Boards Part 1- Spinal Anatomy

• organs
• gut
• repiratory tract
• tubular structures

• paraxial (somatic)
• paraxial (splanchnic)
• intermediate
• head
• lateral plate

musculoskeletal (muscles, ligaments, tendons)

smooth muscle of organs

• urogenital systems
• kidneys

• skull
• muscles and CT of the head
• dentine

• adernal cortex
• blood and lymph cells
• CT
• cardiovascular and lymph

• surface ectoderm
• neuroectoderm (neural tube)
• neuroectoderm (neural crest)

• epidermis
• anterior pituitary
• lens of the eye
• skin
• enamel
• hair
• nails

CNS (brain and spinal cord)

• Sympathetic chain ganglion
• DRG
• ANS
• PNS
• Schwann cells
• parafollicular cells of the thyroid
• adrenal medulla

notochord-> neural plate-> neural groove-> neural tube-> neural crest cells

when the lamina failed to fuse. tuft of hair growth over the sidt called a "fawn's beard"

Folic acid/B9/methyl folate/jtetrahydrofolate

meninges protrude out of spina bifida

spinal cord protrudes out of spina bifida because meninges not developed properly

spinal cord and meninges protude out of spina bifida

cerebellar peduncles come below foramen magnum

cerebellar peduncles come below foramen magnum and a meningomyelocele (usually in the lumbar spine)

failure of maxillary and palatine bones to fuse

nucleus pulposus

31

membranous vertabral colume

muscle

skeletal muscle

visceral smooth muscle

dorsal/posterior muscles (extensors)

ventral/anterior muscles (flexors)

nerves

cartilage replacement by bone

before birth

after birth

• mesenchymal tissue into bone
• clavicle and all flat bones of the skull

• cartilage to bone
• all other bones in the body (besides clavicle and flat bones of the skull)

the mouth

back of the throat to the 1st 1/3 of the duodenum

last 2/3 of duodenum to 1st 2/3 of transverse colon

last 1/3 of the transverse colon to anus

scrotal ligament (gubernacular testis)

suspensory ligament of the ovary, ovarian ligament, and the round ligament

• prosencephalon
• mesencephalon
• rhombencephalon

• telencephalon
• diencephalon

mesencephalon (crazy!!)

• metencephalon
• myelencephalon

• cerebral cortex
• basal ganglion

1

lateral vesicle

• thalamus (hypo, epi, and sub)
• epithalamus (pineal gland)

2

3rd vesicle

midbrain

3 and 4

aqueduct of sylvius

• pons
• cerebellum

5-8

4th ventricle

medulla oblongata

9-12

the obex (fold at the floor of the 4th ventricle)

send impulses towards the cell body

send impulses away from the cell body

smell

• muscles= -85-90 mv
• neurons= -65-70 mv

• negative charges inside
• positive charges outside (mainly sodium)

sodium rushing into the cell

vibration

joint position sense

pain and temperature

touch

minimum current for action potential

time, using 2x rheobase for action potential

Cl rushes in to cell, may also open K+ channels more to leak out K

glycine

GABA

• vasomotor
• cardiac centers
• autonomics
• CN 5-12

• reflexes to light and sound
• proximal flexor relay
• motoric relaxy
• CN 3 and 4

• relay station
• sensory fibers

integration of sensory information

• ventral posteromedial
• sensory from the face

• ventral posterolateral
• sendory from arms and legs

sensory from the eyes

sensory from the ears

intellect and association

sensory- postcentral gyrus (localization "somatic cortex")

• in the parietal lobe
• abstraction, problem solving

sight

hearing

short term memory

• long term memory
• smell

hippocampal cells

anterograde amneisa

parahippocampal cells in the uncal area

junction of parietal, occipital, and temporal lobe

• sensory matichin
• interpretation (does this make sense? if not, fire sympathetics)

B1/thiamine deficiency d/t alcoholism (wernicke-korsakoff syndrome)

• sensory aphasia- cant understand language
• word blindness in angular gyrus. can read, see, but cant understand

