyroid glands and ultimobranchial body (NC) that is incorporated into the thyroid. 4. Pouch *2* forms palatine tonsillar fossa. Note: Tonsils formed by other invading/migrating tissue

From the mesencephalic nucleus of V, fibers have many different destinations. What type of info will be sent to the: 1. Cerebellum? 2. Vestibular nuclei? 3. Reticular formation?

1. Proprioception 2. Proprioceptive, reflex 3. Change behavioral state

*Cervical Fascial Spaces:* 1. What is the name of the second space? 2. it is located b/w what 2 layers of fascia? 3. It extends from the level of the attachment of what muscle group? to what bone and cartilages above? 4. it then goes to the attachment of the pericardium to the roots of the major vessels in what part of the mediastinum below?

1. Pre-tracheal or visceral space 2. Located between the deepest layer of infrahyoid fascia and the pre-tracheal fascia 3.Extends from the level of the attachment of the *infrahyoid muscles* to the *hyoid bone* and *thyroid cartilage* above, 4. to the attachment of the pericardium to the roots of the major vessels in the superior mediastinum below

*REVIEW* 1. What is the first neuron in the chain of afferent neurons? What type of neuron would that be? 2. Where does the 2nd order neuron go? 3. Where does the 3rd order neuron go? 4. What types of neurons usually make up the 2nd and 3rd order neurons (specific type of neuron) 5. What is the "gatekeeper" of the brain? Why is this important?

1. Primary afferent neuron. They are pseudounipolar neurons. 2. They synapse with the primary afferent neuron, decussate across the spinal column, and then synapse with the Thalamus (3rd order). 3. They go from the thalamus to the cerebral cortex. 4. These are usually multipolar 5. The thalamus is the gatekeeper. It will decide when to allow and when to shut off different sensory information to the brain from the body (reaching conscious level sensation).

*Frontal Lobe* 1. What is Broadmann area #4? What type of fibers will be present here (association/commissural/projection)? 2. What is #6? What is important that happens here? 3. 44,45? What type of muscles do these cells innervate?

1. Primary motor area, also known as *M1* 2. Premotor area, supplementary motor area. This is where motor planning takes place AND connecting complex motor movements (like throwing a ball) 3. Broca's area (only on the left) and they innervate muscles of speech. Its like a premotor area of the muscles that activate our vocal apparatus.

*Parietal Lobe* 1. What is Broadmann area #1,2, and 3? 2. What about 5 and 7? what happens here? 3. what about 39? and 40?

1. Primary somatosensory area, also known as *S1*. 2. Somatosensory association area; this is where all the primary senses together. 3. Angular gyrus and supramarginal gyrus. these are important in our language abilities (its about combining all of our language abilitys like seeing letters and the form of them. comes from the posterior parts of temporal and inferior parts of parietal).

Dorsal trigeminothalamic tract 1. What nucleus is involved? 2. What sensory modalities are found in the DORSAL Trigeminothalamic tract? 3. Ipsilateral, contralateral or bilateral??

1. Principal (main, chief) Sensory Nucleus 2. Fine touch 3. Ascends Bilaterally

What characteristics (3) of the spinal cord differ from one segment region to the other?

1. Proportion of Gray & White matter (size of posterior columns) 2. Shape of Gray matter (size of ventral horns) 3. Presence of specific nuclei

1. What will a golgi stain show in the cortex? 2. What about a nissel stain? 3. What about a weigert stain? 4. What do we use these stains for?

1. Pyramidal neurons 2. Smaller pyramidal neurons 3. White matter and other portions that are not the big cell bodies 4. To differentiate the different layers and histologic appearance of the layers themselves.

Cavernous sinus *1. Receives blood from what veins?* 2. what sinus?

1. Receives the *superior ophthalmic v.* and cerebral veins and emissary veins from the pterygoid plexus of veins 2. sphenoparietal sinus,

*Generalized Ascending Pathway* 1. What is the first portion of the chain in an ascending pathway? 2. After step one, what type of potential is sent and on what neuron [primary/secondary/tertiary]? 3. Where is the cell body *usually* found for #2?

1. Receptor! the chain starts out with a receptor exciting a neuron. 2. It sends out a *generator potential* down the primary neuron. 3. Found usually in the DRG.

Garrett's Fav: *Rubrospinal tract* 1. Origin? 2. Decussates?If so, where? 3. Destination? 4. Affect what musculature? 5. When would this be used?

1. Red nucleus (rostral midbrain) 2. Decussates in anterior tegmentum 3. To cervical spinal cord 4. Laterally-based tract, involved w/flexor muscles (arm?) 5. Not really known what it does in humans, maybe quiescent with normal corticospinal control (but could be a backup if you get damage to normal tract)

1. What is the reflex arc associated with proprioceptive information to the face? (2) 2. If you lose primary muscle for eye lid opening, what muscle can you use to secondarily try to keep it open? 3. What CNs are involved in this reflex arc?

1. Reflex is important in *preventing Ptosis* and important for *raising the eyebrows.* 2. Frontalis 3. CN III (occulomotor neurons) CN VII (frontal neurons)

*Neospinothalamic tract in brainstem:* 1. Remains in the [anterolateral or posterolateral or anteromedial or posteromedial?] aspect of the brainstem on its way to WHAT in the brain? 2. the 2nd neuron synapse on the 3rd neuron where? 3. 3rd neuron ascends via what? 4. The 3rd neuron synapses on what layer of the sensory cortex?

1. Remains in the *anterolateral* aspect of the brainstem on its way to the *thalamus* 2. Synapse in VPL of thalamus (3rd neurons) 3. Ascend in Internal capsule 4. Synapse in Sensory cortex (layer IV)

*Windup:* 1. What is Wind up. 2. how does it work?

1. Repeated stimulation from the same source interpreted as increasingly painful. 2. this is because of a change in the cellular machinery

1. The Superior Nasopharnyx is lined by what kind of ET? 2. What is found jut deep to that ET? 3. What is found at the lower extent of Q2? 4. What is found deep to Q3? 5. What happens to Q3 as it descends?

1. Respiratory (Ciliated Pseudostratified Columnar ET w/goblet cells) 2. Lamina Propria (dense CT) 3. *Pharyngobasilar Fascia* (Elastic Lamina) 4. Superior Constrictor (skeletal muscle) - which may drop out in some spots, but the fascia remains 5. Pharyngobasilar Fascia thins as it descends pharynx (but will remain)

Almost done... *Lymphatics* 1. PW of lymphatic drainage of posterior bit o'head?

1. Retroauricular Nodes/Occipital Nodes → Superficial Cervical Nodes → Superior Deep Cervical Nodes

*Cervical Fascial Spaces:* Space 4: 1. What are the 2 names for space 4? 2. is is smaller or lager the space 3? 3. Is if more anterior or posterior then space 3? 4. it is located b/w what fascias?

1. Retropharyngeal or "Danger" space 2. LARGER 3. more posterior 4. located between the *pre-vertebral and alar/buccopharyngeal fascias*

*Cervical Fascial Spaces:* 1. spaces 3 and 4 are two in number and are classified with what name? 2. They are located b/w what 3 fascias? 3. they are closed laterally by what?

1. Retropharyngeal spaces 2. *buccopharyngeal, pre-vertebral and alar fascias* 3. the *carotid sheath*

*Cervical Fascial Spaces:* 1. What is the names of space 3? (2) 2. Is smaller or larger then space 4? 3. is if more posterior or anterior then space 4? 4. it is located b/w what 2 fascias?

1. Retrovisceral, retroesophageal space 2. SmAlLeR 3. more AnTeRiOr 4. *Buccopharyngeal and alar fascias*

*Bones of the Nasal Cavity:* 1. What 2 bones form the bridge of the nose? 2. What bone form the posterior Nasal Cavity

1. Right and Left Nasal Bones 2. Sphenoid bone

*Bones of the Nasal Cavity: Palatine Bones* 1. What are the 2 palatine bones? 2. What are the 2 plates on the palatine bones? 3. Which plate contributes to the lateral walls of the nasal cavity? 4. Which plate forms posterior 1/4 of Hard plate? 5. Which plate contributes to the floor of the nasal cavity 6. Which plates posterior face is an attachment site for the soft palate?

1. Right palatine bone and Left palatine bone 2. *perpendicular plate* and *Horizontal Plate* 3. *perpendicular plate* 4. *Horizontal Plate* 5. *Horizontal Plate* 6. *Horizontal Plate*

*Practice Problem* Allodynia on the right side of the leg. Name the possible areas where there might be a lesion... (Allodynia is central pain sensitization, possibly due to reorganization of nociceptors, mechanoreceptors and interneurons following injury)

1. Right-sided peripherial axons/free nerve endings 2. Could be in the right dorsal horn (Lamina I-II) 3. Could be coming from the anterior white commissure 4. Could be left lateral spinothalamic tract 5. Could be the left VPL thalamus (less likely if its just leg pain, but still possible) 6. Could be somatosensory cortex as well

*Parotid Gland* *1.* Enclosed by (3)? 2. T/F: Some folks have large parotid glands while other don't 3. T/F: It is extremely rare to have a size difference between left & right glands on a single individual

1. Robust Fascia + "False" Capsule (deep cervical investing facia) + It's own Capsule 2. That's true (everyone is unique - you're special!) 3. False, it's common (you're lopsided!)

1. What causes a *hematoma*? 2. How are they classified? 3. 3 types of *hematoma*?

1. Rupture of vessels in extra cranial regions of head 2. Classified by layer primarily involved 3. i: *Caput succedaneum* ii: *Subgaleal hematoma* iii: *Cephalohematoma*

*Sternocleidomastoid (SCM)* 1. Note: the gross boundaries of the neck are obliquely bisected by the passage of what Muscle? 2. Thereby creating what 2 triangles?

1. SCM 2. *anterior and posterior triangles*

*Cutaneous nerves: Ventral Rami* Medial supraclavicular nerves 1. cross the inferior portion of what muscle? 2. To provide branches to the skin at what 3 locations?

1. SCM 2. base of the neck, upper sternum, and sternoclavicular joint

*Cutaneous nerves: Ventral Rami* Lesser occipital n. [C2, (3)] 1. This nerve ascends the posterior border of which muscle? 2. this innervates what surface of the ear as well as the skin ______ the ear

1. SCM 2. innervates the *medial* surface of the ear as well as the skin *behind* the ear

*Anterior Triangle:* 1. Bounded by what muscle posteriorly? 2. bounded by what superiorly? 3. bounded by what mid-sagittally? 4. It is subdivided by the passage of what 2 muscles? 5. What 4 triangles are in the anterior triangle?

1. SCM posteriorly 2. the angle and inferior margin of the mandible superiorly 3. an imaginary line mid-sagitally 4. Digastric and Omohyoid muscles 5. Digastric (submandibular triangle) and the submental triangle and the carotid triangle and the muscular triangle

*Intrinsic Laryngeal muscles:* 1. Are these small or large muscles? 2. Are they [directly on or inside or both] of the laryngeal cartilages? 3. what are the 2 things they do?

1. SMALL 2. Both directly on and inside the laryngeal cartilages 3. act on the glottis or move laryngeal cartilages

1. What part of the basal ganglia is associated with Huntington's disease? 2. What are the symptoms of this condition?

1. STRIATUM --INDIRECT pathway is diminished relative to direct pathway (taking out the brakes) 2. Sxs: -Chorea (random, involuntary, flicking mvmt.) - Considered a disorder of Hyperkinesia.

*Vagus Nerve* 1. What are the contributions to this nerve? 2. Is it the largest cranial nerve? 3. What does it give parasympathetic innervation to? 3. What about motor innervation? 4. What sensory innervation does it give off? 5. Does it give off taste sensation?

1. SVE, SVA, GVA, GSA, GVE-P 2. Yes 3. Parasympathetic to heart, lungs and most of digestive system (GVE-P) 4. Motor to striated muscles of the pharynx, palate, larynx and proximal 1/3 of esophagus (SVE) 5. General sensation: a) GSA to external ear, external auditory meatus, external surface tympanic membrane, posterior cranial fossa dura mater b) GVA to carotid body, epiglottis, larynx, respiratory system, GI tract to distal 2/3 transverse colon 6. Taste to the epiglottic portion of the tongue (SVA)

*Mononeuropathy* 1. What is damaged? 2. Example of a cause? (sorry) 3. Symptoms?

1. Single *peripheral* nerve is damaged 2. Carpal Tunnel Syndrome 3. Numbness & tingling or pain, weakness/paralysis (*along peripheral nerve distal to damage*)

*Histology of the choroid epithelium:* 1. The choroid epithelium is a single layer of what type of epithelium? 2. What type of junctions does it have? 3. Luminal (apical) side has what 2 things? 4. What is the basement membrane in which it resides?

1. Single layered cuboidal epithelium 2. Tight Junctions 3. Luminal (apical) side has: a) Cilia b) *Aquaporin 1* channels 4. PIA

*Ciliary body:* 1. Is the Ciliary muscle smooth or skeletal muscle? 2. Is the Ciliary Muscle controlled via sympathetic or parasympathetic neurons?

1. Smooth muscle 2. Parasympathetic

Clinical Correlation: *Shaken baby syndrome* 1. Should you violently shake a baby? 2. What is damaged if you shake a baby? 3. Ruptured vessels cause a bleed where?

1. Some say this is not okay 2. ruptures *the veins that bridge the gap between the cerebral hemispheres and dural venous sinuses* 3. *subdural bleed* (Subdural space is not usualy present) bleed can spread to subarachnoid space

1. Where is SHH secreted from? 2. Where is BMP's secreted from? 3. What are somites formed from?

1. Sonic hedgehog (SHH) = secreted signaling molecule; initially expressed in the notochord (N) 2. Bone morphogenetic proteins (BMPs) = secreted signaling proteins with a variety of functions; expressed in ectoderm (ECT) 3. Somites are formed from mesoderm

What sensory does CN II have? What skull foramen does it pass through?

1. Special sensory: *Vision* 2. Optic Canal

1. What does Poliomyelitis target? 2. Symptoms? 3. How might these symptoms disappear for a time? 4. How do symptoms change with aging? Why?

1. Specifically affects LMNs 2. Flaccid paralysis & Hypo/areflexia 3. Vacated LMN are compensated for (*giant motor units*) 4. Compensated neurons begin to degenerate/denervate skeletal muscle, so weakness is more pronounced, once again.

1. What is CN XI? 2. What component does it have? 3. What does it do?

1. Spinal Accessory 2. GSE 3. Motor innervation to SCM and Trapezius

What is transmitted through the foramen magnum (8)?

1. Spinal Cord 2. Spinal roots of CN XI 3. Vertebral aa. 4. Anterior spinal artery 5. Posterior spinal aa. 6. Anterior meningeal branches (from vertebral a.) 7. Posterior meningeal branches (vertebral a.) 8. Dural vv. (internal vertebral venous plexus)

1. Which cranial nerve in posterior neck Δ? 2. What type of fibers within this cranial nerve? 3. Important for innervation of what muscle?

1. Spinal accessory n. (CN XI) 2. GSE (general somatic efferent fibers) 3. Sternocleidomastoid (SCM) muscle.

*Thyroid Gland* - Lymphatics 1. Interlobular lymphatics coalesce to form? 2. From Q1 lymphatic channels ascend & descend to (not specific)? 3. 5 specific nodes involved?

1. Subcapsular plexus 2. Local nodes 3. i: Pre-laryngeal (Juxtavisceral) ii: Pre-tracheal and para-tracheal (Juxtavisceral) iii: Superior & inferior deep cervical

What are the main arteries found in the root of the neck? How do these arteries arise differently on right vs. left sides?

1. Subclavian aa. 2. Common carotid aa. LEFT -- these aa arise directly from the arch of the Aorta RIGHT -- arise from the bifurcation of the Brachiocephalic a. (posterior to sternoclavicular joint)

*Anterior Jugular Veins (L&R):* 1. they come from small veins that start in what 2 regions? 2. the small veins then coalesce at the level of which bone to form the anterior jugular vein?

1. Submental and submandibular 2. Hyoid bone

*Functional Cornea:* 1. What layer is responsible for the transparency of the Cornea? 2. #1 has collagen fibrils that are arranged in lamina that run [Parallel or Perpendicular?] to neighbors. 3. Is the same pattern in #2 found in limbus and sclera? 4. What is important about the pattern in #2

1. Substantia Propria 2. Perpendicular 3. Nope it is lost 4. pattern is important for transparency of the Cornea

*Cornea:* 1. Most of the cornea is made up of what? 2. #1 is just layers of collagen fibers made by what? 3. What is the name of the basement membrane for the most internal layer of the cornea? 4. is #3 mostly acellular or cellular?

1. Substantia Propria 2. corneal fibroblasts 3. Descemet's Membrane 4. Acellular

1. Globus pallidus externa targets what? 2. via which NT?

1. Subthalamic nucleus 2. GABA

If you suspect hypoglossal n. (CN XII) weakness what tests could you perform?

1. Subtle weakness of Tongue could be tested by asking patient to press tongue against cheek or against depressor. 2. Inspect for atrophy or fasciculation of the tongue. 3. Have patient stick out their tongue and see it tongue deviates toward one side (will deviate toward the side of the lesion)

*Bell's Palsy* 1. Symptoms? 2. Cause? 3. Which nerve is under attack? 4. How long until it's resolved?

1. Sudden Onset of facial paralysis and/or paresis (<48 hr) - Rarely b/l. Other symptoms vary. 2. Usually the HERP (herpes simplex virus) 3. CN VII 4. Few weeks - months (rarely permanent)

*Cervical Fascias:* 1. What fascia is connective tissue and a fatty layer that fills in the space b/w the skin and deep fascia covering muscles?

1. Superficial - connective tissue & fatty layer that fills in the space between the skin and deep fascia covering muscles

*Platysma muscle:* 1. The platysma muscles is located within what facial layer? 2. What is its origin? 3. What is its insertion?

1. Superficial fascia layer! 2. 0: Superficial fascia covering the pectoralis major and deltoid 3. I: Inferior margin of the mandible, skin and subcutaneous tissues of the lower portion of the face and corner of the mouth

1. Most blood *drains* from the scalp via? 2. Function of this PW (other than moving the blood out)? 3. Downside to the PW?

1. Superficial veins → *Emissary Veins* → Dural Sinuses around brain 2. Deliver cooled blood to dural sinuses around brain (cool brain) 3. Can deliver infectious agents from wounds in scalp directly to brain

*Thyroid Gland* - Veins 1. Which veins of the thyroid drain into *Internal jugular*? 2. What part of thyroid do each drain?

1. Superior & Middle thyroid vv. 2. *Superior*: drains area supplied by superior thyroid artery. *Middle*: drains lateral surface of thyroid

*Tectospinal tract* 1. Origin? 2. Decussates?If so, where? 3. Destination? 4. Affect what musculature? 5. When would this be used?

1. Superior Colliculus 2. Decussates in posterior tegmentum 3. To cervical spinal cord 4. Affect musculature of neck, eyes 5. Postural reflexes to alarming visual/auditory stimuli

*Ethmoid Bone:* 1. there are 2 middle concha, what are the other 2 concha on the ethmoid bone? 2. What is the space directly next to the #1? 3. What is the space directly next to the middle concha?

1. Superior Concha 2. Superior meatus 3. Middle meatus

1. Explain the trigeminocardiac reflex. What happens to vitals? 2. Where is the tract for this reflex? 3. What is this often a complication from?

1. TRIGEMINOCARDIAC REFLEX > Decreased heart rate > Decreased Blood pressure > Decreased respiration rate 2. via the Spinotrigeminal tract. 3. this reflex is a complication of *neurosurgery* usually from a *massive PARASYMPATHETIC response.* cutting dura and poking around in the skull can cause the reflex

*CERVICAL PLEXUS - Motor* 1. What are the two sections of the ansa cervicalis? 2. What are the cervical levels that provide for each of these? 3. What are the routes of each? 4. Is the joining and subsequent loop variable? 5. From the ansa, individual branches are distributed to innervate what structures?

