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BioMed Exam 4
Biome Exam 3 Spinal Cord-Local Anesthesia
| Question | Answer |
|---|---|
| another name for sensory neurons | afferent from the periphery to the CNS |
| another name for motor neurons | efferent CNS out to periphery (to muscle usually voluntary) |
| how many cervical nerves are there? | 8 C1-C8 |
| how many thoracic nerves are there? | 12 T1-T12 |
| how many lumbar nerves are there? | 5 L1-L5 |
| how many sacral nerves are there? | 5 S1-S5 |
| how many coccygeal nerves are there? | 1 |
| mid-thoracic is what level? | T6 |
| how do you get 8 cervical nerves? | C7 exits superior C8 exits inferior and all other nerves exit below that point 7 cervical vertebra but 8 cervical nerves |
| cervical enlargement is for what? | upper limbs |
| Lumbar enlargement is for what? | lower limbs |
| what are the coverings of the spinal meninges? | dura mater (outer) tough mother arachnoid mater (middle) spider Pia mater (inner) Soft mother |
| where could you have bleeding or pus into the potential space in spinal meninges | arachnoid mater and dura mater hard to get antibiotics into these spaces to fix |
| where is CSF found in spinal meninges? | subarachnoid space |
| where is an epidural given? | just outside the dura mater |
| what is meningitis? | inflammation of the connective tissue coverings of the spinal cord can be bacterial or viral |
| is bacterial or viral meningitis worse? | bacterial because it is difficult to treat with antibiotics |
| where does the spinal cord end? | conus medullaris L1-L2 vertebral level |
| what is caudal equina? | inferior to conus medullaris nerves plus filum terminale |
| what is filum terminale? | extension of pia mater anchors the spinal cord inferiorly |
| what is denticulate ligament? | keeps spinal cord in the center, keeps it from wiggling around tooth-like shape that occurs extension of pia mater and arachnid mater that attaches to the dura mater. ONLY LATERAL |
| what is the dorsal root ganglion? | always sensory |
| what are the coverings of a spinal nerve? | epinurium- around entire nerve perineurium- around individual fascicle endoneurium- around individual axon |
| what does epineurium cover? | around entire nerve |
| what does perineurium cover? | individual fascicle |
| what does endoneurium cover? | individual axon |
| What is the cervical plexus | distributes to the neck region C1-C4 make up the cervical plexus |
| What are the motor nerves of the cervical plexus? | C1-C3 motor only called the ansacervicalus (get the ansa) |
| What are the sensory nerves of the cervical plexus? | C2-C4 sensory only |
| What keeps the diaphragm alive? breathe with? | C3, C4, C5 |
| what is great auricular nerve? | gets the lower part of the ear and the lobe the skin of posterior part of the mandible |
| what is the phrenic nerve? | motor to diaphragm C3, C4, C5 |
| what does T10 dermatome innervate? | belly button |
| what does C7 dermatome innervate? | middle finger |
| what is herpes zoster? | chicken pox virus gets into CNS and goes quiet it follows sensory ganglion and breaks out into skin follows the dermatomes |
| what are the major portions of the brain? | brainstem cerebellum diencephalon cerebellum |
| what are the three extensions of the dura mater in the skull? cerebral folds | Falx Cerebri Falx Cerebelli Tentorium cerebelli |
| what is flax cerebri? | single fold that goes down the sagittal plane down the middle of your brain divides the two hemispheres of the cerebrum |
| what is flax cerebelli? | separates the two hemispheres of the brain |
| what is tentorium cerebelli? | tent shaped structure that is a roof over cerebellum |
| what is the periosteal layer? | layer around the bone |
| what are subdural hematomas? | bleeding deep to the dura in the head pushes on the brain |
| what are the 4 ventricles in the brain? | lateral ventricles (2) third ventricle fourth ventricles |
| what is the choroid plexus | modified capillaries that produce a modification of blood to CSF blood goes through and out comes CSF found in each of our ventricles |
| what does the arachnoid villus do? | project into venus sinuses and absorbs the CSF into the venus system |