• voluntary motor (precentral gyrus)
• brodmans 4, 4s, 6
• corticospinal tracts
• corticobulbar tracts
• biant cells of betz
• executive function
• personality

• broca's speech area in inferior frontal lobe destroyed on the left
• from middle cerebral artery stroke

• left side of the frontal lobe
• controls motor speech and forming words

• pleasure or pain?
• do i need to remember this for survival
• associated with the amygdala

• inhibits the thalamus (stops motor response)
• provides background muscle control

• parkinson's disease: trivial information elicits motor response. paralysis agitans. exhibits pill-rolling tremor, mask-like face. forward stooped posture, shuffling/propulsive gait. lead pipe/cogwheel rigidity
• inclusion bodies: lewy bodies. from decreased dopanine in the substantia nigra in the midbrain

secretes GABA

• huntington's chroea
• in males, fatal by age 50

the putamen + the caudate

the globus pallidus + the putamen

• hunger
• thirst
• temperature regulation
• sex
• rage
• fear

• balance
• equilibrium
• involuntary coordination
• unconscious proprioception

astrocytes and tight capillary beds

stores glucose

macrophages (can adapt to gram + or gram -)

• line the ventricles
• produce CSF in the choroid plexus in the lateral ventricles

in the arachnoid granulations of the superior sagittal sinus

• myelin in the CNS
• derived from neural tube

• multiple sclerosis
• demyelination of the CNS

• myelin in the PNS
• derived from neural crest

Guillian-Barre syndrome (post-infectious polyradiculopathy/ ascending paralysis)- due to post-vaccine or post-infection

peristalsis of the mucosal layer

peristalsis of the muscular layer

from neural crest cells

hirschprung's disease= congenital megacolon

• inhibit alpha motor neurons
• negitive feedback

• quiet, meditative
• disappear in sleep

• intense mental activity
• REM sleep

• deep sleep or coma
• due to ARAS (ascending reticular activating system)- wakes up the cortex

• normal in children, abnormal in adults (stress, suicidal)
• in 2nd, 3rd stage of sleep, non-REM

between lobes of the same hemisphere

connect L and R hemispheres

connect hemispheres to other areas of the brain

• most sensitive to increased pCO₂
• secondarily sensitive to decreased O₂
• found in carotid bodies and aortic bodies
• if sense increased pCO₂ cerebral blood vessels dilate

made in choroid plexus in lateral ventricles-> foramen of monroe-> 3rd ventricle-> cerebral aqueduct of sylvius-> 4th ventricle -> foramen of magendie and foramen of Lushka-> central canal and subarachnoid space-> reabsorbed in arachnoid villi in superior sagittal sinus

middle meningeal artery

damage to venous system

beri aneurysm (circle of Willis)

• from red nucleus of midbrain
• carries proximal muscle fibers of upper and lower extremity

• from reticular formation in midbrain
• carries fibers from extensor muscle of the back and arms
• EXCEPT: any back muscle innervated by a plexus (dorsal scapular- rhomboids and levator, throacodorsal- lat dorsi ventral primary rami)

tectum (midbrain) to neck muscles

• from cerebellum and vestibular nuclei
• carries fibers from extensor muscles of the back and legs

• CN 3, 4, 6
• Medial longitudinal fasciculous for vestibulo-occulor reflex (VOR)

dentate nucleus->anterior horn of spinal cord->gamma motor neurons-> intrafusal fibers for TONE

• precentral gyrus of frontal lobe (giant cells of Betz)
• for flexors of distal extremities

decussates at medulla at medullary pyamids

decussates at spinal level for flexors of trunk

precentral gyrus->anterior horn->alpha motor neurons->extrafusal fibers->movement

• substantia gelatinosa blocks pain
• tract of lissauer
• for spinothalamic tract

nucleus dorsalis of clark (clarks column)

anterior horn, alpha motor

anterior horm, gamma motor

• gray commissure
• central canal

pain and termperature

crude touch and pressure

unmyelinated C fibers, free naked nerve endings

synaps in posterior horn in tract of lissauer (substantia gelatinosa)-> decussates across lamina 7-> travels up lateral spinothalamic tract-> VPL of contralateral thalamus-> contralateral cortex