1. Superior Root and Inferior Root. 2. Superior Root: C1-C2 Inferior Root: C2-C3 3. SUPERIOR: fibers travel with the Hypoglossal N. (CN XII) (descendens hypoglossi) *which parallels the carotid sheath internally between the artery and vein.* INFERIOR: *passes from behind the carotid sheath, wraps around the internal jugular vein and joins the superior root to form the ansa* 4. This is variable! Loop could be at any level from the angle of the mandible to the clavicle. 5. individual branches are distributed to the *infrahyoid muscles*

*REVIEW* 1. What is the cortical area for vestibular response? 2. Afferent fibers communicating with it?

1. Superior Temporal Gyrus/Posterior Insula, Inferior Parietal 2. VPM Thalamus

*Arteries to larynx:* 1. What are the 4 main pairs of arteries to the larynx? 2. What are these branches from?

1. Superior laryngeal artery and inferior laryngeal artery (she just calls this the superior thyroid artery still) the superior thyroid artery and the inferior thyroid artery 2. Superior laryngeal artery comes from the Superior thyroid artery inferior laryngeal artery comes from the superior thyroid artery Superior thyroid artery comes from the external carotid artery inferior thyroid artery comes from the thryocervical trunk from the subclavin artery nevermind she fixed the problem with the inferior laryngeal artery look at the pic

*Cervical Fascial Spaces:* Clinical note: 1. Of extreme clinical importance is the containment and/or spread of infection from one compartment to another. Infections occurring within the anterior visceral compartment (pre-tracheal space) can dissect into What? 2. leading to inflammation of the what veins, what atery, and pericardium. 3. Infections occurring within the "danger space" can lead to __________________ abscess which can lead to dysphagia and dysarthria and can dissect into the posterior aspect of 2 things? 4. i.e., What can lead to mediastinal abscess, thereby leading to inflammation of the esophagus as far distally as the diaphragm.

1. Superior mediastinum 2. Brachiocephalic veins, aorta, and pericardium 3. *retropharyngeal abscess. it can dissect into the posterior aspect of the superior and posterior mediastinum 4. Chronic tonsillitis

1. Which sinus is located bilaterally in the attachment of the tentorium cerebelli to the petrous ridge? 2. This drains posteriorly to where? 3. #1 receives veins from what structures of the head?

1. Superior petrosal sinus 2. Drains cavernous sinuses posteriorly to the *junction of the transverse and sigmoid sinuses* 3. cerebral, cerebellar and tympanic veins

1. What lies within its convex attachment (superior margin); 2. Where does the Inferior sagittal sinus lie?

1. Superior sagittal sinus 2. *inferior margin* (within its concave free border)

*Cervical Fascias: pre-vertebral fascia* 1. What are the superior attachments? (3ish) 2. What are the anterior attachments? (1) extends inferiolry into which part of the mediastinum?

1. Superior: base of the skull anterior and lateral to the vertebral column (specifically to the basilar portion of the occipital, jugular foramen and carotid canal) 2. Anterior: covers the pre-vertebral musculature and extends inferiorly into the posterior mediastinum

*Cervical Fascias: investing fascia* 1. What are the superior attachments of the investing fascia? (4) 2. What are the posterior attachments of the investing fascia? (2)

1. Superior: external occipital protuberance, superior nuchal line, mastoid process and inferior margin of the mandible 2. Posterior: external occipital protuberance, spinous processes CV1 - CV7 via the nuchal ligament

1. Where is the supragranular layers? What type of fiber are they a main source of for corticoefferents? 2. What are they the major source of? 3. Where is the infragranular layers? 4. What are they the major source of? 5. Where is the major area that the corticoafferent fibers will synapse? 6. Where is the major area that the corticoefferent fibers will synapse? 7. What is the line of Gennari in area 17? What type of fibers does it receive?

1. Supragranular is in layers 2-3, major sournce of the association and commissural fibers 3-4. infragranular layers are 5-6 and they are the major source of projection fibers. 5. In layer 4 6. In layer 2-3 and 5-6 7. This is a major section for corticoafferent fibers to synapse at to bring sensory information back to the brain. Done through association fibers and commissural fibers for corticoafferents.

*Eye Formation: Sclera and Choroid* 5th step. 1. Surrounding Mesenchyme becomes tough outer WHAT and inner WHAT?

1. Surrounding mesenchyme becomes tough outer *sclera* and inner *Uvea*

1. The superior constrictor muscle is suspended posteriomedially from/by? 2. Where is the Pharyngeal Tubercle? 3. Any other attachments for superior constrictor muscle? 4. What is the *Pharyngeal Raphe*?

1. Suspended from Occipital Bone (Pharyngeal Tubercle) by *Pharyngeal Raphe* 2. Bump on occipital bone just anterior to foramen magnum 3. Attaches laterally to the Temporal Bone 4. Where all the Pharyngeal constrictor muscles unite (R & L Halves)

1. Once it gets to the mid-pons, where does it go from there? 2. After that stop, where does it go?

1. Synapse in the VPL of thalamus (3rd neuron) 2. Ascend in internal capsule and the synapses in sensory cortex of layer IV

1. T/F: The *Superior Constrictor* is attached to the base of the skull at only a few points? 2. The gaps between attachments is filled with? 3. What pierces Q2 to access the Nasopharynx? 4. Why do they pass through here instead of through the superior constrictor muscle?

1. TRUE 2. *Pharyngobasilar Fascia* 3. *Auditory Tubes* pierce the Pharyngobasilar Fascia 4. So the auditory tubes don't get closed off every time the muscle contracts

Main sensory nucleus/ medial lemniscus & dorsal trigeminothalamic tracts 1. What type of information is carried in the MSN/ML & Dorsal Trigeminothalamic tracts? 2. What are the receptors which gather this information?

1. Tactile Discrimination ---Fine touch 2. *Meissner's corpuscles* *Merkel's disks* *Pacinian Corpuscles* *Ruffini's endings*

*Posterior Column - Medial Lemniscal Pathway* 1. Type of information? 2. Point of origin and receptor involved? 3. Where are the primary cell bodies? 4. Where is the first synapse? Where are these located?

1. Tactile discrimination, conscious proprioception 2. (Pretty much all of them except for the free nerve fibers) Meissner's corpuscles, merkel's disks, pacinian corpuscles, ruffini's endings in skin muscle spindles, golgi tendon organs in muscles, joints and tendons 3. DRG 4. Nucleus cuneatus and nucleus gracilis in caudal medulla

*Eyelid:* 1. What glands are in the tarsal plate? 2. Why type of gland is #1? 3. What is holocrine secretion? 4. Tarsal glands contribute a [watery or oily?] film to tears that helps do what 2 things?

1. Tarsal Glands (Melbomian) 2. Sebaceous glands (Holocrine Secretion) 3. Holocrine secretions are produced in the cytoplasm of the cell and released by the rupture of the plasma membrane, which destroys the cell and results in the secretion of the product into the lumen. 4. OILY -Prevents Overflow (I don't know how this works - garrett) - Retards Evaporation

*REVIEW* 1. What Lobe is auditory coming from? 2. What is the cortical area for hearing? 3. Gyrus? 4. Broadmann's area? 5. What afferent area is helping? 6. Efferent? 7. What Broadmann's area is the efferent in?

1. Temporal 2. Primary auditory cortex (A1) 3. Transverse gyrii of Heschl 4. 41 5. MGN Thalamus 6. A2 7. 42

Superior/Inferior attachments 1. Falx cerebellie extends from what structure superiorly? 2. And goes to what structure inferiorly?

1. Tentorium 2. Occipital crest

1. What type of fibers are found w/in *Rexed lamina V*? 2. What are the functions? 3. What happens when fibers here hit an interneuron that synapses in more dorsal rexed laminae?

1. Terminals of *GVAs* synapsing on 2nd order cell bodies 2. Where visceral pain is received 3. Referred pain (somatic)

1. What type of neurons are found w/in *Rexed laminae VI*?

1. Terminals of *proprioceptive afferents* synapsing on 2nd order cell bodies.

1. Thyroid cartilage begins to elongate and grow during puberty because of what hormone? 2. This causes what to happen? 3. chondrocytes in thyroid cartilage have what type of receptor positive?

1. Testosterone 2. Testosterone mediated change in the male voice during puberty causes squeakiness of the voice 4. Androgen receptor positive chondrocytes in thyroid cartilage

1. What is Globus palidus internal (GPi)s target? 2. What NT does it release? 3. What is the target of the thalamus? 4. What NT does Thalamus release?

1. Thalamus (VA/VL nuclei) 2. GABA (-) 3. Motor cortex 4. Glutamate

*Cerebrospinal Fluid:* The CSF regulates fluid composition 1. The CSF contributes to ion homeostasis for what? 2. maintains [high or low?] protein environment in CNS, [limits or excites] proliferation, and preserves neural connectivity.

1. The CSF contributes to ion homeostasis for optimal neural signaling 2. maintains *Low* protein environment in CNS, *limits* proliferation. preserves neural connectivity. "Remember the brain is a diva"

*Cervical Fascias:* 1. what is the neurovascular component of deep fascia?

1. The Carotid sheath

1. Where is the CSF created? 2. The Choroid plexus is a single layer of what type of cells? then overlaid with a layer of what? 3. What allows macromolecules and ions to flow from the blood into extracellular space? 4. Choroid epithelial cells contain ________ junctions, prevent the diffusion of molecules into the brain 5. Does it also require you to actively pump ions to make CSF?

1. The Choroid Plexus! vessely stuff sitting in lateral, 3, and 4th ventricles 2. Choroid plexus is a single layer of ependymal cells overlaid with a layer of pia. 3. *Fenestrated choroidal capillaries* allow macromolecules and ions to flow from the blood into extracellular space 4. Choroid epithelial cells contain *tight* junctions, prevent the diffusion of molecules into the brain 5. yes

*Cornea:* 1. What is the name of the junction b/w the Cornea and the Sclera? 2. What type of epithelium is Corneal *Epi*thelium? 3. What is the layer lying directly underneath #2? 4. #3 is a relatively thick layer of connective tissue that is very [cellular or acellular?]

1. The Limbus 2000 2. Stratified Squamous 3. Bowman's Layer 4. Acellular

*Macular degeneration:* 1. We alter our gaze to focus objects of interest on what? 2. Loss of central vision greatly diminishes independence and quality of life, how many Americans are affected by macular degeneration?

1. The Macula 2. 10 million check out the bottom right of the pic it shows what you would see if you had macular degeneration

1. In terms of tracts, what is the difference between the posterior spinocerebellar tract and the cuneocerebellar tract? 2. What type of cells in the cerebellum will the PST and the cuneocerebellar pathways synapse on in the cerebellum?

1. The PST has its own named tract that it will run through in the lateral faniculus while the cuneocerebellar has its first neuron running through the cuneate fasciculus tract. 2. Granule cells in the cerebellar cortex.

1. What tract uses the nucleus dorsalis? 2. What tract uses the lateral cuneate nucleus? Here is a schematic of what we just talked about

1. The Posterior spinocerebellar pathway (PST) 2. The Cuneocerebellar pathway

1. When you think of the hyoid what should you think of? 2. why? 3. as the hyoid moves what moves?

1. The Tongue 2. the tongue is integral to the hyoid there is a large muscle called the hyoidglossus 3. the tongue moves

1. What is the white matter bundle the connects Wernicke's area with Broca's? 2. What is the language pathway? What is the job of each piece of the pathway? 3. What is the significants of the proximity of Broca's to Area M1? What about Wernicke's to A1?

1. The arcuate fasciculus 2. Language pathways involve language processing in Wernicke's area, comprehension in the angular gyrus, and production in Broca's area 3. Again, this goes back to the primary sensory complexes (here for auditory and motor) are communicating with the associative corticies just adjacent to them (i.e. Broca's and Wernickes).

*Structure of the Eye: Fluid-filled segments* 1. The posterior segment starts at the retina and goes anteriorly to what? 2. The posterior segment is filled with a gelatinous WHAT? 3. Is #2 stable or dynamic? 4. does #2 have a [fast or slow?] turnover?

1. The back of the lens 2. *Vitreous Humor* 3. Stable 4. Slow Turnover

1. What is Schizencephaly? 2. What is Heterotopias? 3. What is Lissencephaly?

1. The cortex of the brain does not develop properly 2. Cells do not migrate to the cortex leaving grey matter down toward the ventricles (when it should be at the cerebral cortex) *OR* they will have TWO layers of cerebral cortex (an outer and inner layer of grey matter. 3. This is a lack of undergoing the gyrification process. This is known as a "smooth brain" or no gyri.

*thyroid cartilage:* 1. What is the joint b/w the thyroid cartilage and the cricoid cartilage? 2. Is the thyroid cartilage open or closed posteriorly?

1. The cricothyroid joint 2. open in back suckah

The descending and ascending tracts are named differently for the ventral trigeminothalamic tracts. 1. Which is the spinal tract? 2. Which is the other one called?

1. The descending portion 2. Spinotrigeminal tract

1. What can we think of the anterior spinocerebellar tract as? 2. What type of tissue does the AST first decussate? 3. Through what do these fiber ascend in order to get to the cerebellum? 4. What type of tissue does the AST make its second decussation?

1. The double crosser 2. Through the ventral white commissure (through the midline of the spinal cord) 3. Through the superior cerebellar peduncle. 4. Cerebellar white matter (cross midline in cerebellum)

1. What is the reason for the R/L discrepancy in the recurrent laryngeal nerve pathway?

1. The heart initially develops near the brain, and with differential growth, the heart and great vessels move downward into the upper thorax whereas the larynx moves upward into the neck and "drags" its innervation with it.

1. What foramen allows CSF to drain from the lateral ventricles to the 3rd ventricle? 2. What connects 3rd and 4th ventricles? 3. What are the 3 options for CSF to get out from the 4th ventricle into the subarachnoid space? 4. What ventricles have a more leaky blood brain barrier? why?

1. The inter-ventricular foramen one on each side 2. cerebral aqueduct 3. the median aperature (foramen magendie) and the lateral aperatures (foramen of luschka) - old names are better because M with median and L with lateral or you can just said median and lateral I guress 4. roughly around 3rd and 4th ventricle. Do get more products into brain. like the hypothalmus which is by those ventricles

*Cervical Fascias: investing fascia* 1. It is continuous superiorly with what fascia b/w what bone and boney landmark? 2. it also forms a connective tissue capsule for what gland?

1. The investing fascia is continuous superiorly with the parotid fascia in the soft tissue interval between the mastoid and angle of the mandible. 2. It also forms a connective tissue capsule for the submandibular gland.

1. What is the CSF pump? 2. What powers this pump?

1. The movement of CSF fluid through the ventricles into the subarachnoid space and into the venous drainage 2. arterial blood supply and CSF production

*General Considerations:* 1. The neck is bounded by what above and what below? 2. The neck is supported in between those things by what and how many of them?

1. The neck is bounded by the skull above and the thoracic inlet below 2. and is supported in between by seven cervical vertebrae.

Explain what happens in the pontine flexure? 1. What stretches? 2. When the grows over the top of it? 3. What does it then give rise to?

1. The the *dorsal roof of the myelencephalon* stretches out, 2. the *dorsal metencephalon grows caudally* to bridge the space. 3. This then creates the *cerebellum*.

*Cutaneous nerves: Dorsal Rami* C3-C6 1. Dorsal rami pierce deep musculature to reach subcutaneous areas near the dorsal midline and extend laterally to cutaneous areas over what muscle?

1. The trapezius

*Practice Problem* Lesion of the right fasciculus cuneatus at C2. Tell me all of the sensory systems affected, and on which side of the body...

1. The two pathways that would be effected are the PCML pathway and the Cuneocerebellar Tract. 2. This would result in: a. Right-side effected (ipsilateral presentation) b. Upper-Limb (cuneatus is upper limb information) c. Tactile discrimination (from PCML) d. conscious properioception (from PCML) e. unconscious properioception of individual muscles/tendons (From Cuneatuscerebellar tract)

REVIEW QUESTION! If you had a left had that was numb to temperature and basic touch, where might you suspect damage?

1. There could be an issue with the peripheral nerve itself (specifically at the dorsal root/dorsal root ganglia). 2. Up in the cortex of the brain (right side) 3. A common pathway in the brainstem

1. What is the Bell-Magendie law? 2. What are closer to the BMP rich region? 3. What are going to be closer to the SHH rich region?

1. These rich, old, white guys found that roughly the more dorsal area of the neural tube is going to be sensory area and the ventral area will be strictly a motor area. 2. The sensory areas 3. The motor areas

*Corniculate:* 1. where are they located? 2. What are they good for? 3. does it move independent of the arytenoid?

1. They are located on top of the Arytenoid cartilage 2. They are important to lengthen the arytenoid cartilage and give it a more mechanical advantage 3. Nope moves with the arytenoid

*Blood Supply to Face* 1. Does the Internal or External Carotid artery supply blood to the face?

1. They both do!

1. What is a Nasal Laryngoscopy?

1. They take a camera through the nose just check out the pick.

*Transcutaneous Electrical Nerve Stimulation (TENS):* 1. What is transcutaneous electrical nerve stimulation (TENS)? 2. The effectiveness of #1 supports which theory of pain?

1. This is hen they electrically stimulate nerves in certain parts of the body and it causes a reduction of pain in certain parts of the body. look at the picture 2. Effectiveness supports the *gate-control theory* of pain

1. T or F: when first developing, the spinal cord fills the entire vertebral canal. 2. How does this change throughout life?

1. This is true. 2. see pic yo. it migrates rostrally

1. Where is the first synapse in the Corticobulbar tracts?

1. This will found in the CN nuclei --- located in the Medulla.

*Practice Problem* Lesion of Lamina VII in left thoracic spinal cord. Tell me all of the sensory systems affected, and on which side of the body...

1. This would be through the posterior spinocerebellar tract pathway. Therefore: a. Left-side (ipsilateral) b. Lower limbs (again Clarke's Nucleus covers lower limb, only goes C8-L3) c. Unconscious properioception

*Suprascapular a.* 1. Branch of which a.? 2. Crosses posterior Δ inferiorly, medial (deep) to what muscle? 3. Paralleled by its accompanying vein, it is joined by which nerve? 4. Passes out of Δ laterally to enter what region?

1. Thyrocervical trunk (from 1st chunk of subclavian) 2. Inferior belly of omohyoid muscle 3. Suprascapular n 4. Scapular region

*Transverse cervical a.* 1. Branch of which a.? 2. Crosses posterior Δ inferiorly, medial (deep) to what muscle? 3. Eventually exits posterior Δ by passing deep to which muscle?

1. Thyrocervical trunk (from 1st chunk of subclavian) 2. Inferior belly of omohyoid muscle 3. Trapezius (which it supplies)

*Inferior Thyroid Artery* 1. Branch from? 2. Ascends along medial border of what muscle? 3. Passes behind what 2 structures? 4. What structure rests on the inferior thyroid artery?

1. Thyrocervical trunk (off 1st bit'o subclavian) 2. Anterior Scalene 3. Behind carotid sheath & sympathetic trunk @ level of thyroid cartilage 4. Middle cervical ganglion

1. What are the 2 laryngeal membranes we need to know? 2. what are each of them b/w? 3. What is a cric/ cricothrotomy and where do you make the incision?

1. Thyrohyoid membrane and Cricothyroid membrane 2. Thyrohyoid membrane is in b/w the thryoid cartilage and the hyoid bone The cricothyroid membrane is in between the cricoid cartilage and the thyroid cartilage 3. Note: Cric/ cricothrotomy - incision through cricothyroid membrane to establish a patient airway via endotracheal tube

*Clinical Correlation* 1. What muscle is used to elevate the larygneal cartilage or pulling down the hyoid bone? 2. What are cortical bulbar fibers? 3. What vascular structures are they close to? 4. What are the important implications of this relationship?

