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Neuro > anat/physio/patho 2 > Flashcards

anat/physio/patho 2 Flashcards

1
Q

Name the 3 middle ear bones

A

Malleus, incus, stapes

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2
Q

What test should I conduct if I suspect that patient has a CN 8 palsy affecting their balance?

A

Romberg’s test - test for proprioception & balance

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3
Q

** How do I identify vagus nerve palsy?

A

Uvula deviation AWAY from affected side.

Vagus nerve innervates the muscles of the soft palate, in particular, the levator palatini elevates the soft palate.

When functioning normally, both sides of the levator palatini contract to lift the soft palate evenly. This gives rise to an equal level uvula.

Lesion of vagus nerve -> paralysis of the levator veli palatini muscle on one side -> failure of soft palate to elevate

Unopposed pull of soft palate towards the unaffected side -> deviation of the uvula AWAY from affected side

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4
Q

Differentiate between the 2 palsies causing uvula and tongue deviation

A

Uvula deviation:
- AWAY from affected side
- vagus nerve palsy

Tongue deviation:
- TOWARDS affected side
- hypoglossal nerve palsy

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5
Q

Name the 2 nuclei in the thalamus where visual and auditory information synapses

A

Visual -> lateral geniculate nucleus
Auditory -> medial geniculate nucleus

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6
Q

What branch of the ophthalmic nerve sits on top of the levator palpebrae superioris?

A

Frontal nerve

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7
Q

Which branch of trigeminal is the only one to have a motor component?

A

Mandibular, V3

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8
Q

All the muscles of the tongue is supplied by the _ nerve EXCEPT the muscle _ which is supplied by the _ nerve

A

Hypoglossal (CN 12), palatoglossus, vagus (CN 10)

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9
Q

All the muscles of the soft palate is supplied by the _ nerve EXCEPT the muscle _ which is supplied by the _ nerve

A

Vagus (CN 10), tensor veli palatini, mandibular (CN V3)

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10
Q

All the muscles of the pharynx is supplied by the _ nerve EXCEPT the muscle _ which is supplied by the _ nerve

A

Vagus (CN 10), stylopharyngeus, glossopharyngeal (CN 9)

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11
Q

In a thyroidectomy, what are the 3 vessels I am worried about affecting?

A
  1. Superior thyroid artery <-> external laryngeal nerve -> cricothyroid muscle -> high pitched sounds
  2. Inferior thyroid artery <-> recurrent laryngeal nerve -> posterior cricoarytenoid muscle -> abducts the vocal folds
  3. Cervical sympathetic trunk -> loss of sympathetic function to head and neck region -> ptosis, miosis, anhidrosis
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12
Q

What are the 2 key branches of the cervical plexus?

A
  1. Phrenic nerve
  2. Anas cervicalis -> innervation of the strap muscles (omohyoid, sternohyoid and sternothyroid) EXCEPT thyrohyoid (CN 12)
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13
Q

Which 2 veins combine to form the external jugular vein? How does the EJV relate to the SCM and describe its trajectory to becoming the brachiocephalic vein.

A

Posterior auricular vein + retromandibular vein -> external jugular vein

EJV crosses the SCM anteriorly -> subclavian vein

Subclavian (right and left) + internal jugular vein (right and left) -> (right and left) brachiocephalic vein -> superior vena cava

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14
Q

Name the 5 broad groups of muscles in the face & scalp

A
  1. Muscles of mastication (CN V3)
  2. Muscles of facial expression (CN VII)
  3. Muscles of the cheek - buccinator
  4. Orbicularis oris (mouth) & oculi (eye)
  5. Muscles of the scalp - occipital & occipitofrontal (forehead)
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15
Q

Name the deep and superficial muscles of the neck.

A

Deep: strap muscles (omohyoid - superior & inferior belly, sternohyoid, thyrohyoid, sternothyroid)

Superficial: platysma

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16
Q

Name the infra and supra hyoid muscles

A

Infra: strap muscles - omohyoid - superior & inferior belly, sternohyoid, thyrohyoid, sternothyroid

Supra: geniohyoid, mylohyoid, digastric (anterior & posterior), stylohyoid

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17
Q

State which nerves innervate the anterior and posterior belly of digastric, as well as the superior and inferior belly of omohyoid

A

Anterior belly of digastric: nerve to mylohyoid
Posterior belly of digastric: CN VII

Superior & inferior belly of omohyoid: anas cervicalis (C1-C4)

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18
Q

Between which 2 muscles does the brachial plexus lie within?

A

Anterior and middle scalene muscles of the neck

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19
Q

Name the 2 types of orbicularis oculi muscle

A
  1. Palpebral - close eye gently
  2. Orbital - close eye tightly
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20
Q

Name the layers of the scalp and name which layer is the most vascular

A

Skin
Connective tissue (dense)
Aponeurosis
Loose connective tissue (**Most vascular layer)
Pericranium

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21
Q

Describe the sensory innervation to the face

A

Anterior to vertex ear chin line: Trigeminal nerve
Posterior: branches of superficial cervical plexus

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22
Q

Name the 3 sutures of the skull and roughly where they are

A

Anterior left to right: coronal
Posterior (occipital region) left to right: lambdoid
Anterior to posterior: sagittal

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23
Q

The pterion is the junction between which 4 boenes?

