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Hi, I'm just gonna give people a second to pile in and I'm just gonna set up the powerpoint while we wait. I put poll in just because I'm sure some people have been to previous events versus before because I'm trying to get new people versus old people to get an idea of what nutrition rate is, et cetera, et cetera. What I'll do is I'll, I'll give it maybe another minute and then we'll get started just gonna turn on share screens so you guys can make sure it's working. She had an high screen. She was working. There we go. Ok. Ok. That should be working fine. Wait until it gets to two minutes past just so you have time to go. This is a nice easy one. This is, this is a lot easier than the previous one you've been through. And it's, I say it's easier than motor disorders in some ways it will seem like revision in other ways that will teach you some of the facts, which will be a good foundation of clinical, but there's a lot of preclinical foundation information, right? So, ok, let's begin. Ok, so I'm just gonna do a quick intro for people who are new to it. So there's a brain book here. This is a brain book lecture. Just gonna move this. So you can see the name. Hi, this is OK. So this is a brain book lecture. Effectively, we're talking about the bone anatomy. So we're gonna be talking about the vertebrae. We're gonna be talking about some areas on the skull. This is of course part three, we've done two other neuroanatomies before and I'd say out of the three of them and comparing two motor, this is probably I'd say the easiest. So this is gonna be fairly strict. But as I say, it's good of vision, I don't think it's gonna take a full hour. It's probably gonna take more like 30 minutes. I'm gonna put on presenting mode. Cos that way you guys can see the notes I have, which if you want to back, you'll have more information. I think that's more useful for you guys. Also, you have more context of what's coming up. OK? So our goals are going to be to look at the bones, look at some of the cranial nerves, name some parts of the vertebrae. I'm also going to look at them and we're going to make sure we can tell the difference between it is an important skill to have and it's something that once you've got it, you've got it and it's good. It, it's a good piece of vision. I'd say, OK, so we're gonna cover the basics here. You're probably gonna remind there's a picture of the penguin in the bottom, right? I'll cover that in a second. So, of course, the basics, of course, you've got the frontal, the parietal. You've got the Zygomatic, which is where the cheap bones are. You've got the mandible, you've got the bone and you've got the maxilla here. Of course, that's, there's different angles. The thing you should know here, which is interesting is most of these are sealed together, two of them aren't. And that's the vomer and the mandible. So someone gets hit in the door, it's possible to get your jaw dislocated. Also, most people know this. The vomer can we dislocate the doorstep now in the Penguin, which is the HBO show, which is actually pretty good. There's a scene where a character gets a pair of pies sticks off someone's nose and tries to basically pull the middle of the nose down. And that's something you can actually do because the vomer is something that can be touched, it can be pulled out. So that's just something you can remember. So if you ever want to remember that fact, I'd recommend watching the HBO show with the Penguin, which would be a way of justifying revision. I guess I have to give you some basic facts. It's made up of 14 digital bones. Generally speaking, it isn't really something I need to know when it comes to finals, but it's good foundation. Not as, it's more of this type of stuff. The 1st 3rd of this lecture I'd say is going to be mostly and then we'll get onto some stuff and we'll cover a few operations. I'd say, ok, so we want to look at some stitches. So I'm sure you guys know this all fairly quickly. So there's a coral. So you think Jesus Christ being BC? And of course he has a crown of thorns and the area where it's put in is in that plane. So it's a Coronal. You've got Lando, I've got a picture here. So that's Lando cos that's the landlord shape. You can think of the Lando fighter, fighter, fighter aircraft in Star Wars. Of course, you've got squareness here and this is the temporal area interestingly here. This is a very important point and this is very clinically relevant and it's also tied to the dark night. One of the things about be makes him so threatening is he knows how to hurt people in that scene where he's fighting batman where he's broken his back and he's on the floor. What he does is he hits him on the side of the head. Now, the part of the head where he hits him happens to be the material and it shows a few since that's a terrible place to hit someone. The reason for it is because it effectively the cracks. That's the weak part of the head, we can cause the most damage that maybe the eye being the exception. And that's because underneath it is the middle meningeal artery. So it's, that's intuitively a very, very dangerous place to hit someone. And of course, it's much more like to lead to trauma. And the, as a result, similar I did it, this is a different angle. So we've got the myopic, this normally fuse us a lot sooner. You see this in babies and it normally disappears by the time you are an adult or even a teenager, this is completely