| what are the parts of the brain stem? | medulla oblongata pons midbrain |
| what does cerebellum do? | controls fine motor control |
| what are the parts of the diencephalon? | epithalamus, sub thalamus, thalamus, hypothalamus |
| what does the thalamus do? | takes all sensory information to cortex |
| what does the hypothalamus do? | controls autonomics |
| what are the four lobes of the cerebral cortex? | frontal lobe, parietal lobe, occipital lobe, temporal lobe Insual cannot be seen |
| what does the frontal lobe do | voluntary motor and personality |
| what is pre central gyrus? | voluntary motor |
| what is post central gyrus? | primary sensory |
| gyrus is what? | folds, bumps |
| sulcus is what? | groove shallower folds between |
| what is the function of parietal lobe? | sensory |
| what is the function of occipital lobe? | vision |
| what is the function of temporal lobe? | hearing, memory |
| how does CSF flow? | created in choroid plexus and flows in ventricles flows outside the brain from subarachnoid space reabsorbed by arachnoid villi of dural venous sinuses |
| what is the central sulcus? | between the frontal lobe and the parietal lobe |
| what does the insula do? | part of the limbic system which deals with emotions |
| what are commissural fibers? | mylinated axons that connect both hemispheres corpus callosum is the largest |
| What is cranial nerve I | olfactory sensory, smell |
| what is cranial nerve II | optic sensory, vision |
| what is cranial nerve III | oculomotor motor, movement of eyeball |
| what is cranial nerve IV | Trochlear motor, movement of eyeball |
| what is cranial nerve V | trigeminal both, sensation from face, oral region; motor to muscles of mastication, movement of mandible |
| what is cranial nerve VI | abducens motor, movement of eyeball |
| what is cranial nerve VII | facial both, motor to muscles of facial expression; taste from anterior 2/3 of tongue |
| what is cranial nerve VIII | vestibulocochlear sensory, balance and hearing |
| what is cranial nerve IX | glossopharyngeal both, taste from posterior 1/3 of tongue elevates pharynx during swallowing |
| what is cranial nerve X | vagus both, swallowing, coughing, vocalization sensation in pharynx and epiglottis |
| what is cranial nerve XI | spinal accessory motor, movement of head and shoulders |
| what is cranial nerve XII | hypoglossal motor, movement of tongue during speech and swallowing |
| what is the major vascular supply to the brain? | vertebral artery Internal carotid |
| what are the three branches that supply the cerebral cortex? | posterior cerebral artery -->middle cerebral artery--> anterior cerebral artery |
| what makes up the circle of willis? | basilar artery-->posterior cerebral artery-->post communicating artery--> internal carotid artery--> anterior cerebral artery--> anterior communicating artery |
| what do autonomics innervate? | smooth muscle cardiac muscle glands (secretomotor) |
| where is the cell body located in the autonomic nervous system? | lateral horn cell body, preganglionic terminates in a ganglion |
| parasympathetics originate where? | cranial nerves (3,7,9,10) or sacral nerves |
| sympathetics originate where? | spinal cord only (T1-L2) travel to head but do not originate there |
| Sympathetics are... | fight or flight |
| Parasympathetics are... | rest and digest |
| what are synonyms for the sympathetic ganglia | chain ganglia, paravertebral ganglia, or prevertebral ganglia |
| sympathetic neurons length | preganglionic is relatively short post ganglionic is relatively long |
| parasympathetic neurons length | preganglionic is relatively long post ganglionic is relatively short |
| sympathetic neurons neurotransmitters | preganglionic release ACh which binds to nicotinic receptors postganglionic release Norepinephrine which binds to adrenergic receptors |
| Parasympathetic neurons neurotransmitters | preganglionic releases ACh which binds to nicotinic receptors postganglionic releases ACh which binds to muscarinic receptors |
| which system causes vasoconstriction in the head? | sympathetics |