1. Thyrohyoid muscle 2. Nerves the originate in the cortex that flow through cranial nerves to innervate specific areas of the body (communication from cortex to body; think of the humunculus!). 3. Middle cerebral artery! 4. if you get strokes up in that area, you can lose the cortical bulbar input from the humucular area of the mouth (specifically in the pharynx and the larygnx), interrupts the ability to talk and swallow very well.

*Larnx:* 1. what are the 2 cartilages in the larynx? 2. What is the bone? 3. what is Endochondral ossification which #2 goes through? 4. What type of mucosa is here? 5. Everything in the larynx has the epithelium in #4 EXCEPT for what? which has what type of epithelium?

1. Thyroid and cricoid cartilage 2. Hyoid bone 3. cartilage is laid down first then it becomes bone 4. Mucosa is Respiratory Epithelium 5. EXCEPT for some portions of True vocal folds which are (stratified squamous), don't want to mess with the voice

1. What are the 3 large cartilages in the Larynx?

1. Thyroid cartilage cricoid cartilage and the Epiglottis

What are the 3 unpaired cartilages?

1. Thyroid cartilage 2. Cricoid cartilage 3. Epiglottic cartilage

*Surface Anatomy:* 1. Opposite of what 2 cervical vetebrae is thyroid cartilage located? 2. what 2 things of the thyroid cartilage are easily palpable anteriorly?

1. Thyroid cartilage - located opposite the fourth and fifth cervical vertebrae, 2. the superior thyroid notch and laryngeal prominence are easily palpable anteriorly

Review for MSN/ML & Dorsal trigeminothalamic tracts 1. Where is the first pseudounipolar neuron? 2. Where is the first synapse? 3. Does it decussate after first synapse? 4. What tract does it ascend through? 5. Where is the second synapse? 6. Pathway of 3rd neuron?

1. Tirgeminal ganglion 2. Main sensory nucleus 3. Yes for the most part 4. Medial Lemniscus 5. VPM of thalamus 6. Through *internal capsule* and *corona radiata* to the *cortex*

1. What is frontonasal prominence anomaly? 2. How does it present? 3. What other anomaly can it be in conjunction with?

1. Tissue that persists in the frontonasal region of development (did not undergo cell death). 2. Broad nasal bridge and hypertelorism (increased distance between the eyes). 3. Tetralogy of Fallot --> NEURAL CREST CELL ISSUES!!

1. Why are the Middle and Superior meatus important? 2. What is another name for the lateral nasal wall on the ethmoid bone? 3. What is the space b/w middle concha and lateral nasal wall

1. To increase surface area of mucosa so that the air passing through the nasal cavity has a much larger area to interact with the mucosa 2. Lateral mass 3. Middle meatus

*Surface Anatomy:* 1. are tracheal rings complete or incomplete? 2. their D-shaped cartilage openings face anterior or posterior? 3. The thyroid isthmus is usually palpable across the level of what 3 tracheal rings?

1. Tracheal rings - incomplete, 2. "D"-shaped cartilages, their open areas face posteriorly 3. Note: The thyroid isthmus is usually palpable across the level of the 2nd, 3rd and 4th tracheal rings

What are the tributaries to the major veins in the root of the neck?

1. Transverse cervical v. 2. Dorsal scapular v. 3. Vertebral v. 4. Suprascapular v. 5. Inferior thyroid v.

*Posterior Triangle:* 1. it is bounded by what muscle posteriorly? 2. it is bounded by what muscle anteriorly? 3. it is bounded by what bone inferiorly? 4. It is subdivided by the passage of the [superior or inferior?] belly of what muscle? 5, What are the 2 triangles in the posterior triangle?

1. Trapezius 2. SCM 3. Clavicle 4. *inferior belly of the omohyoid muscle* 5. Occipital triangle and Omoclavicular (subclavian or supraclavicular) triangle

*Propriospinal Neurons* 1. Location? 2. Provide communication b/w what?

1. Travel in *Fasciculus Proprius* in *Propriospinal tract* in Spinal cord itself 2. Different spinal cord segments

1. What is the name of CN V? 2. What component/s does it contain? (2) 3. One component splits into 3 trunks. Which one? Name the trunks. 4. The aforementioned component is considered the Major ________ Nerve of the Head, providing innervation to ___________ 5. Finally, this component also provides ___________ fibers to ALL of the ____________ muscles of the head

1. Trigeminal 2. GSA, SVE 3. GSA: Ophthalmic (V1), Maxillary (V2), Mandibular (V3) 4. Major Sensory Nerve of the head. Provides innervation to: - Portion of scalp - Most of face - All conjunctiva - Epithelium of nasal cavity - Paranasal sinuses and oral cavity - Skin of outer ear - External auditory meatus - External surface of tympanic membrane - CRANIAL DURA MATER 5. Proprioceptive; SKELETAL

Homologous structures from spinal cord and trigeminal system for *touch and proprioception*. What structure in the trigeminal system is homologous to the: 1. dorsal root ganglion? (2) 2. Posterior column nuclei? 3. Medial lemniscus? (2) 4. VPL

1. Trigeminal ganglion, mesencephalic nucleus 2. Main sensory nuclei 3. Medial lemniscus, dorsal trigeminal tract 4. VPMHomologous structures from spinal cord and trigeminal system.

1. What is the name of CN IV? 2. What component/s does it contain? 3. Which 1 muscle does it innervate? 4. Why is this muscle called the "depressed muscle"? 5. How is this CN different from all the others?

1. Trochlear 2. GSE 3. Innervate ONE extraocular eye M.: Superior Oblique 4. B/c when you are depressed you are "down and out" which are the actions of the muscle. 5. The only CN that comes off Dorsally, and it also has the *Longest Course*

*Telencephalon Developed in Two Waves* 1. T or F: the inital pattern of gray and white matter development is similar to that of the rest of the neural tube. 2. How many layers does the neocortex have? How much of the cerebral cortex does it make up? 3. What makes up the allocortex? How many layers do each of them have? 4. What layer of the allocortex does each of the following derive from? -Olfactory areas -Hippocampus -Uncus -Dentate gyrus 5. Which areas degenerate first in the case of neurodegenerative diseases?

1. True 2. The Neocortex (6 layers) undergoes a second pattern of development, ~90% of cerebral cortex 3-4. The Allocortex has fewer layers: Archicortex (3 layers): -Hippocampus, dentate gyrus Paleocortex (3-5 layers): -Olfactory areas, uncus 5. Allocortical areas are early to degenerate in neurodegenerative diseases

1. What is the shape of the actual muscles in the pharynx? 2. Why is it this shape? 3. So are there really gaps b/w the muscles laterally? 4. Why are these fascial-spanned-gaps important?

1. U-shaped that's open anteriorly 2. Allows communication with Nasal Cavity, Oral Cavity & Larynx (please look at image) 3. Nope, actually filled w/fascia 4. Important structures traverse these gaps to gain access to the internal pharynx & related anterior cavities.

*Anterior Spinocerebellar Tract* 1. Type of information in pathway? 2. What is the point of origin and receptors involved? 3. Where are the primary cell bodies located? 4. Where is the 1st synpase located?

1. Unconscious proprioception 2. muscle spindles, golgi tendon organs in muscles, joints and tendons 3. DRG 4. Lamina VII

Clinical Correlation: Middle meningeal artery continued 3. What 4 things often result from the epidural hematoma?

1. Unilateral compression of cerebral arteries 2. Shifting of mid line structures away from the side of the fracture/hematoma 3. Uncal herniation 4. Tonsillar herniation Lethal if left untreated

1. What are unimodal association cortices? 2. What are multimodal association cortices? 3. Which is closer to the primary cortex, unimodal or mutlimodal?

1. Unimodal corticies elaborate on basic information in reference to a primary cortex (for example, the primary motor cortex will use an associative cortex to help process the motor information. One type of sensory input, like motor, equals a UNImodal cortex). 2. Multimodal corticies connect multiple sensory modalities. (ex. hearing the sound of a duck, seeing a duck, and then tasting a duck. All those things together tell you that its a horse. j/k, its a duck. imagine tasting this bad jackson....) 3. Unimodal! Multimodal are usually further away.

*Motor neurons* 1. Which motor neurons are found in the *white* matter? 2. Which motor neurons are found in the *gray* matter?

1. Upper Motor Neurons (UMN) (*axons*) 2. Lower Motor Neurons (LMN) (*cell bodies* in specialized LMN pools)

1. What neurons make up the efferent (or descending) pathways from the brain to the body? 2. What is the "stuff" that makes up the spinal nerves and cranial nerves? 3. Which reflexes are the simplest of the neural pathways? The take place (contralaterally/ipsilaterally/dorsalaterally] 4. What will come together to form the spinal nerve?

1. Upper motor and lower motor neurons. 2. Both primary afferents and lower motor neurons are, at least in part, the stuff that makes up spinal nerves and cranial nerves 3. Spinal cord reflexes, the simplest of the neural pathways, take place ipsilaterally 4. Primary afferent neurons + Lower motor neurons = Spinal nerves.

1. At what week of development is the basic pattern of the cortex that will persist through the rest of life developed? 2. What are the zones that are seen at this time? 3. What regions combine after birth/as we grow into adulthood? 4. What is deep to the cortical plate in adults? 5. Where will grey matter be found in adults (what zone)? 6. Where will white matter be found in adults? 7. Where would you find adult neural stem cells? 8. What do you see the subventricular zone associated with in the adult brain

1. Usually by about week 12 (see pick) 2. Marginal zone cortical plate subplate intermediate zone sub ventricular zone ventricule zone 3. the cortical plate further differnetiates and connects to itself 4. White matter tracks 5. In the superficial areas 6. Deeper to CO, WM area 7. In the ventricular zone 8. The lateral ventricles! (Think telencephalon)

1. Is the auditory tube (connecting pharynx to middle ear) usually open or closed? 2. Why would the auditory tube open? 3. What is responsible for opening the auditory tube when swallowing?

1. Usually closed so you don't get infection into the ear 2. To equalize pressure in the ear 3. Contraction of the Levator Veli Palatini

*Clinical Note* 1. What is the previous approached used for? 2. If #1 is left in, what will it lead to?

1. Utilized to *remove atherosclerotic plaque which may gather at the branch point of the internal and external carotid aa. from the common carotid artery* where turbulent blood flow is increased causing injury to the endothelium with deposition of fat, cholesterol, clotted blood, and eventually calcium. The removal of the accumulated plaque, *carotid endarterectomy,* eliminates the stenotic segment. 2. If left in situ, can lead to *transient ischemic attacks* (decreased blood flow to the brain) and *possible micro emboli formation leading to strokes.*

1. What is the name of CN X? 2. What component/s does it contain?

1. Vagus 2. SVE, GSA, SVA, GVA, GVE-P

*Eye Formation: Sclera and Choroid* 5th step. Part 2 1. What 2ish things make up the Uvea?

1. Vascular choroid and ciliary body/muscle

Pharyngeal plexus - *iii: Sympathetic Chain* 1. What does it do? 2. Which ganglia house it's cell bodies?

1. Vasomotor (BV dilation & constriction) 2. Superior, Middle, & Stellate Ganglia

Once More... 1. LMN cell bodies located where (2)? 2. Types of LMNs that innervate skeletal muscle? 3. UMN cell bodies located where (6 specific neural PWs)?

1. Ventral horn of the spinal cord (RL IX) *&* Brainstem motor nuclei 2. Alpha (α) & Gamma (γ) motor neurons 3. i: Cortex (Corticospinal & Corticobulbar) ii: Vestibular nuclei (Vestibulospinal) iii: Superior colliculus (Tectospinal) iv: Red nucleus (Rubrospinal) v: Reticular formation (Reticulospinal) [Pro-tip: use the names of the tracks to clue you in to where the 1st nucleus is located.]

Repetition is good, right? 1. LMN cell bodies located where (2)? 2. Types of LMNs that innervate skeletal muscle? 3. UMN cell bodies located where (6 specific neural PWs)?

1. Ventral horn of the spinal cord (RL IX) *&* Brainstem motor nuclei 2. Alpha (α) & Gamma (γ) motor neurons 3. i: Cortex (Corticospinal & Corticobulbar) ii: Vestibular nuclei (Vestibulospinal) iii: Superior colliculus (Tectospinal) iv: Red nucleus (Rubrospinal) v: Reticular formation (Reticulospinal) [Pro-tip: use the names of the tracks to clue you in to where the 1st nucleus is located.]

*Brachial Plexus* 1. Composed of what nerves? 2. Roots of the brachial plexus will pass b/w which muscles? 3. Then enters which Δ?

1. Ventral rami of C5-T1 2. Anterior & Middle Scalenes (*scalene Δ*) 3. Enters anterior/inferior bit'o posterior Δ

1. During development, each vesicle (lumen of neural tube) produce a different what? 2. Where does the lateral ventricle come from? 3. What about the third ventricle? 4. What about the aqueduct? 5. Where does the fourth ventricle arise from? 6. Where does the central canal come from?

1. Ventricle 2. Telencephalon 3. Diencephalon 4. Mesencephalon (midbrain) 5. from the Rhombencephalon; just posterior to the pons and anterior to the cerebellum. 6. Spinal cord

*Developing cerebral cortex* 1. Where does neuronal cell proliferation take place? 2. What do the divided cells grab on to in order to migrate? 3. What zone do they then migrate through? 4. Where do they settle down and put down some roots? 5. What zone do their projections go into? 6. Where are the youngest cells at? 7. How then does our cortex develop (from where to where)?

1. Ventricular zone (right by the ventricle) 2. Radial glial cells 3. Intermediate zone 4. Cortical plate 5. Marginal zone 6. They are closer to the pia mater, or the surface. 7. from an inside-out development (older is deeper, younger is more superficial).

1. What is the venturi effect? 2. What is the bernoulli's principle?

1. Venturi Effect: the reduction in pressure that results when a fluid/air flows through a constricted section of a pipe. 2. Bernoulli's Principle: an increase in the speed of a fluid/air occurs simultaneously with a decrease in pressure

1. What is the name of CN VIII? 2. What component does it contain? 3. What senses is it responsible for and where does it get its fibers from?

1. Vestibulocochlear 2. SSA 3. Hearing (Cochlear part) -Afferent fibers from Organ of Corti Equilibrium (Vestibular part) - Afferent fiber from Semicircular Canals, Utricle, and Saccule of Internal ear

1. the glottis is made up of what 2 pairs of things on either side? 2. What 2 landmarks are important to locate when looking at the larynx especially in a Nasal Laryngoscopy b/c there can be alot of pathologies here?

1. Vocal ligament and vocal folds that can open or close the glottis 2. The cuneiform and corniculate tubercles

*Arytenoid:* 1. It is a very important cartilage b/c it is attached to what? 2. What is the arytenoid cartilage important for?

1. Vocal ligament. which is attached to the vocal cords. So if the arytenoid cartilage is moved then it can move the vocal cords and increase or decrease the tension in the cords. 2. the production of sound

*larynx:* 1. what muscle can be seen with the true vocal fold?

1. Vocalis Muscle

*Corticospinal Tract PW* (the basics for now) 1. What type of info? 2. Where in the brain does it begin? 3. What happens to it in the brainstem? 4. In which part of cord does it descend? 5. Where does it synapse?

1. Voluntary Motor function (descending) 2. Begins in *motor cortex* (eg on the L) 3. cross to other (eg R) side in brainstem 4. descends in *lateral funiculus) 5. in ventral horn (then off to skeletal muscle) [*L cortex → R spinal cord → R body*]

*Bones of the Nasal Cavity:* 1. What bone forms the inferior portion of the bony septum? 2. What bone is continuous with the Nasal Crest of the Palatine and Maxillary bones?

1. Vomer 2. Vomer

Flip Card por pregunta mi amigos

1. WHAT THE DEVIL IS WRONG WITH THIS EYE???!!?!?!?!?!?!?!!??! 2. What is the name of the most common of #1? 3. What is the cause of #1? 4. How do you treat this? We're going down down something about lilly around sugar we're going down swinging 1. Cataract 2. Senile Cataract (old age) 3. Many causes, clinical diagnosis denoting lose of optical function of the lens 4. Surgically removed and replaced with artificial lens. 3.6 million/year in US. <20 million worldwide (my friend had cataracts in both eyes when he was 22 and got them removed and now he has his text size to super old man size so you anyone can read it from 2 blocks away)

1. Depending on activity we want to perform, not only will we change the # of muscle fibers recruited, but also what? 2. What are the 3 types of muscle fibers?

1. We will recruit different *types* of muscle fibers 2. Slow, Fast fatigue-resistant, Fast fatiguable

1. At beginning of WHAT week, WHAT cells migrate into the developing arches, forming the cartilaginous rods and developing into the skeleton and connective tissue of much of the face, heart, great vessels, adrenal cortex etc. 2. Teratogens do what to this process?

1. Week 4 *NEURAL CREST CELLS* 2. Teratogens disrupt this process, example alcohol can cause apoptosis in NC cells note: Various congenital anomalies result from problems with this complex migration of neural crest cells.

Answer questions on the back.

1. What blood supply feeds 1 and 2? 2. What is #3 for? 3. Where are the fibers going in #4? 4. Where are the cuneate fibers and gracile fibers usually found in reference to #4? 5. Where does #4 get its blood supply? 1. Posterior spinal arteries. 2. This is where the fibers are decussating 3. They are ascending through the ML to the Thalamus 4. Cuneate fibers are more dorsal, Gracile more ventral 5. Anterior spinal artery!

question on the up your bum side

1. What is the top arrow pointing to? 2. What is the bottom arrow pointing to? 1. internal capsule 2. Thalamus

question on the other side

1. What section of the brain stem? 2. what is the arrow pointing to? 1. Caudal medulla 2. neospinothalamic tract

question on the far side

1. What section of the brain stem? 2. what is the arrow pointing to? 1. Mid-Pons 2. Neospinothalamic tract

question on the back side

1. What section of the spinal cord? 2. what is the arrow pointing to? 1. Cervical cord 2. Neospinothalamic tract.

1. Choroid Epithelium 2. choroid plexus 3. pia 4. ependymal cells 5. Ventricle (CSF) 6. Brain Tissue

1. What the eff is this? 2-6 identify 1. Choroid Epithelium 2. choroid plexus 3. pia 4. ependymal cells 5. Ventricle (CSF) 6. Brain Tissue

Question on the backside....

1. Whats wrong with this eye!?!?! 2. Failure of what layer caused #1? 1. Corneal Edema (Hydrops) 2. Consequent to failure of the Corneal Endothelium results in clouding

question on back of card

1. Whats wrong with this kids eye?!?!?!?! 2. does the inflammation of #1 affect the sclera, cornea, or both? (scroll down for answers) 1. Conjunctivitis 2. Inflammation stops short of cornea. affects SCLERA only

*Cuneocerebellar* 1. When above ____ (what vertebral layer), synapse in (what specific) nucleus? 2. What portion of the medulla will this happen?

1. When above C8, synapses in accessory/external/lateral cuneate nucleus 2. Caudal Medulla

*Dorsal Spinocerebellar* 1. When below ______ (what vertebral layer), will have [conscious/unconscious] proprioceptive info hitchhike on [posterior/anterior] column. 2. Will synapse in Lamina _______? 3. Visible from L__ to C__? 4. If it will synapse in the lamina from #2, what will it synapse in specifically? (an artifact found here)

1. When below C8, unconscious proprioceptive info hitchhikes on posterior column. 2. Synapses in Lamina VII 3. Visible L3 to C8 4. CLARKE'S COLUMN/CLARKE'S NUCLEUS/NUCLEUS DORSALIS

*PCML vs. Spinothalamic* What are the 2 big differences between the pathways of the PCML and the Spinothalamic tracts?

1. Where they decussate: PCML = At medulla ST = in the spinal cord about where it enters 2. Type of Ascending Fibers: -ST: 2nd neuron on the contralateral side of the skin. -PCML: Still primary neuron on the ipsilateral side of the skin.

flip the card for the question

1. Which of the images would be indicative of a failure of teh maxillary prominences to fuse in midline? 2. Which of the images would be indicative of a failure of maxillary prominences to fuse with medial nasal prominences (or intermaxillary segement)? 1. E/F 2. B/C/D/F (apparently F can be caused by both....?)