gone. Now, most switchers will have basically disappeared completely fused by the age of 25. So if you're my age that they will be pretty much gone. But you can see from a different angle, of course, you've got a sag and that's of course, like the plane. So that's fairly straight forward. Most of these are fairly straight as far as I say, the only one that's a bit different, which you might have come up in pediatrics is this one which is the metopic, which fuses a lot earlier than 25. Ok. We'll just cover this here. So please go to have some surgical relevance. This is an area where you can have the pituitary and this isn't really talking about the con of the nose. It's to say that you've got a clear path here where the bone here between the outside world and the pituitary is actually quite small. And of course, you can do a transphenoidal surgery where if you have a tumor in the pituitary, you can effectively go through it and take the tumor out. So that's the main thing. And I say that's fairly important and that is something that definitely will come is very relevant. This is fairly straightforward. So we're just gonna cover it just for a bit anatomy if you've got the sinuses, of course, if they swell, if they get inflamed, you can get a banging headache, which can be absolutely terrible. It can last for two weeks. I mean, the treatment is not true. I think it's fenoxyl, penicillin or penicillin, vi believe. Now, of course, this can be affected by strep pneumonia. It can be affected by flu. I'd say it is very big, very big. Ok. So the, the, this is the part of the skull of the, it's the sort of like which can be lifted off and, and some tribes could be used as a B for some blood, et cetera about the scalp. Here. I'm going to show you some pictures cause pictures are always better than words. So I'm not gonna spend too long with here. So you see the frontal here. You've got a space here which is good for protecting people from concussion, an airspace. We've got parietal here. We have occipital here. We have sphenoidal here which sorry, the sphenoid, which I I'm told this person look like a bat personally, I've never really seen it. I'm going to look at the fire for the cream nerve shortly. We have the temple here and of course, this is another angle of the occipital. It's now going to break it into different sections. So you can see up here, this is the anterior cranial fossa. This is clinically relevant because this is an area where damage you can get the leaking through the nose and to the signs here that you should be aware of. If, if someone has a lots of smell and have clear fruit coming from the nose, like I sign that you got an in brain, its fluid down the nose, that's something to be aware of. So in essence, if you got clear fruit coming from the nose, trauma and a loss of smell, consider that you may have trauma to the head and it CSF not s not OK. You can see here, this is a place where you can see the, the SG is part of the dura matter which goes down the middle, it separates the hemispheres and this is the area and this re form plate is where you find the nerve one or the olfactory nerve, which is of course vital for el and that's linked to things like the olfactory B. Now I'm moving on to the middle. So this is a bit like before what we said, this is the only way you're going to find the prescription it's accessed via the cell and it lies around the extreme. So there's a sinus where you can find it and you can endoscopically using a very narrow tube read through and transfer noise, which you can't take out. And the reason you might do this is if there's a tumor, it may be that it's, let's say, walking up the canal. So you can't see properly, sorry, optic nerve, I should say blocking it. So you might have bioral heia. So lateral visions on both sides have been affected. It could be that you're getting too many hormones produced because so many hormones are produced by the pituitary. And that means when you take it out the rest of that person's life, they have to take a regular set of medications. So it's not something that is done lightly. Ok. Here we can see the, so here Haisley Cossa moving on to the posterior. Next. Ok. So this is the most dramatic one, clinically, you can get something called King and the two things to be aware of when you get an increased in intracranial pressure, it can force the brain and effectively you have a large hole forming magnum, which is basically a large hole in Latin if you put too much pressure. And of course, the brain is going to try to escape, it's gonna go from area of high pressure to low pressure. And this is of course, can be caused by hydrocephalus. And that basically means you get higher, more fluid, more pressure, brain tries to move out the hole. And of course, that means that the brainstem gets pressed against the form and magnum. And that leads to death. The reason this causes death is because of tonsillar herniation of the cerebellum. This is also called or brainstem compression. So it leads to a loss of consciousness and loss of respiration because these primitive things we have are also essential in the brain stem without them not able to maintain consciousness or able to stay awake. And I don't mean because we can't really, I mean consciousness in or itself. So in terms of thinking of pathology as the study of the weakest link, the brainstem is a very weak link that we're entirely dependent on. And if something bad happens to it, then that is the game