Nervous System Overview

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Questions and Answers

What is the function of the Circle of Willis?

  • Facilitates the accommodation reflex
  • Transmits nerve signals to the spinal cord
  • Provides blood supply to the brain structures (correct)
  • Regulates blood pressure in the brain

Which cranial nerve is affected when the eye does not constrict?

  • CN5
  • CN2
  • CN3 (correct)
  • CN4

In the context of spinal cord tracts, which of the following is NOT a tract mentioned?

  • Corticospinal
  • Dorsal column pathway
  • Lateral corticobulbar (correct)
  • Spinothalamic anterior

What response does the accommodation reflex involve when shifting focus from a far object to a near object?

<p>Constriction of pupils (B), Contraction of ciliary muscles (C)</p> Signup and view all the answers

Which of the following pathways is NOT involved in the autonomic nervous system functions?

<p>Corticospinal tract (A), Spinothalamic tract (B), Dorsal column pathway (C)</p> Signup and view all the answers

What does the Bell Magendie Law explain about the spinal cord functions?

<p>The dorsal part is sensory and the ventral part is motor. (D)</p> Signup and view all the answers

Which of the following statements is true regarding the Dorsal Root Ganglion (DRG)?

<p>It contains sensory (afferent) fibers. (B)</p> Signup and view all the answers

What is the primary function of the Ventral Ramus?

<p>Innervates the skin and muscles of the anterior body. (D)</p> Signup and view all the answers

How are spinal nerves classified based on their function?

<p>Mixed, containing both sensory and motor fibers. (B)</p> Signup and view all the answers

Which area of the body is innervated by the C8 spinal nerve?

<p>Ring finger. (C)</p> Signup and view all the answers

Which spinal nerve is most likely to be impinged in a posterolateral herniation between L5 and S1?

<p>S1 (D)</p> Signup and view all the answers

Which of the following reflexes is primarily mediated by C5, with a C6 component?

<p>Biceps reflex (C)</p> Signup and view all the answers

What is the neurologic level for eliciting the patellar reflex?

<p>L3, L4 (C)</p> Signup and view all the answers

Which region of the spine is more common for disc herniation?

<p>Lumbar (B)</p> Signup and view all the answers

What other reflex besides the biceps reflex is associated with the neurological levels C5 and C6?

<p>Brachioradialis reflex (D)</p> Signup and view all the answers

Where do the spinal nerves in the lumbosacral region typically exit?

<p>Downward and outward (B)</p> Signup and view all the answers

To elicit the brachioradialis reflex, where should one tap?

<p>Over the radial styloid (C)</p> Signup and view all the answers

Which reflex is commonly referred to as the 'ankle jerk' reflex?

<p>Achilles reflex (A)</p> Signup and view all the answers

Which spinal nerve is affected by a disc herniation between L4 and L5?

<p>L5 (D)</p> Signup and view all the answers

What is the primary purpose of tapping a tendon during a Deep Tendon Reflex assessment?

<p>To assess monosynaptic reflex responses (D)</p> Signup and view all the answers

Which of the following reflexes is commonly referred to as the 'Knee Jerk' reflex?

<p>Patellar Reflex (A)</p> Signup and view all the answers

What type of reflex is classified as monosynaptic?

<p>Deep Tendon Reflexes (D)</p> Signup and view all the answers

Which muscles are assessed by the Medial Hamstrings reflex?

<p>Semitendinosus and Semimembranosus (C)</p> Signup and view all the answers

What is the designation for a monosynaptic reflex involving two neurons?

<p>Myotatic Reflex (C)</p> Signup and view all the answers

During the assessment of the Lateral Hamstrings reflex, which nerve roots are primarily involved?

<p>S1, S2 (A)</p> Signup and view all the answers

Which reflex is involved in assessing the Tibialis Posterior?

<p>Deep Tendon Reflex (B)</p> Signup and view all the answers

Which myotome is responsible for managing a standard hand rim wheelchair?

<p>C8 (C)</p> Signup and view all the answers

What is a critical level for community ambulation in spinal cord injury?

<p>L3 (A)</p> Signup and view all the answers

What hip condition is required for community ambulation?

<p>Both hips should be able to flex (D)</p> Signup and view all the answers

Which muscle is NOT innervated by the C5 myotome?

<p>Neck Lateral Flexors (SCM) (D)</p> Signup and view all the answers

Which of these is a primary requirement for stability in community ambulation?

<p>At least one knee is able to extend (C)</p> Signup and view all the answers

What muscular function is associated with the C4 myotome?