*Spinal Cord Pain Mechanisms:* 1. What type of neuron are these three things describing? Also projects to spinothalamic tract Intensity encoding Number of times it fires denotes modality 2. What type of pain theory does this go with?

1. Wide Dynamic Range (WDR) Neuron 2. intensity based theory. b/c other pain fibers synapse on the WDR neuron so its an additive affect on the WDR before it gets sent up to conscious sensation.

1. do sensory ganglia in the head have psudounipolar cells in them? 2. what are ganglion cells that are not distinct? 3. Which ganglion cells are distinct

1. Yes just like displaced dorsal root ganglia in the brain "ok so you know that in the head." 2. they are hidden you cant see them, in the eye, cochlea, olfactory bulb. 3. CN 5 trigeminal ganglion, CN 7 ganiculate ganglion, CN9 and 10 superior and inferior ganglion specifically of 9 and 10 for GSA and SVAs respectively only the 4 cranial nerves 5,7,9,10 that have discrete ganglia

*Cornea Pathology and Therapy:* 1. Can you treat corneal edema? If so how? 2. How is the treatment in #1 usually successful?

1. Yes, One treatment option is a corneal transplant of cadaveric tissue. ~40,000 of these happen every year in the USA 2. successful b/c corneal is avascular so there is little immune surveillance so you don't have to match donor/recipient

1. Is the human brain big relative to our body size? "Explain it to me as if I dont know what is going on..." How big is it really? 2. How do we deal with this? What are the benefits?

1. Yes, yes it is. The cortical sheet laid out flat is about 2 sq. feet or liek 5 macbook air screens put together. 2. Through gyroification. This is the folding of the cortex in on itself. It serves a functional as well as a structural purpose. Funcationally, brings important neurons closer to each other. Structurally, well.. you get the picture (pun!)

1. Can you get additive effects for each of the previous (last card) sensations? 2. How would a spicy food that his quite warm effect the thermal sensation in the mouth?

1. Yes. this is a dumb card but he mentioned it, so i figured i would make a card 2. It will have additive effects on the "heat" signature for the food. A spicy food (chemoreceptor) that is also hot (thermoreceptor) only fans the flames on the sensation.

1. What is Phantom limb pain? 2. what happens to pain on the battlefield in pain on the battlefield? 3. What is up with pain in depression and pain?

1. You still get pain in a limb that is gone. could be from lots of different issue. thought maybe a confusion of the CNS trying to work out the new signals it receives. 2. This is when you do not feel as much pain in a battle or sporting event. You have top down control to modulate the pain so you don't feel it until you are out of the dangerous environment 3. pain is more intense when you have depression

1. What is the main innervation of the muscles of the neck? 2. Quick review, from what branches does it give off SVE fibers again?

1. You would think that its the vagus (CN X).... and you would be correct! 2. Pharyngeal Superior laryngeal n. Recurrent laryngeal n.

*Lens:* 1. The lens is held in place and is influenced by what? 2. dictated by forces generated by, what muscle, and lens capsule, the lens is constantly changing shape 3. The lens is rounded when focusing on [near or distant] objects? 4. The lens is elongated when focusing on [near or distant?] objects?

1. Zonule fibers 2. Ciliary muscle 3. NEAR (when ciliary muscle contracts parasympathetic) 4. DISTANT (when ciliary muscle relaxes)

Review: 1. What 2 muscles elevate the upper lip (snarl)? 2. What muscle pulls the angles of the mouth laterally (smile)? 3. What muscle closes the oral fissure (kiss)? 4. What muscle Protrudes lower lip + elevates chin (pout)? 5. What muscle Depresses the angle of the mouth (frown)?

1. Zygomaticus Major & Minor 2. Risorius 3. Orbicularis Oris 4. Mentalis 5. Depressor Anguli Oris

*Glaucoma:* 1. What is Glaucoma? 2. What are the 2 forms of Glaucoma?

1. a condition that causes damage to your eye's optic nerve and is often linked to a buildup of pressure inside your eye. 2. Open Angle and Closed Angle (referring to the IridoCorneal angle)

1. What are the 3 paired laryngeal cartilages? 2. Are they bigger or smaller then the unpaired?

1. a) Arytenoid b) Corniculate c) Cuneiform 2. Smaller dollar

*Hydrocephalus:* 1. Occurs from what 3 things? 2. What is the difference b/w communicating and non-communicating hydrocephalus?

1. a) Excessive CSF production b) *Blockage of CSF circulation* c) Deficiency in CSF reabsorption 2. Communicating = ventricle to subarachnoid space problem ( all ventricles expand) non-communicating = within ventricle block (block b/w one of the ventricles) differential ventricle expansion.

1. What are the 2 classes of laryngeal muscles?

1. a) Extrinisc Laryngeal muscles b) Intrinsic laryngeal Muscles

*Paranasal Sinuses:* 1. What are the 4 Paranasal Sinuses? 2 .Which one is the largest? 3. Which one is referred to as "air cells" because there are multiple small compartments instead of one large opening? 4. Which one is very closely related to the pituitary gland?

1. a) Maxillary sinus b) Ethmoid Sinus c) Frontal Sinus d) Sphenoid Sinus 2. Maxillary sinus 3. Ethmoid sinus 4. Sphenoid sinus

*Cerebrospinal Fluid:* 1. What are the 3 functions of the CSF?

1. a) Protects brain from mechanical damage (suspension) b) Regulates fluid composition around neurons c) Provides endocrine/paracrine pathways for non-neuronal signaling

*Third Ventricle:* 1. What 4 recesses does it contain?

1. a) optic b) Infundibular c) pineal d) suprapineal

*Nasal Cartilages:* 1. What are the 4 nasal cartilages ? 2. which one of #1 is U-Shaped and outline the nares (nostrils)? 3. Which one of #1 is continuous with the bony nasal septum?

1. a)Major alar cartilage b) Minor alar cartilage c) Lateral nasal cartilage d) Septal cartilage 2. Major alar cartilage 3. Septal cartilage

*Major Ascending Pathways* 1. What are the major somatosensory to cerebrum pathways (2)? 2. What are the major somatosensory to cerebellum pathways (4)?

1. a. Posterior Column - Medial Lemniscal system (PCML) b. Spinothalamic pathway AKA, Anterolateral system (ALS) 2. a. Posterior spinocerebellar tract b. Cuneocerebellar tract c. Anterior spinocerebellar tracts d. Rostral spinocerebellar tracts

1. What are the three primary brain vesicles found in week 3 of development? 2. What do the 3 vesicles give rise to by the 4th-5th weeks of development?

1. a. Prosencephalon (forebrain and most rostral) b. Mesencephalon (midbrain) c. Rhombencephalon (hindbrain and most caudal) 2. a. telencephalon + diencephalon b. mesenecephalon c. metencephalon + myelencephalon

1. Given the events in this video(video of UCLA stimulating the right and left recurrent laryngeal nerves) what do you think will be the most likely defect in glottal function that a patient would exhibit following accidental transection or compression of the recurrent laryngeal nerve during surgery?

1. abnormal phonation trouble closing glottis on side of problem This is because most of the muscles innervated by the recurrent laryngeal nerve are adductors only one muscle closes the glottis (PCA) so if you cannot close the glottis you will have phonation problem and aspiration problem because you can't close the airway during swallowing if you can't open the glottis you will have problems breathing and abnormal phonation

*Thyroarytenoid Vocalis:* 1. what do the thyroartenoid vocalis muscles do? 2. A shorter vocal ligament = [higher or lower?] sound? 3. A longer Vocal ligament = [higher or lower?] sound?

1. add tension to the vocal ligament which alters the pitch of the sound 2. shorter VL = lower sound 3. Longer VL = higher sound

*Cuneiform:* 1. What is the cuneiform good for? 2. What type of cartilage is it? 3. Where is it in relation to the corniculate cartilage?

1. adds rigidity which can change the quality of sound produced, changes texture of airway 2. rod of elastic cartilage, 3. anterolateral and superior to the corniculate cartilage.)

1. where is CSF created and by what? 2. What is the drainage pathway from the top? 3. CSF travels [dorsal or ventral?] and [anterior or posterior?]. with a [superior or inferior?] flow *4. What drains CSF from the subarachnoid area to the venous system through specifically the superior sagital sinus?*

1. all 4 ventricles, the choroid plexus 2. lateral ventricles -> 3rd ventricle -> aqueduct -> 4th ventricle -> lateral and median foramen -> subarachnoid space -> go down around spinal cord OR up around cerebellum -> goes around tentorum cerebelli to get to cerebrum 3. ventral and anterior, with a superior flow once the spinal cord is full of CSF 4. arachnoid granulations in in the superior skull

*Congenital Anomalies: Neural Crest Disorders* 1. Treacher collins is caused from which arch? 2. What are the 4 main symptoms/structural defects? 3. what did the kid on wonder have?

1. arch 1 structures 2. Malar hypoplasia -Micrognathia -Malformed external/ middle ear -impaired hearing 3. This which is Treacher Collins Note: -1/50,000

*Lens:* 1. New born cells derived from the lens epithelium occur where? 2. Then new born cells elongate and send processes around the lens core. They then form WHAT with those born at the same time on the opposite side? 3. What happens to #2's nucleus?

1. at the equator 2. Suture 3. eventually disappears as it goes towards the center

*Fourth Ventricle:* 1. What structures of the brain is it level with? 2. What are the 2 things that make up the roof? 3. What are the 3 apertures that allow for CSF to flow inot the subarachnoid space of rest of brain?

1. at the level of Pons and Medulla 2. Superior medullary velum and inferior medullary vellum 3. 2 Lateral (*Foramina of Luschka*) 1 Median (*Foramen of Magendie*)

1. Is your CNS a closed or open system? 2. What three things have to all concurrently to maintain fluid homeostasis in the brain? 3. What happens if #2 doesn't work. 4. He said really what 2 things are going to help maintain the pressure in the brain?

1. b/c of the skull and vertebral canal it is like a closed system. 2. Blood, CSF, and ISF (interstitial fluid) have to all concurrently to maintain fluid homeostasis in the brain! 3. You can get a build up of pressure b/c of the closed system which is bad. hydrocephalus or water on the brain. eg is a block in the CSF drainage. 4. the blood brain barrier and the CSF production. helps maintain and shuttle fluid into and out of cranial cavity.

*Cervical Fascias: cervical visceral fascias* Buccopharyngeal fascia: 1. attaches superiorly to what? 2. covers what 2 constrictor muscles on their external surface? 3. fuses laterally with what fascia? at the muscular attachment sites of what constrictors? and at the posteromedial border of what gland? 4. it is prolonged inferiorly for an indeterminable distance where it fuses with the adventitia of what?

1. base of the skull 2. covers the buccinator and pharyngeal constrictor muscles on external surface 3. pre-tracheal fascia at the muscular attachment sites of the pharyngeal coonstrictors and at the posteromedial border of the thyroid gland. 4. Esophagus, blends and goes away. only one that doesn't have a definitive ending

1. The 20 different types of sensations we interpret from free nerve endings depends on what in the nerve? 2. ______________ is umbrella term for "noxious" receptor 3. What are the 3 main types of free nerve endings? 4. What are Silent/sleeping nociceptors? 5. What are Polymodal nociceptors?

1. based on what type of *TRP* (pronounced "trip") channels they have 2. *Nociceptor* is umbrella term for "noxious" receptor 3. Thermal, mechanical, chemo 4. aren't usually activated unless there is inflammation or a chronic injury, They are Pain receptors. additional pain independent of the initial injury 5. Have multiple receptors in one free nerve ending. I.E. chemo and thermal reception or mechanical and thermal reception

Cavernous sinus 1. Is this a midline or bilateral thing? 2. On which bone is it located? 3. how do the two cavernous sinuses communicate? (be specific about location of structures)

1. bilateral 2. body of *sphenoid* 3. intercavernous sinuses located within the diaphragma sellae anterior and posterior to the hypophyseal stalk

1. The bulk of the nasal cavity is outlined by what?

1. boners

*Anterior Triangle:* 1. the submental triangle is bounded laterally by what 3 things?

1. bounded laterally by the two opposing anterior bellies of the digastric muscles and the hyoid bone

*Anterior Triangle:* 1. The digastric (submandibular) triangle is bounded superiorly by what? 2. inferiorly by what?

1. bounded superiorly by the inferior margin of the mandible 2. inferiorly by the two bellies of the digastric muscle

1. What is the name of the superior vocal folds and what do they do? 2. What is the name of the inferior vocal folds and what do they do? 3. What is the name of the space b/w the superior and inferior vocal folds 4. which set have a vocal ligament

1. common name = false folds called the vestibule vocal folds. do move and change the quality of voice but not close to the sound production of the vocal folds 2. common name = true folds called the vocal folds makes the noise 3. Laryngeal Ventricle space or Laryngeal Vestibule space 4. Vocal Folds

*Sternocleidomastoid (SCM)* 1. What is the Torticollis (Wry Neck)?

1. congenital or acquired, results in a shortening of the SCM which places the patients head in a position side bent to the same side and rotated to the opposite of the affected muscle

1. Brainstem's main job? 2. What are some of the types of connections going through it? 3. Are these connections {Voluntary or Unconscious}? 4. Are they {General, Visceral, or Special} *Sensory*? 5. Are they {General or Visceral} *Motor*?

1. connects the body & neural function 2. - Sensory & Motor PW b/w body & brain - Cranial nerves & their Targets (Tracts, Nuclei, Synapses, Decussations) 3. Both 4. All 5. Both (get the idea? It connects EVERYTHING)

*Retina:* 1. The thickness of the retinal layers averages about the thickness of 1/2 of a what? 2. What neuron populates the layers? 3. How do we refer to the layers for which one is inner and which is outer?

1. credit card 2. each layer is populated by a specific type of neuron with a specific function 3. refer to retina and layers in order encountered if looking in through the pupil

*Cutaneous nerves: Ventral Rami* lateral supraclavicular nerves 1. Cross what bone in the area of what joint (which they supply) 2. provides cutaneous innervation to what of the shoulder?

1. cross the clavicle in the area of the acromioclavicular joint (which they supply) 2. provide cutaneous innervation to the prominence of the shoulder

*Cutaneous nerves: Ventral Rami* Intermediate supraclavicular nerves 1. cross what bone? 2. to innervate the skin over what muscle? 3. and as far inferior as what rib?

1. crosses the clavicle 2. innervates the skin over the pectoralis major 3. as far inferior as the third rib

*Lymphatics: superficial cervical lymph nodes* Note 1. lymph drainage from areas of the head not drained by the superficial cervical lymph nodes drains to what lymph nodes? 2. #1 will be considered to be with what? 3. *As a General Rule*, lymphatic drainage from the superficial structures of the head and neck drains via what nodes? which then drain to what nodes? which also receive lymph from the deeper areas of the face, head and viscera of the neck. 4. out of superficial or deep cervical lymph nodes, if you found cancer in which node would you be more concerned?

1. deep cervical lymph nodes 2. the carotid sheath 3. Superficial cervical lymph nodes to deep cervical lymph nodes 4. Deep cervical lymph nodes

*Cervical Fascias: cervical visceral fascias* 1. these encircle the visceral structures of the neck which are what 5 things?j 2. it is composed of 2 separate [anterior and posterior, or medial and latera?] occurring fascias which meet and fuse [medially, laterally, anteriorly, posteriorly?]] 3. what are the names of the 2 fascial layers spoken of in #2? and what layer # of deep fascia are each of them?

1. encircle the visceral structures of the neck, i.e., pharynx, esophagus, larynx, trachea and thyroid gland 2. composed of two separate anterior and posterior occurring fascias which meet and fuse laterally. 3. pre tracheal 3rd layer of deep fascia and Buccopharyngeal 4th layer of deep fascia

Ventral tract 1. Where does it enter the brainstem? 2. What occurs to the primary afferent neuron in the ventral trigeminothalamic tract after it enters the brainstem?

1. enter the *Pons* and 2. *DESCEND to spinal trigeminal nucleus* (STT) *in the Medulla.* it will *decussate* in the medulla and *ascend*

*Respiratory Epithelium:* 1. The Epithelium sits on what? 2. #1 is basically like a penis in the nose which means it has what type of tissue? 3. The nasal mucosa ciclically does what? 4. This does what to air flow 5. What else can do the same thing as #3 and #4

1. epithelium sits on a vast venous plexus 2. The venous plexus is erectile tissue. 3. The nasal mucosa cyclically pools blood and becomes congested (he gave the example of when you wake up stuffy but then 20 minutes later you are fine) 4. This diminishes air flow 5. Inflammation can do the same i.e. congest the venous plexus and diminish the air flow

*Superficial structures:* 1. What 2 pairs of veins are superficial?

1. external jugular veins (paired left and right) and the anterior jugular veins (paired left and right)

*Anterior Jugular Veins (L&R):* NOTE: 1. In the submandibular region the facial vein joins with what vein? 2. in turn they form what vein? 3. #2 then pierces what to join what vein?

1. facial vein joins with *anterior division of the retromandibular vein* 2. They form the *common facial vein* 3. piercing the carotid sheath to join the *internal jugular vein*

1. How are most muscles in the larynx named? 2. What are the 6 intrinsic muscles of the larynx?

1. for the inferior attachment below to the superior attachment above 2. a) Cricothyroid b) oblique arytenoid c) transverse arytenoid d) Posterior Cricoarytenoid e) Thyroarytenoid f) Vocalis

*Functional Cornea:* 1. Corneal Epithelium is renewed by a stem cell population, which is found where? 2. What layer lies deep to the basement membrane and is a barrier to protect underlying Substantia Propria. 3. Does #2 regenerate? What happens when it is damaged?

1. found in the Limbus (junction b/w the Cornea and the Sclera) 2. Bowman's Layer 3. does not regenerate, damage leads to scarring

*Iris:* 1. Both muscles in the iris are derived from the neural outgrowth of what? 2. spasms in the dilator pupillae can cause a misshapen pupil called what? 3. pigmented parts of the iris are from what type of tissue?

1. from the BRAIN 2. "Tadpole" pupil 3. Neural Tissue

*Congenital Anomalies:* 1. What is Ectopic Glandular Tissue? 2. what is the cause? 3. Looks like a cyst along what line?

1. glandular tissue persists along course of migration. (thyroglossal duct) 2. Cause: glandular tissue persists along course of migration. 3. Midline

*Nasal Cavity:* 1. again what is the role of the nasal cavity in conditioning air? 2. if you breath in 72° F air that is 50% humidity through your nose by the time that air reaches the larynx what is its temperature about and its humidity about? 3. what about when it reaches the main bronchi? 4. Do we take back the heat and humidity when we exhale? 5. what animal is really good at #4? 6. What part of the nasal cavity allows for this process?

1. heat and humidify air 2. 90°F and >90% humidity 3. 98.6°F ~100% humidity 4. yes a little bit but we suck at it. from main bronchi of 98.6°F and ~100% humidity we only get it down to 90° F and >90% humidity when we exhale. 5. Camels dawg 6. turbinates

*3 Orbicularis Muscles* 1. What are they + Where are they? 2. These serve as an attachment for?

1. i/ii: 2x *Orbicularis Oculi* (surround eye) iii: *Orbicularis* Oris (surround mouth) 2. Many other muscles of facial expression

Results of UMN (lateral corticospinal tract) damage... 1. 3 major signs/symptoms? 2. *Amyotrophic Lateral Sclerosis (ALS)*: where do you see degeneration? 3. ALS: leads to what symptoms?

1. i: *Babinski's sign*: Toes point up instead of down ii: *Spasticity*: Corticospinal influence inhibit brainstem control of postural muscles (relaxes 'em) iii: Loss of fine motor control 2. *Corticospinal & LMN degeneration* 3. Progressive weakness (usually fatal w/in 5 years of onset- unless you're really smart [Stephen Hawking - 55yrs w/ALS]) [10% of cases are familial]

*Innervation* 1. 2 major CNs to the head (+ which is sensory & which is motor)? 2. Major methods that each get around the head?