| which system causes vasodilation in the head? | parasympathetics |
| what is miosis? | constriction of pupil |
| what is ptosis? | Drooping of the upper eyelid |
| what is anhidrosis | lack of sweating |
| what are the cranial nerves and ganglia of parasympathetics found in the head? | 3, 7, 9 |
| where does cranial nerve 10 of parasympathetics go? | neck, thorax, abdomen |
| cranial nerve 3 of parasympathetics go where and do what? | ciliary ganglia pupillary constriction |
| cranial nerve 7 of parasympathetics go where and do what? | pteryogopalatine ganglia which controls lacrimation or tears submandibular ganglia which controls submandibular and sublingual salivary glands |
| cranial nerve 9 of parasympathetics go where and do what | otric ganglia parotid salivary gland |
| what is responsible for salivation? | parasympathetics: watery secretions sympathetics: thick, viscous secretions |
| the postganglionic neurons from the otic ganglia are cut, what is the loss? | watery secretions from the parotid salivary gland function would not loose the viscous secretions |
| the postganglionic neurons from the submandibular ganglia are cut, what is the loss? | submandibular and sublingual salivary glands function |
| the postganglionic neurons from the pterygopalatine ganglia are cut, what is the loss? | lacrimation doesn't function |
| the postganglionic neurons from the ciliary ganglia are cut, what is the loss? | pupil dilates, could not constrict pupil |
| what is hornet's syndrome? | loss of the sympathetics to one side of the head ptosis: drooping eyelid, vasodilation, pupil constriction (meiosis), anhydrosis or loss of sweating |
| what is the major controls center of the autonomics in the brain | hypothalamus |
| what is Raynaud's disease? | massive sympathetics vasoconstriction white fingers |
| what is autonomic Dysreflexia? | exaggerated response of sympathetic nervous system in cases of spinal cord injury above T6 so affects sympathetics vasoconstriction happens so elevates blood pressure pounding headaches, sweating, cool dry skin below |
| what is sjogren's syndrome? | autoimmune disease that attacks various autonomic functions |
| what are the three divisions of the trigeminal nerves? | V1, V2, V3 |
| Where does V1 of the trigeminal nerve go through in cranial cavity and deep spaces? | superior orbital fissure orbit |
| where does V2 of the trigeminal nerve go through in cranial cavity and deep spaces? | foramen rotundum pterygopalatine fossa |
| Where does V3 of the trigeminal nerve go through in cranial cavity and deep spaces? | foramen ovale infratemporal fossa |
| what does V1 of the trigeminal nerve innervate? | forehead, eyeball, bridge of nose to tip of nose |
| what does V2 of the trigeminal nerve innervate? | lower eyelid all to the upper lip |
| what does V3 of the trigeminal nerve innervate? | cheek, tongue, lower lip and chin |
| what is the only division of the trigeminal nerve that is mixed? | V3 |
| what are the sensory divisions of the trigeminal nerve? | V1 and V2 |
| what are the muscles of mastication? | temporalis masseter lateral pterygoid medial pterygoid |
| what is the one exemption that the trigeminal nerve does not innervate on the face? | great auricular nerve from cervical plexus innervates the angle of the mandible |
| what are V1 branches | major: frontal nerve Frontal nerve branches to supraorbital nerve and supra trochlear nerve lacrimal nerve (purely sensory) nasociliary nerve which branches to eyeball and nose (sensory) |
| what are V2 branches | zygomatic nerve which branches into the zygomaticotemporal nerve and zygomaticofacial infraorbital nerve which supply max dentition: anterior superior alveolar nerve, middle superior alveolar nerve and posterior alveolar nerve |
| What are the V2 deep branches to palate? | pterygopalatine fossa which branches into greater palatine nerve (hard palate) and lesser palatine nerve (soft palate) nasopalatine: anterior hard palate, behind central incisors |
| what does the greater palatine nerve do? | hard palate |
| what does the lesser palatine nerve innervate? | soft palate |
| what are the branches of the pterygopalatine fossa? | greater palatine nerve lesser palatine nerve nasopalatine nerver V2 nerve |