over. Whereas if you damage to the brain, I've seen people who have been shot in the head and quite often they don't make a complete recovery. They may have some memory lost, but a lot of them can recover to a tremendous degree being shot in the head. Doesn't mean you die, you get shot in the brainstem that that is it OK. And so this is a different angle here. It's effectively the important up making and it is mostly the same point side. OK. Now let's move on to talking about the cranial nerve. So this is going to talk about some of the functions and it's going to talk about some of the ways I remember the farm best if you break it up into groups and think about it in relation to the others. Ok. Now, ideally damaged was supposed to be larger. I apologize for that. So I'm gonna go through it and read them out. So one is olfactory to smell. Two is optic which is free is ocular motor which is do in moving the eyes and the pupil Boris tro which is also to do with moving. II believe that's the superia a week. And you've got five, which is the trigger, which is sensation of the face as well as clenching the mastication muscles, which is for facial incision. I apologize. And you've got number six, which ablutions which is also linked to moving the eyes. I believe that's the lateral rectus. Number seven, facial, which is for moving the face and salivation. It also interestingly is tied to the ears and that's gonna be relevant in a second for the path it takes. Because if your number seven is damaged, you will find that some things you hear will sound far too loud. Your brain doesn't have the ability to sort of turn down the volume if you like. So that's something to be aware of. Number seven, then you have number eight vestibular cochlear. So that's a case of bouncing and a case of ears, vestibule, you have vestibules in the bouncing apparatus in the ear and cochlear is linked to hearing. So it's fairly intuitive. Number nine, glossopharyngeal, which would do with taste and swallow vagus, which of course is parasympathetic to heart rate and digestion accessory, which is linked to moving the head. And of course, hypoglossal, which is linked to movement. So that's not, it's not the main point. We're going to focus primarily on the bony side of the anatomy more to the foreign. That's just a bit if I OK. So we can see these here, something like in text. But I think it's much better if you have it as an image, which I'm gonna show you now. OK. So as I mentioned before, olfactory goes through the gray form plates, he got off to come out here and most of the nerves that move the eye through the superior orbital fissure, which is your right hand. So that's all of these there. And when it comes to number five, you have three branches of the trigeminal and they go through a different form in each 123. So optic nerve, that's fairly simple. It's nice and round as easy to find on to the superior orbital vision. And that's the movement nerve to the eye as well as the first one for trigger. Then the second for trigger, which is maxillary and the third, which is the mandibular. I think that's fairly ii, I'm sorry, just to recap when it comes to general. It is. Yes. Involved in that medication. Ok. So what we have here, of course, is, of course, round return is of course circular here, which is smaller. I always used to struggle because I used to think, well, which one is the rotund, the really small one or the big one just speaking it, it's a bit crude. But if there's two things competing for the same title, the big one normally gets the title that a bit of a crude way of me. But that's how it sticks in my head. Spinosan, of course, is for the middle artery. And that is relevant. Cos we talk about that before because that goes to the pa here, which is the weak part of the head. If you get hit at the side of the head, this can lead to a lot of bleeding. It's very dangerous to be there more so than OK. So we see here, we have the internal acoustic mats which goes to the outside to the external acoustic mats which is around the mastoid. So you have the facial now, as I said, the facial is t to hearing. So it basically allows you to tune down really loud sounds and if it's damaged like a mean, it sounds, appear too loud. So it is in a sense linked to it and of course, it's right next to the Creon of eight which is in two balance in hearing. So that's a good way of remembering that a nice, simple one. Remembering this, the farm, every single one of these has an X men and, and II say it's fairly intuitive. You've got this prosal line here and it all basically go through, sorry, you've got this line here, which looks regular and it all basically go from here. All the extras go from here. You've got the hypoglossal canal. This is more a case. It's the one closest to the foreign. This is intuitive because it's fairly hard to miss. And naturally, if you got this one here, which is the brainstem 12 is going to be the last one. So it's going to be here. So just sort of break it down so you can have this one here. And since that's optic and you just count through the my, I think the spurs must be middle men. This looks fairly irregular and remember all the s go through the irregular, it caused internal acoustic meters to have seven and eight because they're both linked to the and that's effectively where it was as well. You have the internal chronic canal. I'm just having a look to see if there's anything I miss. Ok. The, the main one I, this is this one