1. i: *CN V (Trigeminal)* - Sensory ii: *CN VII (Facial Nerve)* - Motor 2. *V*: Branching in cranial vault *VII*: Exits 1 foramen & branches on face

More Muscles! 1. 4 muscles that help Orbicularis Oris *elevate* the mouth? 2. 3 muscles that help Orbicularis Oris *depress* the mouth?

1. i: *Levator Labii Superioris* ii: *Zygomaticus Major* iii: *Zygomaticus Minor* iv: *Risorius* 2. i: *Mentalis* ii: *Depressor Labii Inferioris* iii: *Depressor Anguli Oris*

*Cervical region* 1. What is the White Matter like (3)? Why? 2. What is the Grey Matter like (1)? Why?

1. i: Abundant White matter (lotsa ascending & descending fibers to body thru here) ii: Wide medio-laterally iii: 2 bundles w/in each Posterior Funiculus 2. Large ventral horns (many motor neuron cell bodies going to innervate upper limb

1. What 4 layers make up the *scalp*? 2. What 3 layer below the *scalp* (before you hit dura)?

1. i: Epidermis ii: Dermis iii: Hypodermis (dense CT) iv: Galea Aponeurotica 2. i: Subaponeurotic tissue (loose CT) ii: Pericranium (Periosteum) iii: Calvaria (superior bit'o skull)

*Vestibulospinal tracts* 1. What are the 2 main vestibular PWs + role of each?

1. i: Lateral vestibulospinal - Maintain posture (compensate for body movement); *Ipsilateral*, posture, includes extensors (*lower* spinal cord) ii: Medial vestibulospinal - Coordinate head & eye movement, stabilizes head; *Bilateral*, head position stability (*cervical* cord)

*Superior Constrictor* 1. Dude, there are *4* freaking attachments for this muscle (where are those attachments)?

1. i: Mylohyoid (on mandible) ii: Retromolar Trigone (mandible) iii: Pterygomandibular Raphe iv: Medial Pterygoid Plate

*Orbicularis Oculi* 1. 2 parts to it? 2. Origin? 3. Interdigitates where?

1. i: Orbital bit (surround) ii: Palpebral bit (eye lid) - distribute tears over eye 2. *Medial Palpebral Lig.*, Frontal bone, Lacrimal bone, Maxilla 3. At *Lateral Palpebral Raphe*

*Neuromuscular junction (Motor end plate)* 1. 3 components? 2. T/F: most often 1 NMJ per muscle fiber 3. T/F: most often 1 NMJ per axon

1. i: Presynaptic element (axon terminal/vesicles) ii: Synaptic cleft iii: Postsynaptic element (Nicotinic Ach receptor) 2. True (1 NMJ/muscle fiber) 3. False (# of NMJ per axon varies)

*Lower Lumbar* 1. What is the White Matter like (3)? 2. What is the Grey Matter like (1)?

1. i: Relatively round ii: Small posterior funiculus iii: Very little white matter 2. Large ventral horns

*Inferior Constrictor* 1. Yo, what are it's 2 parts? 2. Function of the transverse portion of the above muscle?

1. i: Thyropharyngeus Muscle (oblique) ii: Cricopharyngeus Muscle (transverse) 2. Acts as UES (upper esophageal sphincter)

*Lower Sacral* 1. What is the White Matter like (3)? 2. What is the Grey Matter like (2)?

1. i: Very round ii: Very small posterior funiculus iii: Minimal white matter 2. i: Large ventral horns ii: Large dorsal horns

1. Spinal cord growth is complete when? 2. The vertebral column continues to____ through puberty 3. ∴ spinal cord is much_____ than the vertebral column, but has the same number of _______ & _______ (+1 cervical)

1. in late fetal development 2. lengthen (differential growth) 3. shorter, segments & nerves

*Macular degeneration* 1. Where does macular degeneration begin? 2. What are the 2 forms of age-related macular degeneration? 3. Which one is more common? 4. How do each occur? 5. Which one has a slow onset which one has a rapid onset? 6. What are the treatments for each?

1. in the retina or underlying choroid 2&3&4&5&6. -dry: most common - Drusen (debris) accumulation - slow progression - no current therapy - Wet: Less common- Abnormal angiogenesis- rapid progression - therapy, block new BV

1. Where is CSF produced? 2. What is the drainage of the CSF starting in the lateral ventricles?

1. in the ventricles, lateral ventricles (1 and 2) and ventricles 3 and 4. 2. Lateral ventricles -> 3rd ventricle -> through cerebral aqueduct -> 4th ventricle -> drains into subarachnoid space to bath brain and spinal cord.

*External Jugular Veins (L&R):* Clinical notes: Prominence of the external jugular v. beyond normal can reveal much about the health status of the individual. 1. increased filling is an indication of increased _____________ to flow in what conditions? (4)

1. increased resistance to flow in such conditions as heart failure, SVC obstruction, enlarged supraclavicular lymph nodes or increased intrathoracic pressure

*Veins to Larynx:* 1. what are the 5 main veins that help with drainage of the larynx? 2. what does each drain into?

1. inferior thyroid vein, middle thyroid vein, superior thyroid vein, superior laryngeal vein, and inferior laryngeal vein. 2. Inferior thyroid vein drains to brachiocephalic veins Middle thyroid and superior thyroid veins drain to the internal jugular vein Superior laryngeal and inferior laryngeal veins drain into the superior thyroid vein

*Nasal Cycle:* 1. What is Obstinate Vasodilation?

1. inhalation of irritants, infectious disease and allergic reactions can alter the cycle, often resulting in this "obstinate vasodilation" of the deep sinusoidal structures. Patency of the nasal passage is lost bilaterally. "become a mouth breather"

*Retina:* 1. What are the 3 layers of the posterior eye (inner layer, middle layer, and outer layer) this includes the retina and these are not layers of the retina. 2. What is the membrane that separates the middle and inner layers? 3. The choroid is in what layer? 4. is the choroid a vast blood supply likely beyond nutritional needs of the Retina?

1. inner layer = retina middle layer = Uvea outer layer = Sclera 2. Bruch's Membrane 3. Uvea, Middle layer 4. Yup

*Retina:* 1. What is the names of the 4 layers? 2. the inner layer is the output cells of the retina only axons that leave the retina and the eye form what/

1. inner layer- retinal ganglion cells (RGC's) - Inner Nuclear Layer (interneurons) - Outer Nuclear layer (Photoreceptors) outer layer- Retinal Pigment Epithelium (RPE) 2. the *OPTIC NERVE*

*innervation of larynx:* 1. What are the 2 branches of the superior laryngeal nerve? 2. These supply sensory and motor to what muscle group? 3. What nerves comes from the vagus up to the larynx from below?

1. internal and external laryngeal nerves 2. the intrinsic muscles 3. The left and right recurrent laryngeal nerves

*Cervical Fascias:* What are the 6 layers of the deep cervical fascia going superficial to deep?

1. investing fascia 2. infrahyoid fascia 3. Pre-tracheal fascia 4. Buccopharyngeal fascia 5. Pre-vertebral fascia 6. Alar Fascia

*Cervical Fascias:* 1. What fascia surrounds the entire neck from above downward and posterior to anterior, provides a roof for the anterior and posterior triangles? 2. What 2 muscles does investing fascia surround entirely?

1. investing fascia 2. the trapezius and the SCM muscles

1. Why is the posterior cricoarytenoid so important? 2. Vocalis is more medial or lateral to the thyroarytenoid muscle? *3.* What does the vocalis muscle do?

1. it is the only muscle that aBducts the glottis 2. Vocalis is more medial 3. puts tension on the vocal ligament by constricting

1. Moving from the caudal medulla up through the rostral medulla, what happens to the medial lemniscus as it ascends? 2. Where do the cuneate fibers start (in terms of their orientation)? What about gracile? 3. With the rotation, where do cuneate fibers end up in the mid-pons? Gracile? 4. What about their orientation at the midbrain?

1. it rotates! 2. cuneate fibers start dorsal while gracile fibers start ventral. 3. Cuneate fibers are more medial and the gracile fibers are more lateral. 4. The cuneate fibers then move more anterior and medial where the gracile fibers are more dorsal and posteriolateral in the midbrain.

1. Damage to these pathways would present with what symptoms? 2. Would they be contralateral or ipsilateral?

1. lack of coordination 2. ipsilateral due to the fact that they do no decussate

*Olfactory Epithelium:* 1. Olfactory neurons are in what layer again? are they considered to be ciliated? 2. What is different b/w normal cilia and the olfactory neuron cilia? what are on the cilia in the olfactory neuron?

1. layer 2, is considered to be 'ciliated' 2. the cilia are sensory and not motile the odorant receptors are on the cilia

*Cervical Fascias: cervical visceral fascias* Pre-tracheal fascia: 1. Pre-tracheal fascia is located [anterior or posterior?] and [medial or lateral?] to the larynx and trachea? 2. it is attached above to what bone? 3. It is attached laterally to what cartilage? 4. It blends posterolaterally with what fascia? 5. it splits to enclose what gland? 6. it is prolonged inferiorly where it attaches to the adventitia of what? and fuses with fibrous what?

1. located *anterior and lateral* to the larynx and trachea, 2. hyoid bone 3. thyroid cartilage 4. buccopharyngeal fascia 5. thyroid gland 6. adventitia of the aortic arch, and fuses with the fibrous pericardium

*Unconscious Proprioception* 1. With signals going to the cerebellum, these signals with help maintain what two things in the body? 2. What are the two receptors that feed back to the cerebellum (more classes than anything) 3. What are the 4 different tracts that feed into the cerebellum?

1. maintenance of tone and posture. 2. Proprioceptors and some mechanoreceptors. 3. Posterior spinocerebellar tract Cuneocerebellar tract Anterior spinocerebellar tract Rostral spinocerebellar tract

*Nasal Cycle:* 1. Why does the nasal cycle happen, What where the 3 maybe reasons he gave us?

1. may flush out the mucosa removing debris????? May load the epithelium with IgA to enhance immune response????? May alter air flow so different odorants reach the Olfactor epithelium on each side. Enhanced detection of odorants????

*Anterior Fontanelle* 1. What would a small anterior fontanelle indicate? 2. What if it is bulged? 3. What if it is depressed?

1. means premature fusion 2. increased intracranial pressure (hydrocephaly) 3. dehydration

*Central sensitization:* 1. What is hyperalgesia? 2. What is allodynia?

1. metabolic changes in neurons so that pain feels worse. I.E. opioids cause change in NMDA so when you have the same pain stimulus after opioid abuse the pain is worse because of the metabolic change 2. This is when you have a wiring problem a non-nociceptive fiber is synapsing on a nociceptive fiber for some reason. I.E. a different stimulus is wired to a pain neuron so you feel pain from a non-nociceptive stimuli. usually post injury.

*Bones of the Nasal Cavity:* 1. Which Concha are part of the ethmoid bone 2. Which Concha are seperate bones?

1. middle and superior chonca 2. Inferior concha

*Dorsal scapular n. (C5)* 1. Passes thru what muscle? 2. to gain ventral/medial surface of what muscle? 3. Descends along the medial border of what bone?

1. middle scalene 2. levator scapulae 3. scapula (ventral to the rhomboid muscle)

1. The Larynx is a *Complex* combination of what 4 things?

1. muscles, cartilages, nerves, mucosal, and vascular structures

1. Neural crest cells migrate through what? 2. What substance that a mother drinks can cause FAS facial characteristics, small eye openings, smooth philtrum and smooth upper lip by causing apoptosis in NC cells?

1. neural tube 2. Alcohol

1. Would the ventricular system exist without the brain? 2. is it a positive or negative space? 3. What is a ventricle? 4. how is it useful to us for the practical?

1. no 2. negative space 3. fluid filled open space 4. to locate other structures of the brain

*Optic disc:* 1. Why is there a blind spot? 2. What exits and enters the eye here?

1. no photoreceptors in this area so no vision 2. Axons from RGC's coalesce and exit the eye through the optic disc, Blood vessels enter the eye here as well

*Structure of the Eye: Fluid-filled segments* 1. Is the eye hollow? 2. The eye is split up into 2 segments. What do we call them?

1. nope it is fluid feeled 2. Posterior Segment and Anterior segment

*Iris:* 1. how robust are the dilator and sphincter pupillae? 2. What are 2 ways to tell the dilator pupillae apart from the sphincter pupillae?

1. not at all robust they are tiny check out the pic 2. - Dilator Pupillae *never* have more then a tiny strand of "muscle" - Dilator Pupillae *Always* associated with pigmented epithelium of Iris

1. What will the thyroid and cricoid cartilages do as you age? 2. This will cause a change to the quality of voice when you are around what age?

1. ossify 2. 70-80

*Retina:* 1. Why do we have the best vision at the fovea? 2. The fovea is part of the macula. What is the Macula? 3. Damage to the macula which results in loss of central vision is called what?

1. overlying cells are pushed aside, only cones present (maximum packing density) 2. Larger region of high visual acuity surrounding (and including) the fovea 3 .Macular degeneration

1. what is the *spino-bulbo-spinal* mechanism? 2. What lamina are WDR neurons located?

1. pain going to the spine up to the brainstem and then the brainstem sending axons back down the spine to modulate pain 2 Lamina V

*Accessory phrenic n. (usually C5)* 1. Descends parallel to what nerve? 2. on lateral surface of what muscle?

1. phrenic n 2. Anterior scalene

*Axon Reflex:* 1. What is Axon Reflex? 2. What 2 substances cause more pain? 3. the axon reflex contributes to what other things?

1. physical damage to the axon. so substance P and histamine are released. these go back and cause more pain. wakes up the sleeping receptors. feel pain even though it is the secondary affects of your body trying to heal itself 2. Glutamate and Substance P 3. Windup

1. There are more mucus glands on the roof of the nasal cavity or the posterior inferior portions of the nasal cavity?

1. posterior and inferior portions of the nasal cavity. the roof is for the olfactory epithelium. this is one way to tell the difference b/w the two epithelium

*Anterior Triangle:* 1. the carotid triangle is bounded superiorly by what muscle? 2. anteriorly by what muscle? 3. and posteriorly by what muscle?

1. posterior belly of the digastric 2. superior belly of the omohyoid 3. SCM

*Cutaneous nerves: Ventral Rami* C2-C4 1. The 4 nerves that come from C2=C4 emerve from beneath the posterior of what muscle? 2. #1 is in what triangle?

1. posterior border of the *SCM* 2. in the *posterior triangle* to distribute to their respective receptive fields

*Cutaneous nerves: Ventral Rami* Supraclavicular nerves (C3,4) 1. it arises from a common trunk which crosses the inferior portion of what triangle where it divides into three branches. 2. what are the 3 branches of this nerve?

1. posterior triangle 2. Medial supraclavicular nerves Intermediate supraclavicular nerves lateral supraclavicular nerves

*Anterior Triangle:* 1. The muscular triangle is bounded posterior-superiorly by what muscle? 2. Posterior-inferiorly by what muscle? 3. anteriorly by what?

1. posterior-superiorly by the superior belly of the omohyoid 2. posterior-inferiorly by the SCM 3. Anteriorly by the median line of the neck to the hyoid bone

*Neocortex Summary* 1. When talking about cortical projection neurons, what cell types are we talking about? 2. When talking about cortical internuerons, what cell types are we talking about? Check out the summary slide on the back.

1. pyramidal, betz, and fusiform 2. stellate (granule), chandelier, horizontal, basket, cell of mortinotti He hasnt mentioned chandelier, basket or cell of Mortinotti up to this point, so not sure if they are absolutely necessary to know.

1. What is the point of the Spinoreticular and spinomesencephalic tracts?

1. receive pain input to the brainstem on its way to the brain and be able to affect the circuit down in the dorsal horn of the spinal cord to change or modulate or lessen that pain sensation

Cavernous sinus 1. What does it communicate with anteriorly and posteriorly? (1) 2. communicates with #1 via what sinuses? (2)

1. sella turcica 2. anterior and posterior intercavernous sinuses In pic 13 Ant. & post. intercavernous sinuses 14 Cavernous sinus

*Pharyngeal Apparatus:* 1. Separated externally by [pouches or clefts?]? 2. Separated internally by [pouches or clefts?]? 3. composed of what 4 things?

1. separated externally by *clefts*, 2. separated internally by *pouches* 3.composed of: *cartilage* supportive rod, *musculature*, *blood supply* (aortic arch system), and a *cranial nerve* supplying these arch structures

1. what does omo mean in greek?

1. shoulder

1. Axons of LMNs innervate what again? 2. What makes up a *motor unit*? 3. T/F: most often 1 LMN per muscle fiber 4. ↓ or ↑ the # of motor units changes what?

1. skeletal muscle fibers 2. 1 LMN + *all* fibers it innervates 3. F: Usually 1 LMN innervates > 1 fiber 4. Amount of force produced by a muscle

*Receptive fields* 1. Smaller receptive fields tend to have [many/few] sensory neurons associated with them where large receptive fields have [many/few] neurons associated with them. 2. Which of the above fields would have a larger area in the sensory cortex? 3. There is a(n) [inverse/direct] relationship between the size of receptive field and size of cortical area representing that region.

1. small fields = many neurons; large fields = few neurons. 2. The smaller portion would, because they have more neurons coming back from the field. 3. inverse relationship.

1. Manipulation of the pipe shape cause the alteration of what? 2. The vocal ligaments vibrate together to produce what? 3. Muscles facilitate laryngeal cartilage articulation. This allows manipulation of the vocal folds and the production of what?

1. sound brah 2. Sound brah 3. Sound brah

*Cervical Fascias: investing fascia* 1. The inferior attachments of the investing fascia would connect what spinous process, what 2 things of the scapula, and what other 2 bones? 2. It blends with the inferior attachments of what 2 muscles and what portion of the clavicle? 3. Where the laminae from both surfaces of the SCM fail to fuse anteriorly and inferiorly they form WHAT? 4. what is #3 filled with and what does it contain? 5. Why would it be bad if it was attached to deeper structures?

1. spinous process of CV7, spine of scapula, acromion, clavicle, and manubrium 2. SCM and Trapezius, and attaches to the intervening middle one-third of the clavicle 3. a small suprasternal space 4. which is normally filled with fat and contains a vein which communicates with the inferior portion of the anterior jugular veins 5. couldn't move your neck as well

*Cervical Fascias: Infrahyoid fascia* 1. The superficial layer invests what 2 muscles? 2. The superficial layer is prolonged inferiorly to attach to the posterior surface of what? 3. laterally the superficial layer fascia fuses with what the periosteum of what 2 things? 4. from #3 it forms a sling for what tendon of what muscle?

1. sternohyoid and omohyoid muscles 2. the manubrium 3. the clavicle and the first rib 4. forms a sling for the intermediate tendon of the omohyoid muscle

1. What is the Adnexa?

1. structures around the eye that help support it

*Lymphatics:* 1. what lymph nodes are superficial in this area? 2. nodes of this system include what 4 nodes?

1. superficial cervical lymph nodes 2. Submental, submandibular, external jugular, and anterior jugular

CSF reabsorption 1. Where does CSF get reabsorbed? 2. What reabsorbs CSF in #1? 3. Is this the only region that CSF reabsorption takes place?

1. superiorly into the *superior sagittal sinus* 2. arachnoid granulations 3. Yes

*Cervical Fascias: Carotid sheath* 1. surrounds what 2 arteries and what vein and what nerve? 2. It is attached superiorly to the base of the skull at the margins of what foramen and what canal? 3. inferiorly it fuses with the adventitias of the great vessels and WHAT pericardium? 4 What are the 3 great vessels?

1. surrounds the common and internal carotid arteries, the internal jugular vein and the vagus nerve. 2. It is attached superiorly to the base of the skull at the margins of the jugular foramen and carotid canal 3. Inferiorly it fuses with the adventitias of the great vessels and the fibrous pericardium 4. (aorta, pulmonary trunk, superior vena cava)

*Nasal Cavity: Septum* 1. What is the function of the nasal cavity again?