A

Frontal
Parietal
Sphenoid (greater wing)
Temporal

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24
Q

What is the needle looking bone of the skull near the ear canal and what is the other closely related bony part where many muscles attach to?

A

Needle: styloid process
Point of muscular attachment: mastoid process

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25
Q

Name the 3 dural infoldings and where is each located

A

Falx cerebri - separate right and left cerebral hemispheres
Tentorium cerebelli - separate occipital lobe & cerebellum
Falx cerebelli - separate right and left cerebellar hemispheres

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26
Q

**Describe CSF drainage

A
  1. Produced by choroid plexus in lateral and 3rd ventricle
  2. 3rd to 4th ventricle via cerebral aqueduct
  3. 4th ventricle has openings which allows CSF to enter subarachnoid space

For recycling,
4. Arachnoid granulations absorb the CSF (more is found in transverse sinus and superior sagittal sinus)
5. Arachnoid granulations drain to dural venous sinuses

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27
Q

Name the 6+1+2 (parasym) muscle of the eye

A

Extraocular muscle (6):
- Superior, inferior, lateral, medial rectus
- Superior and inferior oblique

Levator palpebrae superioris

Parasym (2):
- Sphincter pupillae
- Ciliary muscle

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28
Q

What opening is the same level as the inferior concha in the nasal cavity?

A

Eustachian (auditory) tube

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29
Q

What opening is the same level as the superior concha in the nasal cavity?

A

Spheno-ethmodial recess

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30
Q

Name the 4 paranasal sinuses and which is the largest

A
  1. Frontal
  2. Ethmoidal
  3. Sphenoidal
  4. *Maxillary (LARGEST & also the most commonly infected)
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31
Q

What are the 3 ligaments that support the TMJ joint?

A
  1. Temporomandibular
  2. Stylo mandibular
  3. Spheno mandibular
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32
Q

The _ palatine nerve/artery innervates the _ palate while the _ palatine nerve/artery innervates the _ palate

A

GREATER -> HARD
LESSER -> SOFT

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33
Q

What is the main artery of the tongue and oral cavity?

A

Lingual artery which is the 3rd branch of the ECA

34
Q

What muscles am I using to close my mouth (elevation of mandible)?

A

Temporalis, masseter and medial pterygoid

35
Q

What muscles am I using to open my mouth (depression of mandible)?

A

Lateral pterygoid and supra and infrahyoid muscles

36
Q

What muscles am I using to protude my mandible?

A

Lateral and medial pterygoid, masseter

37
Q

What muscles am I using to retract my mandible?

A

Temporal and masseter

38
Q

Describe the histology of salivary glands

A

Sublingual - purely mucinous (highest concentration of clear cells)
Submandibular - mix of mucinous and serous
Parotid - purely serous (looks the most compact)

39
Q

What 2 nerves is the submandibular gland closely related to?

A

Lingual nerve and CN 12

40
Q

What vessels is closely related to parotid gland?

A

**FACIAL NERVE
Posterior auricular artery

41
Q

Name the muscles of the pharynx (internal and external), state the special exception of innervation

A

Internal (elevate and widen pharynx during swallowing and speaking) – *stylopharyngeus, salpingopharyngeus, palatopharyngesus

*All muscles of pharynx is innervated by pharyngeal branches of CNX except stylopharyngeus which is innervated by CN IX

External (constrict walls of pharynx during swallowing) – superior, middle and inferior constrictor

42
Q

What are the 2 muscles in the ear and their function

A

Tensor tympani and stapedius

When sound is too loud, the 2 muscles contract reflexively to pull the ossicles away from the external ear. This reduces the amount of sound transmitted and hence protects the ossicles.

43
Q

What is the main artery supplying the inner ear?

A

Labyrinthine artery (branch of basilar artery <- vertebral arteries)

44
Q

Briefly describe how sound is perceived (pathway)

A
  1. Vibration of fluid in cochlear passed from external -> middle -> inner ear
  2. Displacement of stereocilia of hair cells in the cochlea
  3. Depolarisation and generation of action potential -> generate an electrical impulse
  4. Cochlear branch of CN VII transmits this impulse to medial geniculate nucleus in thalamus then to auditory cortex
45
Q

What kind of epithelium normally lines the larynx and vocal fold?

A

The vocal fold is the only part of the larynx that is lined by stratified squamous epithelium while the rest of it is by respiratory epithelium (pseudostratified ciliated columnar cells with goblet cells).

46
Q

Which muscle of the larynx is responsible for high pitched sounds and how?

A

Cricothyroid muscle - tenses the vocal folds

47
Q

Which muscle in the larynx ABDUCTS the vocal folds?