• dilation of central canal (usually C5/6) cuts spinothalamic tracts
• causes loss of pain and temperature in cape and shawl-like distrobution

compression of large A-beta fibers

dorsal columns medial lemniscus

• conscious proprioception
• vibration
• position sense
• 2 point discrimination

• Gracilis- from legs
• cuneatus- from arms

• Ab fibers
• meissner's and merkels- touch
• pacinian- vibration
• ruffini-joints position sense

legs-> Ab fibers-> spine (fasciculus gracilis)->dorsal columns->medulla (nucleus gracilis)-> decussation (medial lemniscus)-> VPL of contralateral thalamus-> contralateral cortex

arms-> Ab fibers-> spine (fasciculus cuneatus)-> dorsal columns-> medulla (nucleus cuneatus)->decussation (medial lemniscus)->VPL of contralateral thalamus-> contralateral cortex

• flocculonodular- midline, balance of the spine
• anterior lobe- balance from arms and legs
• posterior lobe- how cerebellum talks to cortex

• fastigial-spine
• Globus- proximal joints (glenohumeral)
• Emboliform- middle joints (elbow)
• -globus + emboliform= interpose nuclei
• Dentate- distal joints (digits)

• superior cerebellar peduncle-> midbrain
• middle cerebellar peduncle-> pons
• inferior cerebellar peduncle-> medulla

• info to the cortex travels via superior cerebellar peduncle
• info back to cerebellum travels via middle cerebellar peduncle
• info from SC/body travels via inferior cerebellar peduncle

carry unconscious proprioception

receptor-> peripheral nerve-> spinal cord-> brainstem-> cerebellum-> superior cerebellar peduncle-> red nucleus-> thalamus-> cortex->middle cerebellar peduncle-> cerebellum

spino-olivary tract-> inferior olivary nucleus->climbing fibers->inferior cerebellar peduncle-> ipsilateral cerebellum

dorsal spinocerebellar tract->inferior cerebellar peduncle-> ipsilateral cerebellum

ventral spinocerebellar tract-> decussates across at spinal level->midbrain-> decussates back through superior cerebellar peduncle-> ipsilateral cerebellum

• posterior portion
• contains superior and inferior colliculi
• reflex to light and sount (tectospinal tract)
• corpora quadrigemina- the 4 colliculi

• CN 3 and 4 + axons
• cerebral aquaduct
• (CN 4 posterior)

• anterior portion
• contains corticospinal tracts
• red nucleus- rubrospinal tract
• substantia nigra- dopamine for thalamus (parkinsons)

olfactory

frontal lobe

• cribiform plate
• ethmoid bone

smell (sensory)

optic

thalamus

• optic foamen
• sphenoid bone

• vision (sensory)
• afferent pupillary light reflex (reflex)

opthalmic

midbrain

• superior orbital fissure
• sphinoid bone

• muscles: superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae superioris
• reflex: pupillary constriction
• efferent pupillary light reflex

trochlear

midbrain (posterior)

• superior orbital fissure
• sphenoid bone

superior oblique (SO4)

trigeminal

• V1= opthalmic nerve
• V2= maxillary
• V3= mandibular

pons

• superior orbital fissure
• sphenoid bone

• corner of canthus to bald spot (sensory)
• afferent corneal and afferent oculocardiac (reflex)

pons

• foramen rotundum
• sphenoid bone

corner of cantus to corner of mouth (sensory)

• foramen ovale
• sphenoid bone

• corner of mouth to chin (sensory)
• general sensation to gongue as lingual nerve
• muscle: temporalis, masseter, medial pterygoid, lateral pterygoid, tensor tympani
• jaw jerk (reflex)

abducens

pons

• supraorbital fissure
• sphenoid bone

lateral rectus (LR6)

facial (chordae tympani in middle ear)

pons

• internal auditory meatus-> stylomastorid foramen/temporal bone
• pierces the parotid gland