1. take air from cool and dry to Warm and moist

1. Sigmoid sinus is located on the internal surface of which bone? 2. Where is it located relative to the petrous ridge?

1. temporal 2. Posterior to petrous ridge

*Structure of the Eye: Fluid-filled segments* 1. The Anterior Segment starts at the Cornea anteriorly and ends at what posteriorly? 2. What is the Anterior Segment filled with? 3. is #2 rarely or constantly replenished?

1. the Lens 2. Aqueous Humor 3. Constantly replenished

*Macular degeneration:* Photoreceptors are intimately associated with RPE's 1. The apex of the photoreceptor is buried within what? 2. The function and health of the photoreceptor is reliant on interaction with what? 3. How does Macular degeneration cause vision loss?

1. the RPE 2. the RPE 3. Compromises the RPE -> Compromise Photoreceptors -> Compromises vision

*innervation of larynx:* 1. It is accomplished via what nerve? 2. Is it laterally or bilaterally? 3. What is the first branch going to the larynx from the nerve in #1?

1. the VAGUS! 2. Bilaterally 3. Superior laryngeal nerve

*innervation of larynx:* 1. the left recurrent laryngeal nerve goes around what? 2. The right recurrent laryngeal nerve goes around what? 3. Which recurrent laryngeal nerve is longer?

1. the aortic arch 2. the right subclavian artery 3. The left one

*Olfactory Epithelium:* 1. Olfactory epithelium located in the Nasal cavity has to communicate with what? 2. to accomplish #1 axons transverse what bone? 3. through what specific part of #2

1. the brain 2. Ethmoid bone 3. cribiform plate (full of holes) in which the axons from the olfactory epithelium pass thru

1. Basilar plexus is located between opposed layers of dura on the basilar portion of which bone? 2. Basilar plexus connects what sinuses? 3. What plexus does it receive? 4. It communicates with what portion of the occipital sinus?

1. the occipital bone 2. Connects opposing *inferior petrosal sinuses* 3. receives the *anterior internal vertebral venous plexus* 4. Marginal portion

1. What is prosody? 2. Can someone say "Im sorry" (for ex.) if they have damage to the left frontal gyrus? 3. What about if they have damage to the right inferior frontal gyrus? 4. What about the Left superior temporal gyrus? 5. What about the Right superior temporal gyrus?

1. the patterns of stress and intonation in a language. 2. Can't say it 3. Aprosodic, meaning that they lack "weight" or intonation to their speech. (In appropriate intonation even) 4. They cant understand what is being said 5. They cant interpret the prosody of the individual saying it to them.

*Cutaneous nerves: Ventral Rami* C2-C4 ventral rami (of the cervical plexus) participate in cutaneously innervating what 5 things?

1. the pinna (outer ear) 2. as well as the region directly behind and in front of the ear 3. lateral and anterior areas of the neck 4. upper anterior thorax 5. and prominence of the shoulder

1. what are brachial arches? 2. What vertebrates have pharyngeal arches?

1. the same thing as pharyngeal arches 2. de all du

*Respiratory Epithelium:* 1. The lamina propria extends all the way down to what? 2. Is there a submucosa? if so where is it?

1. the supporting bone or cartilage 2. Nope, there is no submucosa - its *all* mucosa baby

*Anterior Jugular Veins (L&R):* Clinical Note: 1. The anastomoses of the anterior and posterior divisions of the retromandibular vein provide an important route for returning blood from inside the skull to what? 2. Should the internal jugular vein become blocked as its origin what 2 veins will provide blood to the retromandibular and facial veins to be drained from the head? 3. The previously described anastomoses with the posterior auricular vein forming the external jugular vein and the formation of the common facial vein through the anastomosis of the facial vein and anterior division of the retromandibular vein ultimately return blood to the subclavian/internal jugular veins [proximal or distal?] to the blockage allowing blood to return to the heart without increasing what?

1. the thorax 2. Emisary veins and opthalmic veins draining through the scalp and orbit respectively 3. *distal* without increasing intracranial blood pressure

*Cricothyroid:* 1. Cricothyroid muscle brings what 2 things closer together when it contracts? 2. Does it lengthen or shourting the vocal ligament? 3. Does this cause more or less tension on the vocal ligament? 4. does this increase or decrease sound frequency? 5. Does this increase or decrease the pitch?

1. the thyroid cartilage and the cricoid cartilage 2. Lengthens the vocal ligament 3. Causes more tension on vocal ligament 4. Increases sound frequency 5. increases pitch

*innervation of larynx:* 1. the recurrent laryngeal nerves ascend via what groove? 2. recurrent laryngeal nerves can also be called what? 3. The recurrent laryngeal nerves also help supply sensory and motor to what muscle group in the larynx?

1. the tracheal-esophageal groove 2. Inferior laryngeal nerves 3. intrinsic muscles of the larynx

*Respiratory Epithelium:* 1. What are basal bodies? 2. are #1 eosinophilic or basophilic? 3. what is the shape of the goblet cell nucleus? 4. what is a basal cell?

1. they attach the cilia to the apical surface of the cell in respiratory epithelium. bulb like structure 2. They stain very eosinophilic so there is a eosinophilic line on the apical cell surface in an H&E staining. 3. triangle 4. stem cells of respiratory epithelium. create both goblet and ciliated cells, which happens alot because the nasal cavity is a dangerous place

1. What is the bad thing about the connection b/w the nose and the brain via the cribiform plate? 2 What free living amoeba found in warm fresh water that survives by ingesting bacteria can access nasal cavity of swimmers (mostly males/mostly adolescent) and pass through the cribiform plate? 3. What does it do in the brain? 4. What is the infection called and what are the symptoms? 5. what is the mortality rate? and it is usually due to what?

1. things can get into the brain! 2. Naegleria Fowleri 3. Digests neural tissue in piecemeal fashion (bit by bit) 4. Naegleriosis characterized by severe headache, stiff neck, fever, confusion, seizures, and coma 5. mortality >95%. usually due to increased intracranial pressure and brain herniation

1. When you hear retropharyngeal abscess what should you think? 2. what is the mortality rate in adults for retropharyngeal abscess?

1. think *medinastinits, pericarditis, asphyxiation* 2. 25% can cause acute necrotizing mediastinitis

1. Access to CSF to venous drainage is through WHAT to WHAT sinus? 2. CSF is produced [superficial or deep?] in the brain and then flows out [medially or laterally?] and [superiorly or inferiorly?]

1. through arachnoid granulations into the Superior sagittal sinus found in dura mater up against skull 2. CSF is produced in the *deep* brain and then flows out *laterally* and *superiorly* (to cerebrum) *or* *inferiorly* (to spinal cord) NOTE: Arachnoid villi..efflux along cranial and spinal nerves (and olfactory routes) seems to be even more important than the granulations. this was in his notes but he didn't talk about it so idk

*Aqueous humor:* 1. How often is the total volume replaced? 2.What are the names of the cells on the ciliary processes that produce the aqueous humor?

1. total volume replaced every 1-2 hours 2. non-pigmented epithelial cells

*Nasal Cavity* 1. Increased surface area created by the complex architecture of the nasal cavity in combination with the venous plexus and secretions from the epithelium warm incoming air to WHAT temperature and increase humidity to greater then WHAT %?

1. warm incoming air to body temperature and increase humidity to >80%

1. Can you see the vocal folds on ultrasound? 2. do vocal folds or vestibule folds or both make midline contact to produce sound? 3. Vestibular folds are [superior or inferior?], do they change the shape of the vocal pipe and alter sound type/quality

1. yes ma'am 2. Only the vocal folds make midline contact to produce sound vestibular folds do not make midline contact 3. Superior, Yes sir

*Paleospinothalamic pathway:* 1. is this different from the neospinothalamic pathway? 2. Type of information in the pathway? 3. Point of origin (3) 4. Receptors involved (1)

1. yes that's why we are talking about it and why it has a different name 2. Poorly localized pain 3. in Skin, viscera, muscles 4. *free nerve endings (TRP channels)*

*Cribiform Plate & Olfatory Epithelium:* 1. axons coalesce and form around how man bundles that pass thru the cribiform plate? 2. collectively those bundles are called what?

1. ~50 2. Olfactory Nerve (CN I)

again... 1. The anterior segment is filled with what fluid? 2. The Posterior segment is filled with what fluid?

1.Aqueous humor 2. Vitreous humor

1. What is the pain matrix? 2. What 3 things can affect pain modulation from the pain matrix?

1.pain matrix contains brain structures (parts of brainstem, hypohalamus, thalamus, amygdala, and areas of the cerebral cortex, limbic system) that process and regulate pain information. 2. Emotional responses, previous pain experience, placebo can also affect pain modulation from Pain Matrix

3. Within what do the Facial Nerve (VII), External Carotid A & Retromandibular V travel?

3. *Interlobular Septa* CT

*Structure of the Eye:* 3. The middle Sphere is called what? 4. #3 gives rise to what 2 things anteriorly? 5. #3 gives rise to what posteriorly?

3. *Uvea* 4. Ciliary body and iris 5. Choroid

Main venous patterns of drainage for the spinal cord... 3. The veins of the spinal cord will drain where + which veins are involved (4)? 4. In what space are these veins found?

3. *Vertebral Plexus* (segmental, intervertebral, ascending lumbar v. and "Batson's plexus") 4. Epidural Space

*Lymphatics* 3. PW of lymphatic drainage of anterior bit o'head?

3. Buccal/Submandibular Nodes → Superior Deep Cervical Nodes

*Thoracic region* 3. Another name for *Nucleus Dorsalis*? 4. From what spinal levels? 5. Part of what Tract?

3. Clarke's nucleus 4. from T1-L2 5. Dorsal Spinocerebellar Tract

*Muscle Stretch Reflex* 3. 3 other names for the *Muscle Stretch Reflex*? What is it used for? 4. What are the events within a muscle stretch reflex (3)?

3. Deep tendon reflex, Monosynaptic stretch reflex, or Myotatic Reflex 4. i: Stretch of muscle spindle → ii: DRG cells synapse on ventral horn neurons innervating that muscle iii: Contraction of the stretched muscle

*Thyroid Gland*- Veins 3. What structures do *Inferior thyroid vv.* drain (4)? 4. Where do these vv. drain into?

3. Drain: Inferior bit'o thyroid gland, esophagus, larynx, trachea 4. Drain into: R & L *Brachiocephalic vv.*

3. SVE: Motor innervation to SKM of which pharyngeal arches? 4. Which SKM's are those?

3. Four (4) and 6 4. Muscles of the pharynx and palate (superior, middle and inferior pharyngeal constrictor muscles, salpingopharyngeus, levator veli palatini, palatoglossus, palatopharyngeus), larynx (posterior and lateral cricoarytenoid, transverse and oblique arytenoid, thyroarytenoid, cricothyroid) and upper portion of the esophagus

3. After this, where does it go? 4. What are the significant branches of this artery? 5. What nerve crosses the occipital a. at its origin (and what is that origin again?)?

3. From there, it enters the scalp and parallels the course of the greater occipital n. 4. Its significant branches include: (1) Sternocleidomastoid branch (2) Meningeal a. (3) Auricular a. (4) Mastoid a. (5) Descending branch (to deep neck) 5. The *Hypoglossal N.* crosses the occipital a. at its origin from the external carotid.

3. Where does this artery enter the face? 4. What are the branches does this give off?

3. It leaves the submandibular region by coursing around the sharp inferior border of the mandible at the anterior edge of the attachment of the masseter muscle and enters the face. 4. Its submandibular branches include: (1) Tonsillar a. (2) Ascending palatine a. (3) Glandular a. (4) Muscular a. (5) Submental a.

*Motor neurons* 3. Which motor neurons directly innervates muscle? 4. Which motor neurons are in a series of neurons in the brain that will innervate a LMN? 5. Where do UMNs begin? PW down?

3. Lower Motor Neurons (LMN) 4. Upper Motor Neurons (UMN) ...sorry 5. Motor cortex → Internal Capsule → Brainstem → Spinal Cord → Ventral Horn → Interneuron or on LMN

3. SVE provide _______ innervation to one Skeletal m. (________) from which pharyngeal arch? 4. GSA: Sensory to a portion of the ___________ 5. SVA: Responsible for _______ from the _________ ______ portion of the tongue 6. GVA: Sensory to epithelium of _____________ origin lining the majority of Pharynx from base of skull to Laryngeal aditus, Eustachian tube, Middle ear, Internal surface of tympanic membrane, Mastoid air cells, Tonsils, Posterior Third of the Tongue, Parotid gland, Carotid Sinus.

3. Motor; (Stylopharyngeus) Arch 3 4. Skin of External Ear 5. Taste; Post. 1/3 portion 6. Endodermal

3. How successfully does our Pericranium repair damaged bone? 4. Sweet mnemonic for the layers of the *SCALP*?

3. Not so good. 4. *S*kin *C*onnective tissue (dense) *A*poneurosis *L*oose CT *P*ericranium (don't forget that the actual "scalp" stops w/aponeurosis)

*Occipitofrontalis* 3. On which part of the skull does it attach posteriorly? 4. Where does it attach anteriorly? 5. Primary function of this muscle?

3. Supreme & Superior Nuchal Lines 4. Skin & muscles around the eye (so, not to bone) 5. Elevate the brow

*Recurrent Laryngeal N* 3. What do the specific fibers it carries attach to and provide to these attachments? 4. What are they referred to once they pass into the larynx?

3. They provide: (1) Motor fibers (SVE) to all intrinsic muscles of the larynx EXCEPT the cricothyroid (this is done via the superior laryngeal branch, external branch). (2) General sensation fibers (GVA) to the entire mucosa inferior to the true vocal folds (3) Secretory fibers (GVE-P) to the entire mucosa inferior to the true vocal folds 4. Once the recurrent laryngeal nerves pass into the larynx, they are referred to as inferior laryngeal nerves.

*Propriospinal Neurons* 3. These ascend & descend in order to talk to different parts of the spinal cord, what about that is weird? 4. T/F: They communicate only on one side at a time

3. b/c they ascend/descend w/in the grey matter (not white) 4. F: can communicate bilaterlly (varying lengths)

*Thyroid Gland* 3. i: What affect does Thyroxin have? ii: What affect does Calcitonin have? 4. Located posterior to what 2 muscles?

3. i: Thyroxin: controls metabolic rate ii: Calcitonin: decreases circulating Ca2+ 4. Sternohyoid & sternothyroid muscles

*(Neo)spinothalamic pathway:* 4. Where are the primary cell bodies? 5. Where is the 1st synapse? 6. Where in the spinal chord does it enter?

4. *DRG* 5. *lamina I, II* 6. *dorsal horn (lissauer's Fassciculus to ascend at least 1 segment)*

*Trachea* 4. Closed posteriorly by what? 5. Function of this muscle?

4. *Trachelais* muscle (smooth) 5. Regulates tracheal diameter

*Orbicularis Oculi* 4. How often do we blink? 5. What part of Orbicularis Oculi do we use when we *blink*? 6. What part of Orbicularis Oculi do we use when we *forcibly close our eyes*? 7. Why might we forcibly close our eyes?

4. 15-20x /minute 5. Palpebral bit 6. Palpebral & Orbital bits 7. Additional protection to eye (brow & skin bunch up over globe)

*Esophagus* 4. What 2 structures are anterior to the esophagus? 5. What structures are lateral to the esophagus? 6. What structures are posterior to the esophagus?

4. Ant: Trachea & recurrent laryngeal nn. 5. Lat: Thyroid gland, carotid sheath, thoracic duct (on left) 6. Post: Buccopharyngeal, alar, & pre-vertebral fascia over pre-vertebral mm. & vertebral column.

4. What is its relation to the vascular structures as it descends and when does this relationship start? 5. What area does it enter and what muscle signifies this point? What other muscles does it pass to get to its target?

4. As the hypoglossal nerve descends, it courses *between the internal jugular v. and the external carotid a. at the origin of the occipital a.* 5. It enters the *submandibular triangle* deep to the *posterior belly of the digastric muscle* just *above the hyoid bone*. Here it passes *between the mylohyoid and hyoglossus muscles to enter the tongue.*

4. {Ascending or Decending or Both} tracts in *Posterior* Funiculus? 5. {Ascending or Decending or Both} tracts in *Lateral* Funiculus? 6. {Ascending or Decending or Both} tracts in *Anterior* Funiculus?

4. Ascending 5. Both 6. Both

4. What is the derivative of the telencephalon? 5. What are the derivatives of the diencephalon? 6. Which portion of the brain overgrows, being disproportionate relative to the rest of the neural tube? 7. What structures are overgrown by #6?

4. Cerebrum 5. Eye + Thalamus + Hypothalamus + Epithalamus 6. Telencephalon 7. Diencephalon and Mesencephalon are both overgrown by the telenecephalon

4. If Sensory *inter*neuron cell bodies are in the dorsal horn, then where are the sensory *neuron* cell bodies? 5. In what part of the spinal cord is the lateral horn present? 6. What type of cell bodies are found in the lateral horn?

4. DRG 5. only in *T1-L2* & *S2-S4* 6. autonomic neurons

1. Recall: Through what foramen does the facial nerve (VII) poke it's little head? 2. Recall: (after emerging) Where is it's early course & branching taking place?

4. Emerges from *Stylomastoid foramen* 5. Parotid Gland (we literally just went over that)

4. After providing innervation to SCM, it exits which surface & goes where (which direction, deep to which muscle, joins what plexus)? 5. What nerves does it join?

4. Exits Medial Posterior surface → crosses Δ floor → obliquely/inferiorly/posteriorly → passes deep to Trap → *subtrapezial plexus* 5. Branches of ventral rami of spinal nerves C3 & C4

*Vestibulospinal tracts* 4. *Vestibular* system: input from what part of the ear? 5. *Vestibular* system: which nerve? 6. *Vestibular* system: which nuclei & where? 7. *Cerebellum* input: from which part of cerebellum? 8. *Cerebellum* system: which nuclei & where?

4. From semicircular canals 5. CN VIII (Vestibulocochlear nerve) 6. Vestibular nuclei in medulla 7. Vermis (midline of cerebellum) 8. Vestibular nuclei in medulla

*Laryngopharynx* - Recall: 4. What gap is associated with it? 5. What Ligament spans that gap? 6. What 3 things are found w/in that gap?

4. Gap 3 5. Thyrohyoid Ligament 6. Superior Laryngeal Vein, Artery & Nerve (internal branch)

*Parotid Gland* 4. In what way is it bigger than it looks? 5. What punches right though the gland?

4. It goes pretty deep into your face (like a transformer, parotid glands are more than meets the eye) 5. Facial Nerve (VII)

From the mesencephalic nucleus of V, fibers have many different destinations. What type of info will be sent to the: 4. Motor nucleus of V? 5. Facial Motor nucleus?

4. Jaw jerk reflex 5. Primary gaze frontalis reflex

4. What about vibration? 5. What are the ones the respond to pain, temperature, and itch? 6. Of these, which one will participate in the posterior medial lemniscus pathway? What about the spinothalamic pathway?

4. Pacinian corpuscles (vibration) 5. Free nerve endings (pain, temperature, itch) 6. 1-4 (merkel, ruffini, meissner, and panician) all go through the PML while the free nerve endings go through the spinothalamic pathway.

*Sternocleidomastoid (SCM)* 4. What is the Action unilaterally? 5 What is the action bilaterally? 6. What is the innervation?

4. Rotates head toward side opposite while elevating chin (side bends) 5. Flexes head; limited extension of the atlanto-occipital joint; functions as an accessory muscle of respiration 6. Spinal Accessory Nerve (CN XI) and cervical spinal nerves C2 and C3

*Lymphatics* 4. PW of lymphatic drainage of Lips/Chin?

4. Submental → Submandibular/Superior Deep Cervical Nodes

*Thyroid Gland* - Lymphatics 4. In general, lymph from *superior 1/2 of gland* drains to? 5. In general, lymph from *inferior 1/2 of gland* drains to? 6. However, all lymph from the thyroid gland ultimately drains to?