<p>SH Shrug (Trapezius) (B)</p> Signup and view all the answers

Which of the following myotomes relates to neck flexion?

<p>C1 (D)</p> Signup and view all the answers

What primary role does the suprahyoid muscle group have in cervical myotomes?

<p>Diaphragm control (B)</p> Signup and view all the answers

Which cranial nerve is primarily responsible for mediating light and accommodation reflexes?

<p>Cranial Nerve III (Oculomotor) (B)</p> Signup and view all the answers

What does anisocoria refer to in the context of eye and pupil conditions?

<p>Uneven pupil sizes (B)</p> Signup and view all the answers

Which of the following best describes the relationship between the diaphragm and cranial nerve involvement?

<p>Cranial nerve involvement affects diaphragm movement (A)</p> Signup and view all the answers

What is indicated by an uneven eye with respect to cranial nerve function?

<p>Possible cranial nerve damage (A)</p> Signup and view all the answers

Which of the following conditions may result from disrupted function of cranial nerve III?

<p>Ptosis (A)</p> Signup and view all the answers

Cranial nerve III is primarily responsible for which of the following functions?

<p>Eye movement and pupil constriction (A)</p> Signup and view all the answers

What effect does cranial nerve III dysfunction have on pupil response to light?

<p>Pupils may dilate abnormally (D)</p> Signup and view all the answers

Which of the following is not a function associated with cranial nerve III?

<p>Facial sensation (D)</p> Signup and view all the answers

In terms of eye accommodation, cranial nerve III plays a vital role in which process?

<p>Adjusting the lens shape for focus (A)</p> Signup and view all the answers

An uneven pupil size could suggest an issue with which neural pathway?

<p>Oculomotor nerve pathway (D)</p> Signup and view all the answers

Flashcards

Anisocoria

Unequal pupil size in the eyes.

CN 3 (Oculomotor)

Cranial nerve responsible for eye movement.

Pupil

The opening in the center of the eye that controls the amount of light entering.

Light reflex

Pupil's response to light.

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Accommodation reflex

Pupil's response to focusing on nearby objects.

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Sympathetic

Part of the autonomic nervous system, affecting pupil dilation.

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Uneven eye

Eyes are not perfectly aligned.

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RLA-LOCF

Abbreviated term, likely refers to a specific diagnostic method (in context).

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CN3

Cranial nerve 3, responsible for eyelid movement.

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Diphram

Breathing muscle located under the lungs.

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Blood Supply to Brain (Circle of Willis)

The interconnected network of arteries that supplies blood to the brain, crucial for proper brain function.

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Cranial Nerve 3

Controls eye movement and eyelid function; vital for visual processing.

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Spinal Cord Tracts

Pathways in the spinal cord that carry sensory and motor signals between the brain and body.

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Accommodation Reflex

Pupil's adjusting to focusing on near or distant objects.

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Autonomic Nervous System

Part of the nervous system that controls involuntary functions like breathing and heart rate.

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Patellar Reflex

Knee-jerk reflex; a monosynaptic reflex.

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Disc Herniation (L4-L5)

A herniated disc between L4 and L5 compresses nerves.

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Deep Tendon Reflex (DTR)

Muscle stretch reflex, a monosynaptic response.

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Monosynaptic Reflex

Reflex with one synapse between sensory and motor neurons.

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Medial Hamstrings

Muscle group responding to reflexes at spinal levels L5, S1.

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Lateral Hamstrings

Muscle group exhibiting reflexes at spinal levels S1, S2.

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Tibialis Posterior

Muscle responding to reflexes at spinal levels L4, L5.

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Jaw Jerk

Reflex involving the cranial nerve 5.

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Lumbar Disc Herniation

A condition where a disc in the lumbar spine bulges or ruptures, potentially pressing on nearby nerves.

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Posterolateral Herniation

A type of disc herniation where the disc material bulges or ruptures toward the back and sides of the spinal column.

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Neurologic Levels of Deep Tendon Reflexes

Specific spinal levels associated with particular reflexes (muscle stretch).

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Biceps Reflex

A deep tendon reflex elicited by striking the tendon of the biceps muscle, usually found in C5 and C6.

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L5-S1 spinal nerve impingement

Possible nerve compression due to posterolateral lumbar disc herniation (between L5 and S1 vertebra).

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Spinal nerve orientation

In the lumbosacral region, spinal nerves exit downward and outward.

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Herniation Direction and Nerve Impingement

The direction of disc herniation (especially posterolateral) matters since it dictates which nerve root is more likely to be impinged.

