BB EOYS4

Question 1

how do u check for raised intracranial pressure? [1]

Answer 1

opthalmascope - look for optic nerve where it enters retina (eyes are outgrwoth of brain). optic nerve gets squashed at high pressure - causes papilledema / optic discs bulge out

Question 2

** what changes would be felt bc of this lesion (brown-sequard)? **

Answer 2

1. loss of pain and temperature on right side of body below lesion (spinothalamic decussates at level of spinal cord entry)
2. loss of motor movement on same side as lesion (corticospinal goes down ipsilateral side)
3. loss of proprioception and vibration sense on the same side from damage (DCML has already decussated)

Question 3

What are the two layers of the dura mater? [2]

Answer 3

• *periosteal layer** (which lines the inner surface of the bones) [1]
• *meningeal** layer which forms dural folds. [1]

Question 4

which of the following will show localised pain?

corticospinal tract
anterior spinothalamic tract
posterior spinothalamic tract
lateral reticulospinal tract
medial reticulospinal tract

Answer 4

which of the following will show localised pain?

corticospinal tract
anterior spinothalamic tract
posterior spinothalamic tract
lateral reticulospinal tract
medial reticulospinal tract

Question 5

which level of the brainstaim did you find cerebral aquaduct?

midbrain
medulla
thalamus
pons
corpus callosum

Answer 5

which level of the brainstaim did you find cerebral aquaduct?

midbrain
medulla
thalamus
pons
corpus callosum

Question 6

describe pathway of cutaneous afferents from the face? [1]

Answer 6

• Cutaneous afferents from the face travel in cranial nerves and enter the trigeminal nucleus
• Post-synaptic fibres from the trigeminal nucleus decussate and run alongside the medial lemniscal fibres from the body.
• the face afferents end in the VPM thalamus (ventro-postero-medial nucleus),

Question 7

which CN spans all of the brainstem? [1]

Answer 7

facial nerve

Question 8

describe the difference in innervation from facial nerve between upper and lower muscles of face?

Answer 8

muscles of upper part of face - frontalis: bilateral innervation - gets innervation from both contralateral and ipsilateral motor cortex ! (upper motor neurons from L & R of brain synapse the lower motor neuron, which innervates the frontalis)

muscles of lower part of face: just contralteral innervation one upper motor neuron from L or R, travel down and decussate and synapses with lower motor neuron

Question 9

which 2 arteries provide main blood supply to midbrain? [2]

Answer 9

which 2 arteries provide main blood supply to midbrain? [2]

basilar artery

• *- superior cerebellar artery
• posterior cerebellar artery**

choridal atery

Question 10

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

Answer 10

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

Question 11

which 3 reactions does the accomodation reflex test? [3]

Answer 11

constriction of pupils
thickening of lens (cilliary muscle constriction)
convergenece of eye balls ( CNIII: movement of eyeballs - medial rectus muscle !!)

Question 12

what are the three main branches of facial nerve (VII), what type of innervation do they provide?

Answer 12

greater pertrosal: parasympathetic innervation to lacrimal gland (eye fluid & tears)

• *chordae typmani:**
• special sensory innervation to anterior 2/3rd of tongue;
• parasympathetic innervation to sublingual and submandibular glands

motor root: TZBMC (two zulus bit my cat); temporal, zygomatic, buccal, marginal mandibular, cervical: motor muscles of facial expression

Question 13

midbrain:

what is role of:

• superior colliculi [1]
• inferior colliculi [1]
• cerebral peduncles [1]

Answer 13

midbrain:

what is role of:

• superior colliculi [1]
• *eye movements and visual processing**
• inferior colliculi [1]
• *auditory processing**
• cerebral peduncles [1]
• *contains tracts descending from thalamus (CST & CBT)**

Question 14

Brown-Sequard Syndrome is damage to one side of spinal cord.

what paraylsis / loss of senses occurs at:

_ipsilaterally

1/2 levels below lesion ipsilaterally:

2 levels below lesion ipsilaterally

2 levels onwards below lesion on contralaterol sid_

Answer 14

ipsilaterally: get complete paralysis below the level of the lesion: due to blocking of corticospinal

1/2 levels below lesion ipsilaterally: complete anaethesia for 1/2 levels due to block of ispilateral spinothalamic.