4. Superior deep cervical nodes 5. Inferior deep cervical nodes 6. Deep cervical nodes via pattern in image

4. The ______ __________ of the cervical plexus lies within the carotid sheath [lateral/medial] to the common and internal carotid arteries (superior root). It crosses the internal jugular vein [anteriorly/posteriorly] and the courses [inferiorly/superiorly], [medially/laterally] and [anteriorly/posteriorly] on its surface (inferior root). 5. What would also be found along the internal jugular vein? Could they be embedded within the sheath itself?

4. The *ansa cervicalis* of the cervical plexus lies within the carotid sheath lateral to the common and internal carotid arteries (superior root), crosses the internal jugular vein anteriorly and courses superiorly, laterally and posteriorly on its surface (inferior root). 5. *Deep cervical lymph nodes* form a chain along the internal jugular vein and may be embedded within the sheath itself.

*Parathyroid Glands* 4. What is similar b/w the parathyroid & thyroid glands? 5. What would result if the glands were removed?

4. These gland share the same blood supply, venous drainage, and nerve supply. 5. Tetany & death.

4. What does lack of sleep do to pain in lack of sleep and pain? 5. What does chronic pain cause? 6. What are placebos and nocebos? 7. What is pain sensitization

4. lack of sleep and pain = more intense pain that lasts longer, not good mental state modulating pain 5. chronic pain - change in how receptors fire (i.e. rewire of sleep receptors to a different receptor) 6. placebos and nocebos - lots of top down modulation to either cause more pain or no pain for no reason other then what the patient thinks or believes. 7. pain sensitization - mechanisms get high jacked change basic mechanics of receptors. wiring or metabolic problems. i.e. you feel pain to something you didn't feel pain for after an accident or something as such

*Afferent Tract Neurons* 4. Segregated in the spinal cord based on? 5. *Large* diameter (medial) neurons ascend where? 6. Where do these synapse (2)? 7. *Small* diameter (lateral) neurons synapse where?

4. modality & axonal diameter 5. *Posterior Funiculus* in *Fasciculus Cuneatus* or *Fasciculus Gracilis* (aka *Dorsal Column*) 6. on interneurons or LMNs (in gray matter) (if synapse on LMN = reflex arc) 7. On interneurons (2nd order afferents) in gray matter (spinothalamic tract)

*Bell's Palsy* 5. 2 muscles effected that cause the most obnoxious symptoms *+* what are those symptoms?

5. *Orbicularis Oculi*: Can't close eye → dry eye → corneal damage → can't sleep *Orbicularis Ori*: Can't close mouth fully → drooling & difficulty eating

*Branches of the Vagus N* 5. What is the track of the superior larygneal n. as it branches off the vagus in reference to the carotid sheath? 6. What are the two branches it gives off?

5. *Superior laryngeal n*. - passes downward and obliquely forward from the superior portion of the vagus N. to the larynx traveling medial to the carotid sheath. 6. It provides: a. internal branch b. external branch

*Anterior Spinocerebellar Tract* 5. Where in Spinal Cord does it enter and travel? 6. Where does it decussate? 7. Where is the second synapse? 8. What is the final destination?

5. Anterior Spinocerebellar Tract 6. Anterior SPINOCEREBELLAR decussate immediately in the spinal cord (this is our 1 exception) 7. Vermis/paravermis of the cerebellum via *superior cerebellar peduncle. Will then decussate AGAIN* 8. Deep cerebellar nuclei (via *perkinje fibers*)

5. At the point of origins for one of the structures in #4, it is crossed by what nerve? 6. It ascends medial to the mandible in what space? Where does it then terminate into (2)?

5. At the point of origin of the occipital artery, the external carotid is crossed laterally by the *hypoglossal n.* (CN XII) as it passes through the carotid sheath en route to the tongue. 6. Ascending medial to the mandible in the *deep parotid space*, the external carotid artery terminates near the neck of the mandible by bifurcating into the *maxillary and superficial temporal arteries*.

5. GSA: _____________ innervation to skin of the external ear, external auditory meatus, external surface of tympanic membrane, and dura mater of posterior cranial fossa 6. SVA: Taste from which area? 7. GVA: Sensory innervation to epithelium of ENDODERMAL origin which lines which structures? 8. GVE-P: Parasympathetic innervation to mucous glands located where? 9. What is significantly different about the GVE-P for CN X compared to other CN's? 10. Main Trunk of CN X possess Superior and Inf. ganglia which respectively contain the cell bodies of which fibers? (Look familiar)

5. Cutaneous 6. Epiglottic Valleculae 7. Root of tongue, Larynx, Lining of respiratory system, Heart, Entire gut tube to Distal 1/3 of transverse colon, Capsule of other visceral organs (liver, spleen, kidney) and Gonads 8. See #7 9. NOT found in the HEAD. Starts at the Neck. 10. GSA (Superior); SVA/GVA (Inferior) Just like CN IX

*INTERNAL JUGULAR VEINS* 5. How does it end? What does it join? 6. What are the tributaries that it receives along its course?

5. Ends by dilating to form an inferior bulb that lies posterior to the sternoclavicular joint where it joins the subclavian vein to form the brachiocephalic vein. (90% of the time there is a valve there as well) 5. Along its course, it receives these tributaries: 1) Occipital vv. 2) Pharyngeal vv. 3) Facial v. as common facial v. 4) Lingual v. 5) Superior and middle thyroid vv.

5. What NT do these *Renshaw cells* use to perform the inhibition? 6. Recall: what is the excitatory NT again? 7. What does *strychnine* have to do with all this?

5. Glycene (∴ *Glycinergic*) 6. Glutamate 7. Strychnine blocks Renshaw cells → convulsions

*Spino-bulbo-spinal pathways:* 5. Where is the 1st synapse ? 6. Where in the spinal cord does it enter? 7. After 1st synapse it [ascends or descends?], [laterally or bilaterally?]

5. Lamina I-II 6. Dorsal horn (Lissauer's Fassciculus to ascend at least 1 segment) 7. Ascends Bilaterally

*Atrophy* 5. What is *Sarcopenia* & what is it caused by? 6. How is the muscle end plate changed in aging & what does that lead to? 7. Reduction in LMNs from the spinal cord & periphery beginning about what age?

5. Loss of muscle tissue as a natural part of the aging process (probs. due to denervation) 6. Vacated motor end plates are innervated by collaterals of adjacent motor neurons (gives abnormal EMG signature) → *giant motor units* (often pathological sign) 7. ~ 60 yrs [Muscle morphological changes seen in aging look like changes seen from denervation]

*Posterior Column - Medial Lemniscal Pathway (cont.)* 5. Where in spinal cord does it enter? Travel? 6. Where does it decussate? 7. Second synapse? Is this a common stopping point for most of the ascending pathways? 8. Final destination?

5. Medial aspect of dorsal root into fasciculus cuneatus and fasciculus gracilis 6. *Internal arcuate fibers* ventral to cuneatus and gracicils (Becomes *"Medial Lemniscus"*) 7. Ventral posteriolateral nucleus (VPL) of the Thalamus. Yes, yes it is. 8. Primary somatosensory cortex (via *internal capsule* AND THEN *corona radiata*)

*Thyroid Gland* 5. Limited above by attachment of *Sternothyroid* to what? 6. Extends below approximately to level of what tracheal ring?

5. Oblique line of thyroid cartilage 6. 6th tracheal ring

*Muscle Stretch Reflex* 5. What's the *Reciprocal Inhibition* involved? 6. 3 steps of *Reciprocal Inhibition*

5. Produces opposite activity in antagonist muscles 6. i: DRG cells synapse on *inhibitory interneurons* ii: interneurons synapse on neurons innervating antagonist mm. iii: *antagonist mm remain passive*

*Corticospinal tract* 5. Sends many collaterals to what 4 structures? 6. If there's decussation, where would that take place? 7. Which tract would those fibers travel in? 8. Where is this innervating?

5. Reticular formation, trigeminal, facial & nucleus ambiguus 6. *Caudal medulla* (80%) 7. *Lateral corticospinal tract* 8. Limbs, digits (stuff needing fine motor control)

*Thyroid Gland*- Veins 5. Inferior thyroid vv may fuse to form? 6. This will drain into?

5. Single thyroid ima vein 6. *Left brachiocephalic vein*

*CERVICAL PLEXUS - Sensory* 5. What nerve innervates skin at the base of the neck, anterior upper thorax, and lateral and superior shoulder? 6. What nerve innervates the sternoclavicular and acromioclavicular joints? 7. What nerve gives sensory innervation to the pericardium, central portion of the inerior surface of the diaphragm, superior surface of the liver and gallbladder? 8. The sensory fibers from ______ & ______ join the Hypoglossal N and then follow it [retrograde/inferior] into the cranial vault. What do they innervate at this point? 9. What nerve can they also join to accomplish a similar purpose? 10. What types of fibers travel 'disguised' within the spinal accessory nerve? Where do these fibers then leave it again? What never levels are they expressing as they pass through these structures

5. Supraclavicular n. 6. supraclavicular n. 7. Phrenic n. 8. C1 and C2; Retrograde; they participate in innervating the dura mater of the posterior cranial fossa. 9. Fibers from C1 & C2 may also join the *Vagus N. (CN X)* directly to follow it retrograde into the posterior cranial fossa for the purpose of dural innervation. 10. *Proprioceptive fibers* of C2 - C4 travel 'disguised' within the spinal accessory nerve and leave it again as it passes through the *SCM (C2 & C3) and the trapezius (C3 &C4)*

5. Small diameter neurons will do what immediately? What type of afferent? 6. After #5, what type of neurons ascend? What do they then synapse on?

5. Synapse on 2nd order afferents in the spinal cord (spinothalamic tract) 6. Synapse on interneurons in the gray matter

*Spinothalamic Pathway* 5. Damage to this track can cause what symptoms? 6. How is this pathway tested? Where do you start on the body and work toward?

5. a. reduce or loss of sensibility (hypesthesis/anesthesia) b. numbness, tingling, prickling (paresthesia) 6. Test by pinprick, light touch at key dermatomes. Begin with upper body and work toward feet

*Spinothalamic Pathway REVIEW* 5. Where in the spinal cord does it enter? where does it travel? 6. Where does it decussate? 7. Where is the 2nd synapse? 8. What is the final destination?

5. dorsal horn (Lissauer's Fassciculus to ascend 1-3 segment before they meet the second neuron), synapse in dorsal horn, then decussates through anterior white commissure, ascends through anterolateral spinothalamic tract 6. Spinal cord, after 1st synapse (usually 1 level above from where it entered) 7. Ventral posteriolateral nucleus (VPL) of the Thalamus 8. Primary somatosensory cortex (via internal capsule and corona radiata)

*Corticospinal tract*: Spinal cord 6. Pyramids descend on what side of what structure? 7. Decussation where? 8. Travels in what tract? Where s that?

6. *Ventral medulla* 7. In the most *caudal medulla* = *Pyramidal decussation* 8. *Corticospinal tract* in lateral funiculus of opposite side

*Motor neurons* 6. Where are the UMNs (3)? 7. Where are the LMNs (2)?

6. Brain, Brainstem, White Matter 7. Grey Matter, Peripheral Nerve

*Subgaleal hematoma* 6. Why is this one particularly bad? 7. What can result from Q6?

6. Not limited by sutures of skull & ∴ significant blood can pool 7. Hypovolemia (3rd spacing)

Pharyngeal plexus - *ii: CN X* 6. How many branches from this nerve & what are they?

6. Pharyngeal, Superior Laryngeal, & Recurrent Laryngeal (Inferior laryngeal after passing into pharynx thru gap 4) (He said he wasn't really worried about the specific muscles for each branch, but you may want to look at them in the picture anyway)

6. Now onto the other component of the Trigeminal nerve. What was it again? 7. And this one is only contained in V_? 8. Provides _________ innervation to skeletal muscles derived from the __________ Pharyngeal arch. 9. Name the muscles derived from the Pharyngeal arch identified in #8.

6. SVE 7. V3 8. Motor; 1st 9. Muscles of Mastication (4), Mylohyoid, Anterior belly of Digastric m., Tensor Veli Palatini and Tensor Tympani.

6. GSA provides _________ to a portion of skin of the External Ear and _________ _______ _______. 7. What is the embryological origin of GSA's? 8. GSA's jump onto which structure to get to the ear?

6. Sensory; External Auditory Meatus 7. Ectoderm 8. CN X

*Thyroid Gland* 7. How are 2 lobes of thyroid attached? Surrounded by? 8. At what level does this occur?

7. Attached via *Isthmus* & surrounded by *CT capsule* 8. Isthmus crosses 2nd, 3rd, & 4th tracheal rings (around CV 7)

Review for MSN/ML & Dorsal trigeminothalamic tracts 7. Which fibers go ipsilaterally? 8. Where do the fibers from #7 travel up? 9. What nucleus does proprioception go to? 10 What is just lateral to the paraaqueductal gray?

7. Fibers from *oral cavity* 8. *Dorsal trigeminal tract* (not medial lemniscus) 9. *Mesencephalic nucleus of V* 10. *Mesencephalic nucleus of V* (pic on slide 91)

7. What does the internal branch pierce and with what other structure? what are the fibers associated with it? 8. What does it provide for the epiglottic valeculae (what fiber type)? 9. What structures does it give GVA to? 10. What structures does it give GVE-P to?

7. Internal branch (SVA, GVA, GVE-P) - pierces the thyrohyoid membrane with the superior laryngeal branch of the superior thyroid artery. 8. Sensory fibers of taste (SVA) to the epiglottic valeculae 9. General sensation (GVA) to the *epiglottis, aryepiglottic folds, entire internal portion of the larynx above glottis* 10. Parasympathetic innervation (GVE-P) to *mucous glands of the entire internal portion of the larynx above glottis*

*Bones of the Nasal Cavity: Palatine Bones* 7. What is the name of the ridge where the Palatine bones unite? 8. #7 contributes to what?

7. Nasal Crest 8. Contributes to nasal septum

7. GVE-P provide SECRETORY fibers to the ________ ________ gland via the __________ ________ n. and ________ _________ 8. Main Trunk of CN IX possess Superior and Inf. ganglia which respectively contain the cell bodies of which fibers?

7. Parotid Salivary; Lesser Petrosal; Otic Ganglion 8. GSA (Superior); SVA/GVA (Inferior)

*Paleospinothalamic tract:* 8. does it ascend bilaterally through 1 or multiple neurons? 9. As it ascends through the brainstem what does it do bilaterally? 10. The nuclei it is synapsing on in #9 is involved in what? 11. What is the point of the paleospinothalamic tract?

8. can be one but could be more neurons involved. 9. it synapses on the brainstem at multiple spots letting the brainstem know whats up while it is traveling to the thalamus 10. Activate nuclei involved in *descending pain suppression* 11. Get ascending pain up to the brain stem to be the first part of a endogenous control of pain (Whatever that means)

*Trachea* 8. What 2 structures are found posterior to the trachea?

8. i: Esophagus ii: Recurrent laryngeal nn.

Match each of the following with its track and contributions in the thorax: -R superior cardiac N -L superior cardiac N -R inferior cardiac N -L inferior cardiac N A. Pass into the thorax between the trachea and major vessels to participate in forming the deep cardiac plexus. B. Passes anterior to the arch of the aorta to join the superficial cardiac plexus.

A. R and L superior cardiac N AND the R inferior cardiac N. B. L inferior cardiac N. Both superior cardiac nerves and the right inferior cardiac nerve pass into the thorax between the trachea and major vessels to participate in forming the deep cardiac plexus. The left inferior cardiac n. passes anterior to the arch of the aorta to join the superficial cardiac plexus.

GVE - Cranial and Peripheral components

All SN's (sympathetic): -ANS Fibers GVE-P: - CN's: III, VII, IX, X

What are the limits of the middle cranial fossa? Anterior Posterior Floor

Anterior: lesser wings of sphenoid, chiasmatic groove Posterior: petrous ridge Floor: sphenoid (body and greater wings), temporal bone (squamous and petrous portions)

What is the insertion of the *Stylohyoid m.*?

Body of Hyoid bone near lesser horn.

question: Which sinus receives the *inferior sagittal sinus* and *great cerebral vein (Galen)* (drains the core of the cerebrum) A. Right transverse sinus B. Left Transverse sinus C. Straight Sinus D. Sigmoid sinus

C. Straight sinus In the pic #2=Inferior sagital sinus #3= great vein of Galen #4= straight sinus

What passes through foramen ovale? What bone is it on?

CN V3, accessory meningeal a., lesser petrosal n. sphenoid

What will the internal carotid a. pass through in the skull? What other structure passes through this opening?

CAROTID CANAL --The Internal carotid sympathetic plexus will also pass through this structure.

What are the CNs which are exclusively MOTOR?

CN III --> Oculomotor n. CN IV --> Trochlear n. CN VI --> Abducens n. CN XI --> Spinal accessory n. CN XII --> Hypoglossal n.

What cranial nerves will pass through the jugular foramen?

CN IX (glosspharyngeal n.) CN X (vagus n.) CN XI (spinal accessory n.)

Which 2 CN's have both Superior and Inferior Sensory Ganglia to house their GSA (sup) and SVA/GVA (inf) cell bodies?

CN IX and CN X

What is the presentation for a lesion in the CN nucleus on a corticobulbar tract going to the mm. of facial expression BELOW the eyes & tongue?

CN Nucleus lesion will cause: -IPSILTATERAL deficiency

ID the CN that distributes Autonomic fibers to Organs/Glands located in the head

CN V (Distributes Autonomic fibers of CN's: III, VII, IX)

Which cranial nerves will carry both Sensory & Motor fibers?

CN V --> Trigeminal n. CN VII --> Facial n. CN IX --> Glossopharyngeal n. CN X --> Vagus n.

What passes through foramen rotundum? What bone is it on?

CN V2 sphenoid

What is transmitted through the foramen rotundum?

CN V2 (second branch of trigeminal n.) *specifically the maxillary n.

*Hypoglossal N CN ____?* 1. Is it in the carotid sheath? 2. Where does it exit the skull? What relation is that to the internal jugular v. and internal cartoida? 3. What course does it take as it descends? Does it communicate with CN X and if so at what point? What else does it communicate with?

CN XII 1. NO! But its close. 2. Exits the skull via the hypoglossal canal medial to the internal jugular v. and internal carotid a. but still close enough to be invested in fibers of the carotid sheath. (clarification: it must pierce the sheath in order to get from behind the carotid sheath when it exits the skull to the tongue). 3. It descends *posterior to the vagus n*. and as it passes lateral to the transverse process of the atlas it *communicates with CN X, the superior cervical sympathetic ganglion and ventral rami of spinal nerves C1 & C2* (see cervical plexus).

ID CN's which have Parasympathetic ganglia in their pathway.

CN's: III, VII, IX and X

1. What passes through the jugular foramen? (lots) 2. bone?

CNs IX, X, XI, continuity of sigmoid sinus with the internal jugular v., inferior petrosal sinus, posterior meningeal branches of occipital and ascending pharyngeal aa. 2. temporal

What passes through superior orbital fissure? What bone is it on?

CNs Ill, IV, V1, VI, superior ophthalmic v. sphenoid

What passes through internal acoustic foramen? Which bone is it in?

CNs VII & VIII, internal labyrinthine a. Temporal

What branches off of Part II of the subclavian artery (Part II is behind anterior scalene m.)?

COSTOCERVIAL TRUNK --> Divides into the Deep cervical a. and Highest (posterior) intercostal a.

ID the 4 Parasympathetic Ganglia containing Postganglionic Parasympathetic cell bodies that are located along the various routes of CN V, which transport the GVE-P fibers of CN's: III, VII, and IX.

Ciliary Otic Submandibular Pterygopalatine

*Cervical Fascias:* 1. Clinical Note: Since all deep fascias of the neck communicate with and help form the carotid sheath, infections within the pretracheal, retrovisceral and danger spaces can invade the _______________ __________ involving the structures located within it as well as dissect inferiorly within the it to involve the aorta causing WHAT?