| what are the branches of the frontal nerve? | supraorbital nerve and supratrochlear nerve Lacrimal Nerve V1 nerve |
| what are the branches of the Zygomatic nerve? | zygomaticotemporal nerve and zygomatricofacial nerve V2 nerve |
| what does the infraorbital branch into? | maxillary dentition, anterior superior alveolar, middle superior alveolar and posterior alveolar V2 nerve |
| what are the branches of V3 trigeminal nerve? | lingual nerve, buccal nerve, auriculotemporal nerve, inferior alveolar nerve branches to mylohyoid and anterior digastric and mental and incisive nerve |
| buccal nerver has branches that enervate what? | skin and mucosa of the cheek |
| what does inferior alveolar go to? | dentition of mandible |
| what are the branches of the inferior alveolar in V3? | nerve to mylohyoid (muscle of the floor of the mouth) and anterior digastric mental and incisive nerve |
| what does the lingual nerve enervate on the tongue? | sensory only, not taste anterior 2/3 of the tongue |
| are there autonomics that originate with the trigeminal nerve? | NO |
| what does the chord of timpani do? | branch within the ear bone (temporal bone) comes off cranial nerve 7 |
| what are the two major components of the chord of timpani for cranial nerve 7? | parasympathetics- submandibular ganglion and salivation taste- anterior 2/3 of the tongue |
| what are the branches of cranial nerve 7? | Enters internal auditory meatus 1st branch is parasympathetics to lacrimal gland 2nd branch is chord of timpani branch Last voluntary motor branch |
| what does the voluntary motor of cranial nerve 7 do? | lost sensory information, lost the autonomic component purely voluntarily motor |
| which of the cranial nerves of cranial nerve 7 goes through the malleus and incus? | chord of timpani |
| what are the ossicles of the ear bone | malleus, incus and stapes |
| if the lingual nerved was cut what would you loose on the tongue? | loose general sensory as well as taste and parasympathetics |
| if the chord of timpani was cut, what would you loose on the tongue? | loose parasympathetics and taste |
| what are two types of pain fibers? | A delta fibers: thinly mylinated C fibers: unmylinated |
| what are the pain stimulating substances? | prostaglandins kinins potassium ions |
| what are A delta fibers? | sharp, lancing or knifing pain |
| what are C fibers? | burning, aching, throbbing toothaches are these |
| where does prostaglandins and potassium ions come from | the cell itself prostaglandins from cell membrane |
| where does kinins come from? | blood, breaking a vessel |
| what are the neurons of the lateral spinothalamic pathway and what does it make us perceive? | pain from the non head part of the body, sharp pain (A delta) dorsal root ganglion synapses to spinal cord, dorsal horn crosses the midline to go to the thalamus, thalamus to cortex to perceive it |
| what are the neurons of the trigeminothalamic tract and what does it make us perceive? | for pain of head and oral cavity first neuron is trigeminal ganglion, crosses midline to thalamus, thalamus to cortex |
| what gives pain for maxillary dentition? | anterior superior alveolar middle superior alveolar posterior superior alveolar |
| what gives pain for mandibular dentition? | inferior alveolar nerve incisive nerve |
| what pain fiber is in the tooth pulp of teeth? | primarily C fibers originate there |
| what pain fiber is in the dentinal tubules of teeth? | primarily A delta originate here |
| what is allodynia? | nonpainful stimulus that feels painful such as clothes against a sunburn |
| what is hyperalgesia? | a painful stimulus that seems more painful than it actually is |
| how do we normally perceive pain? | arachadonic acid is release from the cell because of some trauma cyclookigerase enzyme or (COX) combines with arachadonic acid to form prostaglandins prostaglandins cause pain |
| how do NSAIDS work? | NSAIDS are COX inhibitors so arachadonic acid and COX don't combine and cause pain |
| what is gating mechanism? | reducing the amount of pain by stimulating mechanoreceptors wiggling a cheek when giving an injection |