• chordae tympani from middle ear to anterior 2/3 of tongue for taste and gustatory sense (sensory)
• facial muscle and stapedius (muscle)
• efferent corneal (reflex)
• lacrimation, salvation

vestibulo-cochlear (auditory)

pons

• internal auditory meatus
• temporal bone

• balance (vestibulo)
• hearing (cochlear)

glossopharyngeal

medulla

• jugular foramen
• temporal/occipital bone

• posterior 1/3 tongue for taste and middle ear (sensory)
• stylopharyngeus (muscle)
• carotid afferent, gag affarent (reflex)
• salvation (paratid gland)

vagus

medulla

• jugualr foramen
• temporal/occipital bones

• tympanic membrane (sensory)
• palate, pharynx, larynx (diaphragm???) (muscle)
• carotid, gag, and oculocardiac efferent (reflex)
• palate to 1st 2/3 of transvere colon

spinal accessory

medulla

• jugular foramen
• temporal/occipital bones

SCM (with C2/3) and trap (with C3/4)

hypoglossal

medulla

• hypoglossal foramina
• occipital bone

intrinsic muscle of tongue (muscle)

• vibration, 2 point discrimination, fine touch
• face-> synapse-> main trigeminal sensory nucleus (principal nucleus)

• down spinal cord to 1st 3 segments, joins spinothalamic tract
• synapse in spinal nucleus V (subnucleus caudalis)
• mesencephalic nucleus= DRG of CNV

• temporalis
• masseter
• medial pterygoid
• lateral pterygoid

• O: temporal fossa
• I: coronoid of the mandible
• A: close jaw

• O: zygomatic
• I: external angle of jaw
• A: closes jaw

• O: medial pterygoid process
• I: internal angel of jaw
• A: closes jaw

• O: lateral pterygoid process
• I: disc of TMJ and condyle of mandible
• A: opens/depresses jaw, protraction of jaw

midbrain-> edinger-westphal nucleus-> ciliary ganglion-> pupillary constriction

• pons-> superior salivarory nucleus-> sphenopalatine ganglion-> crying/lacrimation
• pons-> superior salvatory nucleus-> sphenomandibular gangion-> salvation

medulla-> inferior salivatory nucleus -> otic ganglion-> partoids-> salvation

medulla-> vagal-> throat to 2/3 transverse colon

erection, bladder control, bowel control (distal 1/3 colon)

rest and digest

T1-4

• T5-8
• celiac plexus->digestion (to somach, liver, gallbladder, pancreas, and small intestine)

• T10-11
• kidney and adrenals

• T12
• colon, some kidney

• L1-2
• colon

• fight or flight
• lateral horn T1-L2

intermediolateral horn of spinal cord T1-L2

• visceral efferents- vasoconstriction of central arteries
• vasodilation of arteriols of muscle and capillaries of skin
• erector pili and pseudomotor (sweating) activity
• epinephrine breaks down glycogen to glucose

IMl-> white rami communicantes (B fibers)-> pre-ganglionic= cholinergic synapse on symp chain ganglion-> leaves via grey rami communicantes (c fibers)-> post ganglionic= releases epinephrine and norepinephrine-> stimulates adrenergic receptors

• alpha 1- vasoconstriction of central arteries, dilation of pupils
• alpha 2- autoinhibitory to alpha 1
• beta 1- increase heart rate and contractibility
• beta 2- vasodilation of arteriols of muscles, bronchodilation, glycogenolysis, lipolysis

gray color cell tumor which causes episodic hypertension d/t epinephrine release

• above C4
• pupil dilation

C4-5

C6-8

• C8-T1
• merger between inferior symp chain gangion and upper T/S gangion

• disruption of cervical chain ganglion
• ptosis, miosis, anhydrosis

phenylalanine-> tyrosine-> l-dopa-> dopamine-> norepinephrine-> epinephrine

• cornea to iris
• filled with aqueous humor

• iris to lens
• filled with aqueous humor

by ciliary epithelium in the ciliary bodies

• lens to retina
• filled with vitrous humor to maintain shape

lens placodes

optic stalk gives rise to the optic cup

• most acute vision
• has cones- bright light and color vision
• macular degeneration= cant see light