Clinical Note: Since all deep fascias of the neck communicate with and help form the carotid sheath, infections within the pretracheal, retrovisceral and danger spaces can invade the *carotid sheath* involving the structures located within the sheath as well as dissect inferiorly within the sheath to involve the aorta causing *aortitis*.

What do dural venous sinuses do?

Collect blood and CSF from: 1. Brain via bridging veins 2 Meninges 3. Diploe (highly vascular layer between inner and outer tables of the calvaria) 4. Vertebral column (vertebral venous plexus) 5. Emissary veins

Recall: Scalp anastomoses to superficial veins of the face and neck return blood from the cranial vault to the internal jugular system via which vein?

Common facial vein

What is the found within the Ansa Subclavia? What path does this nerve take?

Contains fibers from: Middle cervical ganglion & vertebral ganglion. --Ansa Subclavia will wrap around the anterior surface of the subclavian artery MEDIAL to the thyrocervical trunk & vagus to rejoin the inferior cervical ganglion.

What is the presentation for a lesion in the cortex on a corticobulbar tract going to the mm. of facial expression BELOW the eyes & tongue?

Cortical Lesion will cause: -CONTRALATERAL deficiency

(Still Trigeminal) GVE (sympathetic) ________ ________ n. and branches of the Internal carotid plexus provide POSTGANGLIONIC Sympathetic Fibers to __ and __ to innervate which structures?

Deep Petrosal; V1; V2 Innervate: Dilator pupillae of eye, Lacrimal Gland, ALL MUCOUS GLANDS of the Head (Nasal, oral, Palatal, Pharyngeal)

What do diploic vv drain?

Diploe is the middle part of the bone sandwiched between the two table of compact bone

What are the two different mechanisms of the basal ganglia? Do not explain yet

Direct Indirect

Where does the costocervial trunk divide? Which division will ascend from division?

Divides after passing over the cupola of the lung. *DEEP CERVICAL a. (ascending division) = dorsal to brachial plexus b/w semispinalis cervicis & capitis mm.

What's the purpose (structurally) of the inferior belly of the omohyoid muscle w/in the posterior Δ?

Divides posterior Δ into larger/superior *Occipital Δ* & smaller/inferior *Supraclavicular (omoclavicular, subclavian) Δ*

What nerve forms a plexus on the External carotid artery? Where do the branches of this plexus travel to?

External Carotid n. >> This n. delivers post-ganglionic sympathetic innervation to: -Blood vessels -Carotid body -Salivary glands -Oral glands -Labial glands -thyroid gland

The middle meningeal a. will pass through which skull structure? Include the bone this structure is found in and what else passes through this structure.

FORAMEN SPINOSUM *Middle meningeal a. *Recurrent meningeal n. (from CN V3)

In general, Which sympathetic spinal cord levels innervate the head, neck & portion of thorax? How doe these fibers reach head and neck?

From Lateral horn neurons at levels of T1 - T4. *Preganglionic fibers will traverse the ventral root, spinal nerve & white ramus communicans to enter the sympathetic chain & ascend to cervical sympathetic ganglia (superior, middle, vertebral, inferior) --then postganglionic fibers travel to innervate specific targets.

Define GVE and GSE. Also, Explain what impulses they carry, where they originate, and where they terminate.

GSE (General Somatic Efferent): -Fibers convey MOTOR impulses to Somatic (Skeletal) Muscles GVE (General Visceral Efferent): -AUTONOMIC fibers which innervate smooth muscle of Gut tube, Arrector Pili hair organs, blood vessels, cardiac muscle, & regulate glandular secretion - Subdivided into: 1. SYMPATHETIC (GVE): found in spinal nerves 2. PARASYMPATHETIC (GVE-P): Found in some cranial nerves

What sensory does CN VIII have? What skull foramen?

Hearing & balance Internal acoustic meatus

*Practice Problem* flip the card over

How will these two patients present differently? A. Anterior spinal artery syndrome (lose the anterior portion of the spinal cord) B. Brown-Sequard Syndrome (lose half of the spinal cord down the middle) A. Loss of motor function bilaterally -Loss of pain and temp bilaterally -Fine touch and proprioception preserved. B. Loss of motor ipsilateral -Loss of fine touch and proprioception ipsilateral -Loss of pain and temp contralateral Probably going to lose only a few segment levels of the spinal cord, most likely going to be a point damage with superior function preserved and damage happening distally to the lesion.

What is the relationship of the hypoglossal canal and condyloid canal?

Hypoglossal canal will open ANTERIOR & lateral to the occipital condyles. Condyloid canal will open POSTERIOR & lateral to the occipital condyles.

Which branch of the thyrocervical trunk will pass behind the carotid sheath & sympathetic trunk? Why must it take this path?

INFERIOR THYROID a. **Artery must provide branches to: -Pharynx -Larynx -Trachea -Esophagus -posterior-inferior portion of thyroid & parathyroid glands.

What foramen is found in the maxilla bone just inferior to the orbit? What structures pass through this foramen?

INFRAORBITAL FORAMEN ---The Infraorbital a. v. n. will pass through this foramen.

The internal labryrinthine artery will traverse through which structure? What bone it this found in and what other components will transmit through this structure?

INTERNAL ACOUSTIC MEATUS *Temporal bone foramen in posterior cranial fossa. *Also transmits: CN VII (facial n.) & VIII (vestibulocochlear n. the acoustic n. part)

What are the symptoms of a CENTRAL facial n. weakness?

Incomplete smile Subtle flattening of affected nasolabial fold *relative preservation of eyebrow & forehead movement.

The Inferior Cervical Ganglion represents fused ganglia of what? What may this ganglion fuse with?

Inferior Cervical Ganglion = Fused ganglia of C7-C8 *May be fused with the first thoracic ganglion (82%) to form a cervicothoracic or stellate ganglion

What is the insertion of the Longus Capitis m.?

Inferior surface, basilar portion of Occipital bone

What is insertion of the Rectus capitis lateralis m.?

Inferior surface, jugular process of occipital (directly posterior to jugular foramen)

Review: If present, the thyroid ima artery will anastamose with what?

Inferior thyroid arteries

Review: Posterior branch of the superior thyroid artery will anastamose with what?

Inferior thyroid artery

What vein is the most important venous drainage of the brain and skull?

Internal jugular vein

If the ascending cervical a. does not branch from the thyrocervical trunk, where will it sometimes arise? What is the course of this artery?

May arise form the Inferior thyroid a. --Ascends the anterior scalene m. medial to the phrenic n. to provide muscular and spinal branches.

Which has the largest distribution of all meningeal vessels? 2. It supplies blood above what structure?

Middle meningeal artery (from maxillary a) 2. Supratentorium

1. Between which structures is the falx cerebri?

Midline sickle shaped extension of dura between *cerebral hemispheres*

What is the origin of the *Mylohyoid m.*?

Mylohyoid line of both sides of mandible.

What runs through the foramen cecum in the frontal bone?

NASAL EMISSARY VEIN

1. Common Carotid a. 2. External Carotid a. 3. Superior thyroid a. 4. Ascending pharyngeal a. 5. Lingual a. 6. Facial a. 7. Occipital a. 8. Posterior auricular a. 9. Superficial temporal a. 10. Maxillary a.

Name 1-10

1. Posterior Auricular v. 2. Retromandibular v. 3. External jugular v. 4. Facial v. & a. you have to reflect/remove the SCM (we're goin deep!!)

Name 1-4 How best can you visualize the carotid sheath relative to the carotid triangle?

1. Carotid fascia 2. Internal juglar v. 3. Common carotid 4. Vagus n. -Investing fascia -infrahyoid fascia -pretracheal fascia -prevertebral fascia (i think there is more so please correct me)

Name 1-4 The orange boxes represent layers of fascia that contribute to #1, what are they?

1. Ectoderm 2. Mesoderm 3. Endoderm 4. Notochord The notochord is mesoderm-derived. It later forms into the nucleus pulposus of the spine

Name 1-4 What does #4 derived from?

Question on back of card Don't do this one as group

Name them *this is the best picture Buck has ever seen for sinuses 1. Superior sagittal sinus 2. Inferior sagittal sinus 3. Great vein of Galen 4. Sinus rectus 5. Confluens of sinuses 6. Left transverse sinus 7. Right Transverse sinus 8. Sigmoid sinus 9. Occipital sinus 10. Marginal sinuses 11. Left sphenoparietal sinus 12. Right sphenoparietal sinus 13. Ant. & post. intercavernous sinuses 14. Cavernous sinus 15. Superior petrosal sinus 16. Inferior petrosal sinus 17. Internal jugular vein

Hey look! An "ID" flashcard...

No Scroll jokes here... just go ↓ for answers A: Retromolar Trigone (mandible) B: Mylohyoid Line C: Meidal Pterygoid Plate D: Medial Pterygoid Plate Other D: *Horseshoe*

On a histo slide when you are trying to differentiate between the spinal trigeminal nucleus and tract what can give it away?

Nucleus should be lighter, tract should be darker

Check out all the bones that make up the Nasal Cavity!

OMG WOOOOOW

Check out this cool photo that is color coated that tracks the development of these pits and such...

OMG woooooooooow

Mnemonic to remember Cranial Nerve Types S-Sensory, M-Motor, B-Both Some Say Money Matters, But My Brother Says Big Boobs Matter Most

Olfactory = Sensory (SVA) Optic = Sensory (SSA) Oculomotor = Motor (GSE, GVE-P) Trochlear = Motor (GSE) Trigeminal = Both (SVE, GSA) Abducens = Motor (GSE) Facial = Both (SVE, GSA, SVA, GVA, GVE-P) Vestibulocochlear (Acoustic) = Sensory (SSA);[SSE] Glossopharyngeal = Both (SVE, GSA, SVA, GVA, GVE-P) Vaugus = Both (SVE, GSA, SVA, GVA, GVE-P) (Spinal) Accessory = Motor (GSE) Hypoglossal = Motor (GSE)

What is the origin & insertion of the Upper portion of the Longus Colli m.?

Origin -- Anterior surface of vertebral bodies Insertion -- Transverse processes of vertebrae BELOW

on the flip side is what was in Dr. George's note for a slide he didn't go into that much detail but I feel it is important for comprehension of what the freak is going on. So enjoy the read.

Pain pathways from periphery to brain. Primary afferent fibres (Aβ-, Aδ-, and C-fibres) transmit impulses from the periphery, through the dorsal root ganglion (DRG) and into the dorsal horn of the spinal cord. Nociceptive specific (NS) cells are mainly found in the superficial dorsal horn (laminae I-II), whereas most wide dynamic ranges (WDRs) are located deeper (lamina V). Projection neurones from lamina I innervate areas such as the parabrachial area (PB) and periaqueductal grey (PAG) and such pathways are affected by limbic areas. From here descending pathways (yellow arrows) from brainstem nuclei such as the rostral ventromedial medulla (RVM) are activated and modulate spinal processing. Lamina V neurones mainly project to the thalamus (spinothalamic tract), and from here the various cortical regions forming the 'pain matrix' (primary and secondary somatosensory, insular, anterior cingulate, and prefrontal cortices) are activated.

Where does the right lymphatic duct travel within the neck?

Passes behind carotid sheath, arches over the cupola of the right lung & enters the RIGHT jugulovenous angle > Receives Right subclavian, Right transverse cervical, right jugular & right bronchomediastinal trunks which return lymph from right upper limbe, right side of head/face and right thorax

How does the suprascapular a. exit the posterior triangle?

Passes out of triangle laterally to enter the scapular region. *passes with suprascapular v. & n.

What is CN III transmitted through? Include the bone it passes through.

SUPERIOR ORBITAL FISSURE --this is found within the Sphenoid bone.

*Brainstem and Spinal Cordin cross-section*

Same as Above. Flip the cards, and I will come back to these.

What is found within the scalene triangle? Why is this clinically significant?

Scalene Triangle contains *BRACHIAL PLEXUS & SUBCLAVIAN artery* . --Because these structures are found between the anterior & middle scalene mm. any tonic contraction of these mm could result in Thoracic Outlet Syndrome.

What is the insertion of the Anterior scalene m.?

Scalene tubercle of 1st Rib

here is a quick review of the associated, commissural, and projections (on back). 1. What layer are the association fibers and commissural fibers coming from? (start with corticoefferents and then corticoafferents) 2. Where are the major projection fibers coming from? (same as order as above)

Scroll down for answers: 1. Corticoefferent: supragranular layers. Corticoafferent: mostly from 3-4, but could be from 2-6. 2. CE: infragranular layers CA: layer 4

Flip for Q

Scroll for answers: A: Fasciculus Gracilis B: Fasciculus Cuneatus C: Dorsal Spinocerebellar Tract D: Ventral Spinocerebellar Tract E: Anterolateral System (Spinothalamic) F: Fasciculus Proprius

As the transverse sinuses drain toward the heart, what sinus do they drain into?

Sigmoid sinuses In the pic: 6&7= transverse sinuses 8=sigmoid sinus

*Arch 2:* Skeletal derivatives 1. this arch becomes what arch? 2. What 5 things are in #1?

Skeletal Derivatives: 1. Hyoid arch: 2. Stapes; styloid process; stylohyoid ligament; lesser horn of hyoid; upper body of hyoid memorizing tool: SSS

*Arch 4* Skeletal derivatives 1. Becomes what 5 laryngeal cartilages?

Skeletal Derivatives: 1. Laryngeal cartilages: Thyroid; cricoid; arytenoid; corniculate; cuneiform

1. What is Sonic Hedgehog Protein (SHH)? 2. What does it form as it spreads? 3. What does it do to cells?

Sonic hedgehog protein (SHH) 1. a morphogen from a defined localized source 2. forms a concentration gradient as it spreads 3. graded signal acts directly on cells and specifies gene expression changes and cell fate selection

What is a cistern? What layer forms them?

Spans space between contours of brain to form cisterns (areas of accumulated C.S.F.) Part without trabeculae Aachnoid

WHat sense does the oflactory nerve have? What skull foramen does it pass through?

Special sensory: *Olfaction (smell)* cribiform plate of ethmoid

Take home Message : The glottal opening is pipe that changes shape, diameter, and rigidity due to [intrinsic or extrinsic?] laryngeal muscle actions = varying tension, length and vibration pattern of the vocal [ligaments or cartilage?]

Take home: The glottal opening is pipe that changes shape, diameter, and rigidity due to *intrinsic* laryngeal muscle actions = varying tension, length and vibration pattern of the vocal *ligaments*

What do all of the "mixed" (sensory and motor) nerves have in common?

These are the ones going to the pharyngeal arches Embryology decides what the nerves will be

*NAME THE TRACT* Which tract would have the following identifying information? -Unconscious proprioception -Info from muscle spindle, golgi tendon organs from muscles and joints. -Primary cell bodies are in the DRG -First synapse is in Clarke's Nucleus of the thoracic cord. -Travels in the posterior funiculi.

This is describing the posterior spinocerebellar tract (or dorsal spinocerebellar tract)

What are the symptoms of a peripheral facial n. weakness?

Unable to wrinkly forehead. Eyelid droops very slightly. Cannot show teeth. Lower lip droops slightly

What is the innervation of the Middle scalene m.?

Ventral rami, spinal nerves C3 - C8

If you see loss of pain and temperature in the *body and face* why might you be led to think this is a brain stem lesion?

Ventral trigeminothalamic (pain and temp of face) ascends near the spinothalamic tract

What sense does the main sensory nucleus receive?

Vibrotactile discrimination (ex. two point discrimination)

Which neuron in the Visceral sensory pathway from the Vagus n. will be found in the Solitary nucleus? Where is the other neuron found?

Visceral Sensory: ---*1st neuron ---Inferior ganglion of CN X* ---*2nd neuron ---SOLITARY NUCEUS* Solitary nucleus think special sense taste

Pharyngeal Arch Nerves & Muscles *Overview PICTURE*

What a great overview now will someone memorize this for me and take the test for me?

1. The carotid canal and the jugular foramen. THIS IS WHERE THE CAROTID SHEATH ATTACHES on the base of the skull (on all boney points that surround the two foramina). 2. The 12th nerve (hypoglossal n.). It comes out the hypoglossal canal that is just superior to the occipital condyle which is just adjacent to the jugular foramen.

What does the red jagged line represent? Why is this important? What important nerve has proximity to the carotid sheath at this point?

1. probably within the aqueduct or higher b/c fourth duct is same size but lateral and 3rd ventricles are bigger 2. non-communicating lots of things that could cause this.

Where's the block? is it communicating or non-communicating?

-Left common carotid is longer than the right -seeing arch of aorta, brachiocephalic trunk, giving rise to right common carotid and right subclavian. Also, seeing left common carotid and the left subclavian branching off arch of aorta.

Which common carotid artery is longer than the other? What other arteries are we seeing here?

*NOTE* What are other structures that are in close proximity to the vagus as it exits the skull? Is it possible that it has relations with any of them?

While in the superior retropharyngeal region, the vagus n. communicates with CNs IX, XI and XII, the superior cervical ganglion and spinal nerves C1 and C2 (see cervical plexus).

Onacouna there is no ventricle associated with it

Why do they call it the *Closed* Medulla?

WE DONE!!!

YEEEAAAAAAA!!

What are the four congenital anomalies of the skull/face are caused by neural crest cell/pharyngeal arch issues??

YOU GOT IT!! 1. Treacher collins 2. Robin sequence 3. DiGeorge Anomaly (CATCH 22) 4. Goldenhar syndrome

6 Major Branches of External Carotid that supply the face (you can flip before you answer... I have a picture to help)

You are so welcome (Rob's fav baseball team is the ori-scrolls) A. Occipital A B. Posterior Auricular A C. Transverse Facial A D. Superficial Temporal A E. Maxillary A F. Facial A

guess what......

You're done!! Wooo!

Brain lab with 2nd

https://docs.google.com/document/d/1xR6zB2SCcuE_Y8yMvgIM5MSh1MOoXz32r8Pk5AuX3f0/edit

Found this gem from the class of 18, If a lesion happens.. then..

https://docs.google.com/presentation/d/1edG_2MtDQeRRpPaVNR6swfcNXoBoF-hehJ8xFMUIHN8/edit

tutor review from class of 2020 staring neil and lexi

https://www.facebook.com/groups/rvucom2020/390918754598770/

"Here is Buck's skull dsa ppt + the structures/foramina from the dissection list that weren't included."

https://www.facebook.com/groups/rvucom2020/397412373949408/

Neal ferrin and Heros test review

https://www.facebook.com/groups/rvucom2020/397469403943705/

"Clinical correlations from this sections' material."

https://www.facebook.com/groups/rvucom2020/397835553907090/

3 part question here... What were the 3 *longitudinal* muscles of the pharynx again *&* what are the 1 attachments for each *&* is each visible internally or externally?

i: *Stylopharyngeus*, Styloid Process, Visible externally ii: *Salpingopharyngeus*, Cartilaginous Auditory Tube, Visible internally iii: *Palatopharyngeus*, Soft Palate, Visible internally

Arterial supply of the pharynx happens primary through what 3 arteries + what do each branch from?

i: Ascending Pharyngeal A. (from Ext. Carotid) ii: Superior Thyroid A. (from Ext. Carotid) iii: Inferior Thyroid A. (Thyrocervical Trunk)

Main venous patterns of drainage for the spinal cord... What are the 5 major veins that drain the entire length of spinal cord? (possible clinical correlation)

i: Ascending lumbar vv ii: intervertebral v iii: hemiazygos v iv: azygos v v: vertebral v. (remember that this is a possible way for infection to spread)

What are the 3 major contributors to the Pharyngeal plexus?

i: CN IX ii: CN X iii: Sympathetic Chain

3 branches of the *Internal Carotid* that make it to the face?

i: External Nasal A. ii: Supraorbital A. iii: Supratrochlear A.

What are the 4 *Infrahyoid mm*. of *Anterior neck Δ*?

i: Sternohyoid m. ii: Sternothyroid m. iii: Thyrohyoid m. iv: Omohyoid m. (All are inferior to Hyoid)