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Brachioradialis reflex

Reflex tested by tapping over radial styloid.

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Bell Magendie Law

Sensory fibers enter the spinal cord dorsally, while motor fibers exit ventrally.

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Dorsal Root Ganglion (DRG)

A collection of sensory neuron cell bodies located outside the spinal cord.

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Spinal Nerve (SN)

A mixed nerve composed of both sensory and motor fibers originating from the spinal cord.

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Dorsal Ramus

Branch of spinal nerve innervating muscles and skin of the back.

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Ventral Ramus

Branch of spinal nerve innervating muscles and skin of the anterior (front) of the trunk and limbs.

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Cervical Myotomes

Specific levels in the cervical spinal cord controlling neck and upper limb muscles.

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C8 Myotome

Cervical spinal level responsible for controlling fine motor control of the hand.

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Sliding Board Transfer

A transfer method utilizing a sliding board to aid patient movement from a bed to a wheelchair or other seating.

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L3 Myotome

Critical spinal level for independent ambulation, responsible for hip flexion strength.

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Community Ambulation

Independent walking, involving multiple controlled movements and specific muscle groups, including L3.

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Upper Extremity Myotomes

Cervical spinal levels controlling upper limb functions from shoulder to hand muscles.

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Hip Flexor Strength

Essential for ambulation; insufficient strength impedes independent walking.

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Knee Extension

Essential for stable ambulation and community mobility.

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Study Notes

Nervous System

  • Neuronal Structures:
    • Ganglion: Collection of nerve cell bodies outside the CNS
    • Nucleus: Collection of nerve cell bodies inside the CNS
    • Dorsal root ganglion (DRG): A type of ganglion containing sensory/afferent fibers
  • Nervous System Divisions:
    • Central Nervous System (CNS): Contains the brain and spinal cord
    • Peripheral Nervous System (PNS): Contains nerves that extend to the body
      • Somatic Nervous System (SNS): Controls voluntary muscles
      • Autonomic Nervous System (ANS): Controls involuntary functions (e.g., heart rate, digestion)
        • Sympathetic Nervous System: "Fight or flight" response (increase heart rate, dilate pupils, etc.)
        • Parasympathetic Nervous System: "Rest and digest" response (decrease heart rate, constrict pupils, etc.)
  • Cranial Nerves:
    • 12 pairs of nerves originating from the brain
    • Specific cranial nerves control particular functions like eye movement, swallowing, chewing etc.
  • Spinal Nerves:
    • 31 pairs of nerves originating from the spinal cord
    • Dermatomes: Areas of skin innervated by single spinal nerves
    • Myotomes: Muscles innervated by single spinal nerves
  • Spinal Cord Anatomy
    • Gray matter: Located inside, contains cell bodies, dendrites
    • White matter: Located outisde, contains axons
    • Dorsal root: Sensory (afferent) fibers
    • Ventral root: Motor (efferent) fibers
    • Spinal nerve: Combined dorsal and ventral roots

Neuroanatomy

  • Brachial plexus: Formed from C5-T1 spinal nerves, innervates upper limb
  • Lumbosacral plexus: Formed from L1-S5 spinal nerves, innervates lower limb
  • Clinical correlation: Different parts of the brain have specific functions; damage can result in distinct symptoms (e.g., aphasia with damage to Broca's area)
  • Blood supply to the brain: The Circle of Willis supplies blood to the brain and spinal cord
  • Spinal cord injury (SCI): In SCI, the neurologic level may not always be at the same level as the vertebral injury.

Autonomic Nervous System

  • Sympathetic division: Uses norepinephrine, generally increases activity
  • Parasympathetic division: Uses acetylcholine, generally decreases activity.
  • Two neuron pathway: Impulses from the CNS travel through two neurons before reaching the target organ

Reflexes

  • Deep tendon reflexes (DTRs): Muscle stretch reflexes, assessed by tapping tendons
    • Monosynaptic: One synapse between afferent and efferent neurons
    • Polyysynaptic: Multiple synapses

Spinal Nerves

  • Orientation: Cervical nerves generally exit above the corresponding vertebrae, while thoracic, lumbar, and sacral nerves generally exit below their corresponding vertebrae.

Other observations

  • HNP (Herniated Nucleus Pulposus, Slipped Disc): Commonly seen in cervical and lumbar spine regions. Posterolateral herniations in lower back are widespread.
    • Symptoms result from nerve compression
  • Neurological levels of DTRs: Reflexes are helpful to assess the integrity of specific spinal nerves.

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