here, the canal for sorry, swelling too here and you can see the jerk of that. Well, which of course in there there isn't, there isn't scenario, but it's leads to different things as well. Ok. So we're talking about procedure here. So if you have hydrocephalus, if you have too much swelling and the pressure of the brain is getting too high, then you're effectively going to have to drain it. It's also called shunting. It's something called Cocker point, which is that you don't need to remember the exact measurements. You're not gonna be quizzed on that. But there could be a multiple choice question on like, what is it? What is the name for the area when someone's got a hydrocephalus, I will say for Hydrocephalus, this is something important for us. Cos I watched a lot of American videos for learning how to understand medicine, particularly things like osmosis. I found that I got called out on the way I pronounced hydrocephalus because I used to say hydrocephalus like Americans and it creates the impression that, you know, more videos than, you know, real life clinical practice. And the question they're asking in the OS is, are you ready for clinical practice? And in reality whether you ce or cephalus, it can actually make a difference except in the mind of the examiner. And it's something I have been called out for in the past. So that's something to be aware of trying to say in the British way. If you're in a British medical school as much as it shouldn't matter, it does matter. It forms an overall impression just like um the to you use or the close you wear. Ok. Now, generally speaking, when it comes to surgeries, you don't know that any could be left in and of itself and it doesn't exactly lend itself to something that you can only truly appreciate by seeing it. And some of the more advanced medical schools, if you have technology to teach people it. So it's not something I can go through, but I can give you the main point if you like that would be the most important for multiple choice questions. The idea, generally speaking is to minimize brain traction and pre prevent risk of contusions. OK. So we're going to have a look at the vertebral column. We're gonna start off with some basic things. So you've got three segments, you can see them on there, you've got 33 bumps and you can probably see I'm reading off the screen here cos the truth is even though I'm a doctor, I don't remember this. This is very much pub quiz stuff. It's more priming material. It's good to say to get some context, but you don't actually need to know this from day to day being a doctor and it's not gonna come as a question, but it is worth covering generically. It's more useful. I'd say for anatomy being able to appreciate the different parts and the different curves and where, which areas curve because that is going to clin. Of course, you've got the sacrum and the coccyx which are fused, which of course link to the pelvis or at least the sacrum does, so we'll move on to that now. Ok. So if you happen to be in the early years, then it could be, they give you a vertebrae and say, differentiate between it's very difficult. But you'll probably find looking at these, you can tell quite easily that this looks big and bulky. Yeah, that's quite a big bulky one. That's lumber. If you think, like, just doesn't look like anything particular, like, looks generic. That's right. It looks very weak. Like if, if you pick it up, I'm going to break this. You think? Cervical, what I found in the is, it's very hard to compare things when you only have one of them. And if they're gonna give you one, it's more impulse to what you think when you're looking at it. If it's like, oh, that's quite big and junky. But sorry, Lumbar. If it looks very fragile, like you could bring it very easily with your fingers. And so, and that's sort of how I learned it, sort of the impulse I had when I was looking at it. And of course, what we can see here, Dumb Benz in for bends out and we're gonna cover that in a second because that's gonna become very relevant for one of the things we're going to look at. So this is just a different way of looking at it. I think generally speaking, car in pictures, it can be a bit tricky so we can see the different facets here. We're going to cover that very closely in a second. We're gonna look at the cervical areas here and of course, Sacrum can't be moved, the ones that can be moved that have the facet and ligaments, that's only the top 24. But again, that's not information you need to know for any of your exams. You probably, I'd be surprised if you even necessarily need to know. That's for the clear though I will confess. It's possible. OK. So this one here is the axis and this is basically like a pivot. This is C two and C one is going to sit on this. So Atlas is gonna sit on here. Atlas goes on top of this and this. Yeah. Y axis if you like goes through here, of course, is named after the, I believe it was the Titan from Greek mythology who had to hold the world up. And of course, in this sense, the brain is the world. It has to be poetry on it to it, I suppose. And this is basically how it looks, but it looks different to the most difficult vertebrae. This is C two because it has at which is something that C one does not have. So that's the main way of trying to part and beyond that, you don't need to know a huge amount about it. At least not for later years. I do have some information here. But if I'm honestly, I would have to be reading that