| what are the classes of endorphin system? | Enkephalins receptors Beta Endorphins receptors Dynorphins Receptors |
| what does enkephalin receptors bind primarily to | mew receptors |
| what does beta endorphins receptors bind primarily to | Delta |
| what does dynorphins receptors bind to primarily | Kappa receptors |
| what does morphine bind primarily to | mew receptors |
| what is analgesia? | absence of pain in response to stimulus that would normally be painful. just pain, no other sensory modalities |
| what is anesthesia? | absence of ALL sensory modalities |
| what is infiltration? | put needle tip and express anesthesia around tooth, best for one or two teeth usually occurs in maxillary arch because bone is porous and can seep through |
| what is a local nerve block? | place needle within a proximity of a nerve and express the anesthesia out to surround the nerve not expressing through bone, bathing around nerve |
| what are the nerves of the maxillary arch? | superior alveolar nerve which branches to: posterior, middle and anterior superior alveolar nerve |
| what are the nerves of the mandibular arch? | inferior alveolar nerve mental nerve and incisive nerve |
| what does the mental nerve innervate? | soft tissue of the lower lip |
| what does the incisive nerve innervate? | canines and incisors |
| what is the PSA or posterior superior alveolar block? | express anesthesia closes to the posterior superior alveolar nerve blocks maxillary molars (1,2,3) |
| what can go wrong often with the PSA block? | hematoma or bruise slow bleeding from vein fast bleeding from artery |
| what can go wrong occasionally with the PSA block? | muscles to eye will be blocked and won't be able to move eye optic nerve can be blocked and patient goes blind only temporary and will wear off |
| what is the middle superior alveolar infiltration or MSA? | slide needle next to maxillae and inject whole region to get through pores maxillary premolars will be totally blocked, sometimes half of the maxillary 1st molar |
| what is anterior superior alveolar infiltration or ASA? | needle slides up along maxilla to bathe bone with anesthesia to go through pores maxillary central incisors and lateral incisors and the canines are blocked |
| what is a infra-orbital nerve block? | local nerve block for an anterior and middle superior alveolar nerve because they branch off the infraorbital nerve premolars and a piece of the second molar are blocked would also numb skin below lower eyelid and superior lip |
| what is a nasopalatine nerve block? | teeth are not involved, only mucosa of palate nasal cavity and the palate blocked |
| what is a inferior alveolar nerve block? | all of the teeth to the midline (quadrant) are blocked needle tip is as close to mandibular frenum, lateral to pterygomandibular raphe, medial to mandible |
| what are the settings of the nerves in mandible? | facial, inferior alveolar, lingual, buccal |
| analgesia refers to the absence of all sensory modalities including pain (T/F) | false |
| to infiltrate you would inject anesthesia around a tooth (T/F) | true |
| to provide a local block you would inject anesthesia around a nerve (T/F) | true |
| for tooth 30, you would preferentially uses ______ to anesthetize the tooth? | local nerve block |
| the majority of complications occur during a posterior alveolar (PSA) block is a | hematoma |
| the middle superior alveolar nerve supplies innervation to outline the maxillary premolars (T/F) | False |
| the anterior superior alveolar nerve supplies innervation to only the incisors and canines (T/F) | True |
| the right infraorbital nerve gives off branches to innervate... | skin of the upper lip tooth number 5 |
| the nasopalatine nerves innervate the incisors and the anterior palatal mucosa (T/F) | false |
| to perform an inferior alveolar nerve block, you place the needle ____ to the mandible | medial |
| if done properly, the inferior alveolar nerve (IAN) block will include the lingual nerve that sits just _____ to the IAN | anterior |
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Chobchi
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