2 levels below lesion ipsilaterally: loss of light touch, proprioception and vibration (due DCML)

2 levels onwards below lesion on contralaterol side: loss of pain, temp and crude touch 2 levels & below level of lesion - due to the nerves in spinothalamic tract crossing over over couple below

Question 15

afferents from the face end come up through the medial lemniscus and terminate in which part of the thalamus? [1]

afferents from the body come up through the medial lemniscus and terminate in which part of the thalamus? [1]

Answer 15

afferents from the face end come up through the medial lemniscus and terminate in which part of the thalamus? [1]
VPM- ventro-postero-medial

afferents from the body come up through the medial lemniscus and terminate in which part of the thalamus? [1]
ventero-postero-lateral: VPL

(together they form complete somatosensory thalamus)

Question 16

what is the blood supply to the medulla mainly from? [1]
- what are the 5 branches? [5]

Answer 16

medulla blood supply = verterbal arteries

• **anterior spinal artery
• posterior spinal artery
• posterior inferior cerebellar artery (PICA)
• anterir inferior cerebellar artery (AICA)
• basal artery**

Question 17

which of the lateral spinothalamic tracts causes arousal & attention to pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

Answer 17

which of the lateral spinothalamic tracts causes arousal & attention to pain?

PAG
mediodorsal nuclei of thalamus
ventromedial (VM) & ventroposterior (VP) of thalamus

Question 18

posterior spinocerebellar tract pathway?

Answer 18

enters via dorsal root into dorsal horn: synapses with secondary neuron here and goes into posterior spinocerebella tract and goes up to cerebellum on SAME side (ipsilateral)

no decussation !!

Question 19

Dolls eye reflex:

Afferent CN? [1]
Efferent CNs? [3]

how do u test? what is a normal reflex and abnormal reflex?

Answer 19

Dolls eye reflex:

Afferent CN? [1]: CN VIII
Efferent CNs? [3] CN III, CN IV, CN VI

• tested by turning head side to side
• normal reflex: head moves to right, eyes move left
• abnormal refelx: head moves to right, eyes follow

Question 20

which is main blood supply to pons? [1]
- branches? [3]

Answer 20

which is main blood supply to pons? [1]
basilar artery

​- branches? [3]
paramedian branches
anterior iinferior cerebelllar artery
superior cerebellar artery

Question 21

describe what innervation the vagus nerve innervation does for the following x

• sensory
• parasympathetic
• motor [4]

Answer 21

• sensory: larynx (superior laryngeal and recurrent laryngeal nerve)
• parasympathetic: goes up to midgut
• motor: soft palate; pharynx; oesphagus; larynx (superior laryngeal and recurrent laryngeal nerve)

Question 22

which part of spinal column does the artery of Adamkiewicz supply? [2]

Answer 22

lower thoracic or upper lumbar vertebrae

Question 23

Answer 23

Question 24

which spinal tract carries the concious proprioception

Cortiocspinal
DCML
Spinothalamic
Spinocerebellar

Answer 24

which spinal tract carries the concious proprioception

Cortiocspinal
DCML
Spinothalamic
Spinocerebellar

Question 25

which of the lateral spinothalamic tracts causes perception of pain? PAG mediodorsal nuclei of thalamus ventromedial (VM) & ventroposterior (VP) of thalamus

Answer 25

which of the lateral spinothalamic tracts causes perception of pain? PAG mediodorsal nuclei of thalamus **ventromedial (VM) & ventroposterior (VP) of thalamus**

Question 26

where do you find the insula? [1] between which lobes? [2]

Answer 26

where do you find the insula? [1] **lateral fissure** between which lobes? [2] **frontal and temporal**

Question 27

what structure connexts the cranial nerve nuclei controlling eye movement and the vestibular nuclei? [1]

Answer 27

**medial longitudinal fasiculus:** CN III, IV and VI

Question 28

which arteries supply the areas where the nerve roots enter and exit the spine dorsally and ventrally, respectively? [1]

Answer 28

**radicular arteries**

Question 29

# :) which of the lateral spinothalamic tracts causes unpleasant quality of painfulness? PAG mediodorsal nuclei of thalamus ventromedial (VM) & ventroposterior (VP) of thalamus

Answer 29

which of the lateral spinothalamic tracts causes unpleasant quality of painfulness? PAG **mediodorsal nuclei of thalamus** ventromedial (VM) & ventroposterior (VP) of thalamus

Question 30

blink reflex: afferent and efferent CNs? gag reflex: afferent CN? efferent CN?

Answer 30

_Blink reflex:_ afferent CN: t**rigeminal - V1** (but also bright light (CN II & loud noise CN VIII)) efferent CN: **CN VII - acts on orbicularis occuli muscle to close** _gag reflex:_ afferent CN: **CN IX** efferent CN: **CN X**

Question 31

vertebral artery is a branch of which artery? [1]

Answer 31

**subclavian**

Question 32

describe what innervation the vagus nerve innervation does for the following x - sensory - parasympathetic - motor [4]

Answer 32

describe what innervation the vagus innervation does for the following x - _sensory_: **larynx (**superior laryngeal and recurrent laryngeal nerve) - _parasympathetic:_ goes up to midgut - _motor_: **soft palate; pharynx; oesphagus; larynx (**superior laryngeal and recurrent laryngeal nerve)