now. And if you want, you can pause psia, OK? So we're going to talk a bit more detail. So this is going to a bit of vision here. So effectively, these click together, there's superior and inferior process to click together. And there's no flexibility with the ligaments that they're able to bend to and from the Demi fits called Demi facets because you have to put two of them together together to form a facet for the rib. So one of these imagine a here having here and forming a larger facet with the inferior acid, which is ironically larger and the head of the rib goes there. So the rib would be here and it goes round and the transverse process, the facet for articulation is on here and having those two attachment points enables to basically not be rotated around, enables them to have a, a sense of rigidity which you need at least at the posterior posterior part of the replication if these are in the wrong angle because these areas are where no is gonna happen. Of course, you can get BP and that's of course we get compression ups against it in the process. The annulus is generally speaking, described as II think it was described to me as being a bit snotty. The idea is a bit of a compression, but generally speaking, the only thing you need to know about it clear that is, if it slides out, it can cause shooting pain in the nerves. And when you're taking a history, that's the thing you need to ask. What is there a shooting pain or multiple? If they say it's shooting, if it gets numb or aching, that's more likely muscular. And of course, the pain relief you give for shooting pains is very different. You have the pain level start with paracetamol and you have to, things like codeine or traMADol. Codeine. Interestingly works on, I think 25% of people with muscular pain, it does not work well with nerve pain. Generally to be strong from the weak opioids for muscular pain, you then go to the stronger ones like morphine sulfate. So you open like that. If it's a shooting pain, then you're more likely to use something like amitriptyline, which is more known for dealing with these pains. So generally speaking, those medications don't work particularly well. It's not a case where you get rid of the pain completely. Unfortunately, and people with chronic pain quite often, if there isn't a surgical solution, it's a case of hoping it fix itself quite often. So this is just another articulation of how the joints fit together. You can see these superior and inferior sticking together and how they end up having a leeway to, to rotate back and forth. That's what we're gonna cover in a second. Uh This is a part time matter which has a certain level of logic to it. So you can see here, here you go, which just logically isn't basically stops it hyperextending too far back. So even far back, you find it's hard to go all the way part of the reason that is anterior longitudinal ligament. Do you think about it if those bones are going to move, if those vertebra is going to be the greatest if you lean backwards? So actually, it's going to have the most constrain from material. And of course, it's the opposite for posterior on your ligament because it stops hyper flexion link to flat is more about maintaining part. That's just more generally speaking about keeping it together, about being partial one way or the other infraspinous is limiting reflection on the spine. That's a similar situation here. And of course, on the other side to the anterior. OK. So this illustrates something before if you have a herniation of the disc, this illustrates it, you have too much pressure. And let's say they're at a slight angle, the disc can start coming out and compressing the nerve which can cause the shooting pains we discuss, which can be very debilitating to people. And of course, that can have a whole n impact that if in the oscopy, it's important to give them space to not just talk about how it's affecting them, but also give them a few seconds because there's probably something else they want to say about how it's affecting their job and their life, a lot of the people in real life and in ay, there will be a sense that their care in room because if they work, apologies for that, my headset started to go off. I'm going to double check, just gonna double check. It's still working. Um Second apologies. Ok. There we go. Ok. So we're on number 30 we'll just get back to that. There we go. Ok. So remember when I told you to think about the way the spine bends, now, there are different ideas for this. There's lordosis and this is where you're bent too far back. So that's to put it crudely where you're sticking ros out too much, so, too much bending in here. And you've got kyphosis here where someone's effectively typically rather crudely slouching. There are these here. This is good posture which frankly you don't see anyone doing, they're swaying back here. So it, it's mainly if someone's sticking their ass up, that's lordosis. If someone's slouching, that's kyphosis. And you see that in the spine that's gonna be relevant. For the next example, I'm gonna give you. Now, some of you may know who this is and I don't mean them to come to that. I mean, the person who's playing, this is also the person Benedict Cumberbatch is playing. This is Richard the third and that's basically Richard the third, the Shakespearean in play. He had scoliosis. So this is along a different plane of the spine here and that's lateral. So of course, that can lead to some slouching. But it is