• found in the periphery
• dim light and night vision

rods

rings around lights

rhodopsin (purple)

vitamin A

• nyctalopia- night blindness
• keratomalacia- softening of the cornea

the nasal tracts decussate at the optic chiasm (carrying temporal fields of vision)

bitemporal hemianopsia (tunnel vision)

• clonus because of consatant firing, no inhibition
• spasticity because increased firing= increased muscle tone
• hyperreflexia because muscle spindle so tight

• fasciculations= muscle dying, spontaneously firing
• hypotonia: lose 1b and 1a afferents for tone
• hyporeflexia: decreased tone on spindles

• UMN: from cerebral cortex to but not including anterior horn cells (alpha motor neuron)
• LMN: from anterior horn cell to muscle
• myosynaptic: strike tendon-> stimulates muscle spindle cells-> synapses on alpha motor neuron

• turns mechanical waves into fluid waves
• sound pounds tympanic membrane-> malleus-> incus-> stapes-> oval window-> perilymph and endolymph

• hair cells
• organ of corti
• spiral ganglion
• CN 8

hair cells rocked-> depolarization-> Na rushes in. hair cells fire cochlear nucleus-> leaves via trapezoid body to brainstem (superior olive in pons)-> leaves medial geniculate body of thalamus as auditory radiation-> superior gyrus in temoral lobe (gyrus of heschl)

• cochlear canal
• separated from scala vestibulae by the vestibular membrane

vestibular canal

• tympanic canal
• inferior canal

• aka Reissners membrane
• above tentorial membrane which is above the basilar membrane

static equilibrium (standing still)

• functional part of the utricle
• linear acceleration (car/elevator)

angular acceleration (roller coaster)

• dilation of semicircular canals
• contains crystals

sensory neuron-> cribriform plate of ethmoid-> olfactory bulb (mitral cells)-> olfactory radiations-> uncus

sense of smell (limbic system)

memory of smells (limbic system)

midline connections of hippocampus (limbic system)

emotional response to smell (limbic system)

posterior ethmoid recess

nasolacrimal duct

frontal, sphenoid, maxillary sinus drainage

• SADISM
• Synarthrosis (Immovable- fibrous)
• Amphiarthrosis (Slightly movablep-cartilage)
• Diarthrosis (Movable- synovial)

• type of synarthrosis
• interosseous membranes

• type of synarthrosis
• sutures of the skull

• type of synarthrosis
• teeth

• type of amphiarthrosis
• temporary, epiphyseal plates, hyaline cartilage

• type of amphiarthrosis
• IVD, pubic symphysis
• fibrocartilage

type of diarthrosis

• hinge
• uniaxial
• cubital/humoeral
• ulnar joint
• mortis joint

• pivot
• uniaxial
• atlas/axis
• proximal radio-ulnar joint

type of diarthrosis

• ovoid
• biaxial
• radiocarpal
• MCP
• TMJ
• knee

• saddle
• biaxial
• thumb
• sternoclavicular joint

type of diarthrosis

• triaxial
• facets
• AC joint
• inter-carpal and tarsal joints

• ball and socket
• triaxial
• coxofemoral joint
• glenohumeral joint

perpendicular articulation of ethmoid and vomer bones

• ALL
• PLL
• IVD
• ligamentum flavum
• capsular ligament
• intertransverse ligament
• interspinous ligament
• supraspinous ligament
• ligamentum nuchae

• anterior longitudinal ligament
• runs on the front of the vertebral bodies from C2-> sacrum
• anterior atlanto-occipital lig: from atlas to occiput
• limits extension

• posterior longitudinal ligament
• runs along the back of the vertebral bodies in the anterior portion of the spinal canal
• wider in cervicals, thinner in lumbars. thinnist at L5, limits flexion

• intervertebral disc
• fibrocartilage
• symphysis joint (amphiarthrosis)
• makes up 25% of the height of the spine