Question 33

describe pathway of anterior spinocerebellar tract xx enjoy

Answer 33

afferent nerve goes in via dorsal horn. synapse with secondary afferent here a) MOST secondary fibres decussate and go up on the contralateral side b) BUT, some fibres: stay on same side and go up ipsilateral side aa) the controlateral ones: go to cerebellum, where they DECUSSATE AGAIN to get back to ipsilateral side bb) ipsilateral side goes up and stays here net effect is that both stay ipsilateral

Question 34

\*\*\* what are the VPM and VPL? [2] \*\*\*

Answer 34

**VPL = Ventral Posterolateral Nucleus**. primary thalamic relays for somatic sensation; that is, nociceptive and tactile/proprioceptive information from the body **VPM = ventral posteromedial nucleus.** primary thalamic relays for somatic sensation; that is, nociceptive and tactile/proprioceptive information from the head both nuclei in the thalamus !!

Question 35

a painful stimulus activates which receptors? [3]

Answer 35

a painful stimulus activates which receptors? [3] **touch receptor wide dynamic range receptor nociceptors**

Question 36

Rule of 4: which 4 midline structures do you get? what are their deficits?

Answer 36

Question 37

explain path of lateralspinothalamic tract - which three nuclei does it terminate at? [3]

Answer 37

lateral spinothalamic tract: decussates at site of entry and goes up - axons reach midbrain, they branch to different nuclei **i) periaqueductal grey (PAG) - arousal ii) mediodorsal nucleus iii) ventromedial thalamic group** ii & iii = where concious perpection of pain is registered ! BUT NOT TO VPL / VPM (i.e. not somatosensory

Question 38

_what happens when have Bells palsy?_ - which part of facial nerve is affected? - what does this present as? _what happens when have stroke palsy?_ - which part of facial nerve is affected? - what does this present as?

Answer 38

_what happens when have Bells palsy?_ - which part of facial nerve is affected: **lower motor neuron** ​- what does this present as: **ipsilateral total paralysis** _what happens when have stroke palsy?_ - which part of facial nerve is affected: **upper motor neuron** - what does this present as: **contralateral lower muscles paralsis**

Question 39

Rule of 4: which 4 lateral structures do you get? what are their deficits?

Answer 39

Question 40

describe pathway of anterior spinocerebellar tract xx enjoy

Answer 40

afferent nerve goes in via dorsal horn. synapse with secondary afferent here a) MOST secondary fibres decussate and go up on the contralateral side b) BUT, some fibres: stay on same side and go up ipsilateral side aa) the controlateral ones: go to cerebellum, where they DECUSSATE AGAIN to get back to ipsilateral side bb) ipsilateral side goes up and stays here net effect is that both stay ipsilateral

Question 41

what is the difference between radicular artereis and segmental medullary arteries?

Answer 41

Radicular arteries Supply the areas where the nerve roots enter and exit the spine dorsally and ventrally, respectively. These arise from anterior cervical arteries in the cervical region, from posterior intercostal arteries in the thoracic region, and from lumbar arteries in the lumbar region. They gain access to the cord via the intervertebral foramina, and important do not travel as far as the midline to anastomose with ASA or PSA. Segmental medullary arteries These are, to all intents and purposes, just like large radicular arteries. They arise similarly from the anterior cervical, intercostal and lumbar arteries, but the key difference is that they travel to the midline and anastomose with the ASA or PSA. The largest and most noteable segmental medullary artery is the great anterior segmental medullary artery of Adamkiewicz, which arises somewhere between T9 and T12, usually on the left, and anastomoses with the ASA to reinforce it as it supplies the lumbosacral spine.

Question 42

where are the lesions? Lesion 1: Lesion 2:

Answer 42

where are the lesions? Lesion 1: **Right CN II** Lesion 2: **Right CN III if things are same = CN II lesion (afferent is ruined) if things are different = CN III lesions (efferent ruiend)**

Question 43

what is romberg's test? what are you testing? how do you perform? what is a postive sign? [1]

Answer 43

**Romberg's test:** - tests proprioception - standing patient and close eyes. instability & loss of balance is a positive sign - called sensory ataxia (due to dorsal column damage)

Question 44

Answer 44

Question 45

why does inflammation produce long lasting pain?

Answer 45

tissue damage releases **pro-inflam chemicals into extracellular space** these chemicals (e.g. bradykinin, K+) **activate nociceptor & cause it to stay open for long depolariastion**

Question 46

what are the three main branches of facial nerve (VII), what type of innervation do they provide?

Answer 46

_greater pertrosal:_ **parasympathetic innervation to lacrimal gland (eye fluid & tears)** _chordae typmani:_ * *- special sensory innervation to anterior 2/3rd of tongue; - parasympathetic innervation to sublingual and submandibular glands** _motor root: TZBMC_ (two zulus bit my cat); temporal, zygomatic, buccal, marginal mandibular, cervical: **motor muscles of facial expression**