also possible for people to adapt, but it also makes people naturally appear shorter. So that's something to be aware of. And if you ever, if you're a fan of Benedict Cumberbatch Richard third is probably some of his best stuff. Ok. And I'll touch very briefly. Cervical spondylosis, basically where you get a decrease in the size of the intravital for which are problems for damage to nerves. But also, of course, side of the person ba Forli in scoliosis, ok. This is straight again. So you can see the angle here and the degree of the angle tells you something about what you're going to do. So I've got them here, Cobb's angle. If it's 1510 degrees, then it's conservative may be manageable. But you keep looking at it because it may change over time. If it's between 20 to 40 degrees, it might be a case of giving them a back brace for a lot of the day. And of course, if it's 40 to 50 that's when you're thinking of surgery. And what you'd want to do is you'd effectively want to look at the spine and maybe fuse it. So that's what you want to think about. You look at Cobb's angle in auto side and management. It may be conservative. It may be with a brace which is more minimal, more conservative than the surgery. And then of course, when it gets to 40 plus, then you thinking of surgery and that is, that is a useful thing for exams, I'd say, ok, laminectomy. So as we were talking about the disc, the snotty disc, which basically acts as a cushion between the vertebrae, it can be pressed out and pressed against the nerves here. Of course, a way of relieving pressure is laminectomy, which of course, a layer on the spine which basically creates a bit more space. So the nerve isn't compressed. All right. Now, I told you this session was going to be a lot shorter. That is larger, cos it's easier. And I'd say the content isn't as hard as the previous stuff. So now what we're going to move on to is the questions. So what movement is this? And I'm talking about the ginger cat. OK. It's a bit of an odd example, but cats do it an awful lot. So I hope you remember it. So its lordosis cos it's sticking its behind up and that's how you can see from the angle. OK. So why would you resect the pituitary gland? And how would you do it? And I'll give you the better part of a minute for this. This might take you a bit of a second. Just think about the slides. We definitely covered it. OK. OK. So as you can see here, you can effectively reach through, basically put it very simply not quite but effectively almost through the nose. This is the sphenoid here. You can reach for it and basically take the pituitary out. And actually, because it produces so many hormones, you will need these to be replaced and finally calibrated and monitored for the rest of the person's life. So it's a very dramatic thing to do. But as surgeries go, it's not as radical to say, taking the whole creme off. So it's something that has huge surgical amplifications that may be necessary if it's too large, if it's compressing the optic nerve, if it's maybe producing too many hormones, which are causing havoc throughout the body. OK, we've covered that there. And I think this is the final or penultimate question. So I mentioned this being important. Imagine you've got an anatomy question. Let's say you're doing the college exam for surgery or you're doing the preclinical questions? Which one is? Which, and the key I'd go with is look at each of them and think how it makes you feel. Is it? Which one makes you think? Oh, that's quite a big one or which one makes you think? Oh, that's just ordinary. Which one makes you think? Oh, I better be careful with that. I could probably crack that with my fingers. OK. I imagine you've all got it. And there we go. So you can see cervical here. This is quite small, you think? Oh, I could probably break that here. You can see how you've got these sticking out more here and this one, the body looks far more chunky. OK. Thank you for your time. Thank you for listening. I appreciate this one's been a lot shorter. I'd say the content covered isn't as much. I would be curious in the feedback that you guys are going to receive. Do you prefer them to be shorter or do you prefer them to be longer? Because that is something that I'm chewing on myself. Is it better to maintain people's attention for less than 30 minutes or is it better to aspire for it to be more like an hour? Because I have read some research saying that people's interest. Once you teach people for an hour, you're lucky if people are paying attention for a third of the time. So that's something I'd like to hear in the feedback. What I will say is the feedback will be sent to you via email afterwards. So you don't need to worry about finding a link. It, it will be sent to you, maybe check your junk folder and we will be doing more teaching events. We will be tailoring it. It will take some time to tailor the resources and edit them, et cetera, et cetera. Make some questions. But I want to say thank you for your time and I wish you all the best with finals and all your medical careers. Ok. All right. Thank you for your time. Ok. That's fantastic. So thank you. Ok, there's some messages here. Ok. I apologize for the sounds. Sounds very bad I don't think. Ok. II I'm sorry about this. I'm sorry. Ok. All right. I've just seen the comments about the sound problems. I apo I apologize about that. I'm going to have a look into that. Ok. But thank you for your time and I hope to see you all next time. Ok.