• runs lamina to lamina along the posterior portion of the canal
• posterior atlantoaxial lig: from C2-C1
• posterior atlanto occipital lig: from C1 to C0
• high elastic content
• limits flexion

articular process to articular process

TP to TP

SP to SP

from spinous to spinous

supraspinous ligament from C7 to C0

holds the dens in the focea dentalis of the atlas

• C0 to the body of C2.
• cross shaped
• includes transverse ligament as horizontal portion

• sides of the dens to occipital condyles
• "check ligament"
• limits rotation of C2

• apex of the dens to anterior aspect of foramen magnum
• limits flexion and extension of C2

21 ligaments connecting the pia mater to the dura mater along the spinal cord

• obliquous capitus superior
• obliquous capitus inferior
• rectus capitus posterior major
• rectus capitus posterior minor

• O: lateral mass of C1
• I: occiput above the nuchal line
• A: extension and ipsilateral rotation of the head

• O: SP of C2
• I: lateral mass of C1
• A: rotation of C1 on C2

• O: SP of C2
• I: lateral nuchal line
• A: extension and roation of the head

• O: posterior tubercle of C1
• I: below nuchal line
• A: extension and rotation of the head

• lateral portion of suboccipital triangle
• not attached to C2

• inferior part of suboccipital triangle
• no C0 attachment

• medial part of suboccipital triangle
• not attached to C1

• not part of suboccipital triangle
• not attached to C2

• 8 cervical
• 12 thoracic
• 5 lumbar
• 5 sacral
• 1 coccygeal

• largest transverse diameter at C1
• C3-T2 is cervical enlargement for tracts for arms
• T10-12 is thoracic enlargement for tracts for legs

• median sacral crest- SPs
• medial or intermediate crest- fused articular pillars
• lateral sacral crest- fused TPS

23

fibrocartilage

type 2 collagen

age 20

movement of the spine imbibes nutrients

• 1-2
• contralateral rotation

• 2-3
• contralateral rotation

• 3-6
• contralateral rotation

• from L2-S2
• contains only the cauda equina

from conus medullaris at L1-L2 spinal level down to S2

• from conus medullaris (S2 spinal layer) to the coccyx
• inner portion made of pia mater
• outer portion made of dura mater

the end of the dural sac around S2 spinal level

• ribs 1-7
• articulate with the sternum

• ribs 8-10
• articulate with costocartilage of 7th rib

• ribs 11-12
• no articulation with the sternum

ribs 3-9

ribs 1,2,10-12

• short and flat
• groove for subclavian A and V
• tubercles for anterior scalene and middle scalene muscles
• full facet and demifacet on T1, doesnt articulate with 2 vertebra

tubercles for posterior scalene and serratus anterior

full facet and superior demifacet on T10

• single full facet
• floating ribs

• radiate ligament: on the front of the head of the rib connecting to body of vertebra
• interarticular lig: on front of rib to body of vertebra
• costotransverse ligs: connect rib to TVP

• from C1
• motor to suboccipital muscles

• from C2
• medial dorsal primary rami

• from C2-3
• sensory behind the ear

• from C3
• 1st nerve compressed by a disc

• C3-4
• sensory on and around the ear

• C3,4,5
• motor to the diaphragm

• C5
• motor to rhomboids and levator scap

• from C5-6
• divides into subclavian n, axillary n, and upper and lower subscapular nn

• from C5,6,7
• gives rise to lateral pectoral n and musculocutaneous n

• from C6,7,8
• motor to latissimus dorsi

• from C5-T1
• motor to upper extremity
• brachial plexus

• from C5-T1
• brachial plexus
• motor to upper extremity

from C8-T1

frome C8-T1

from C8-T1

• from T12
• sensory

• from L1
• sensory

• L1
• sensory

• from L1-2
• afferent and efferent of cremaster reflex

• L2-3
• sensory to lateral thigh

• from L2,3,4
• leg extension

• from L2,3,4
• thigh adduction

• from L4-S1
• motor to gluteus minimus and medius and TFL

• from L4-S3
• splits into tibial (L4-S4) and common peroneal (fibular)

• L5-S2
• motor to gluteus maximus

• from S1-S3
• sensory to posterior thigh

• from S2-4
• erection and bowel and bladder control