A

Posterior cricoarytenoid muscle

48
Q

Which 2 cartilages articulate to form the adam’s apple?

A

Left and right thyroid cartilage

49
Q

Describe the UMN and LMN of the corticospinal tract

A

UMN: Axons descend from motor cortex (THROUGH THE INTERAL CAPSULE) to ventral horn of spinal cord

LMN: Ventral horn of spinal cord -> effector muscle

50
Q

Describe the UMN and LMN of the corticobulbar tract

A

UMN: Axon descends from motor cortex to cranial nerve motor nuclei in brainstem

LMN: Cranial nerve motor nuclei in brainstem -> effector muscle in the head and neck region

51
Q

Do all corticospinal nerve fibres decussate? and at where?

A

No, about 10% do not decussate. If they do decussate, it is at the level of the medulla.

52
Q

Name the type of influence in the corticobulbar tract and name the exception to this rule

A

Bilateral influence (ie. UMN signals come from both sides of the brain).

Except for the lower half of the face of CN VII which receives contralateral LMN signals.

53
Q

Name the motor nucleus for CN V

A

Trigeminal motor nucleus

54
Q

Name the motor nucleus for CN VII

A

Facial motor nucleus

55
Q

Name the motor nucleus for CN IX & cranial part of CN X

A

Nucleus ambiguus

56
Q

Name the motor nucleus for spinal part of CN X

A

Spinal accessory nucleus

57
Q

Name the motor nucleus for CN XII

A

Hypoglossal nucleus

58
Q

What is the function of the frontal eye field? What happens if there is a lesion to it?

A

FEF controls eye movements to focus on a central object. Each FEF causes conjugate eye movement towards the opposite side.

If the right FEF is damaged, it will not be able to oppose the action of the left FEF which thus pushes both eyes towards the right.

Lesion results in conjugate deviation of the eyes towards the side of lesion.

59
Q

What do the limbic system control?

A

Components include hippocampus, amygdala

ELMO - emotion, learning, (long term) memory and olfaction

60
Q

Which part of the brain is linked to aggression?

A

Amygdala

61
Q

**Where does the ACA supply (ie what brain part and hence what function)

A

Medial surface of frontal & parietal lobes

Motor & sensory cortices of lower limbs

62
Q

**Where does the MCA supply (ie what brain part and hence what function)

A

Lateral surface of frontal, parietal & temporal lobes

Motor, sensory cortices of upper limb, auditory cortices

63
Q

**Where does the PCA supply (ie what brain part and hence what function)

A

Inferior surface of temporal lobe and occipital lobe

Visual cortex

64
Q

What is the watershed area?

A

An area of lack of collateral circulation, thus patients with severe episodes of hypotension = poor perfusion to the brain = are at risk of infarction occuring at these watershed regions.

65
Q

**Name the branches of the basilar artery

A
  1. Posterior cerebral artery - temporal and occipital lobe
  2. Superior cerebellar arteries - cerebellum
  3. Pontine arteries - pons
  4. Labyrinthine arteries - inner ear
  5. Anterior inferior cerebellar arteries - cerebellum
66
Q

**What would I expect to see in a patient with ACA occlusion?

A

Contralateral hemiparesis and hemisensory loss involving mainly the leg and foot (ie. face and upper limb spared/not as affected).

Damage to frontal lobe - apathy, personality changes and astereognosis (inability to identify objects correctly)

67
Q

**What would I expect to see in a patient with MCA occlusion?

A

Contralateral hemiparesis and hemisensory loss in the face and arm but spares the leg.

Gaze deviation to ipsilateral side (due to frontal eye field)

Expressive dysphasia (Broca’s area affected)

Hemineglect (due to inferior parietal lobe damage)

Dressing apraxia

68
Q

Which vessel is the most commonly affected in ischemic stroke?

A

MCA

69
Q

**What would I expect to see in a patient with PCA occlusion?

A

Contralateral homonymous hemianopia with macular sparing (due to primary visual cortex damage)

Macular sparing is due to dual supply by MCA and PCA to the portion of the visual cortex representing the macula.

Dominant hemisphere: patient may exhibit difficulty in naming objects and inability to read.

70
Q

What would I expect to see in a patient if there is an occlusion in their superior cerebellar arteries?

A

Vertigo, nausea, vomiting, cerebellar signs eg. finger nose dysmetria, ipsilateral ataxia, dysdiadochokinesia

71
Q

What would I expect to see in a patient if there is an occlusion in their pontine arteries?

A

Pons affected.

Cranial nerve impairment
- CN 3 - diplopia, ptosis and impaired eye movements
- CN 7 - ipsilateral facial weakness
- CN 10 - dysphagia and hoarseness
- CN 12 - tongue deviation

Unilateral or bilateral hemiparesis (as most of the motor nerve fibres pass through the brainstem to reach the cerebral cortex)

72
Q

Name the 3 components of the blood brain barrier and what is its function

A

Components:
1. Endothelium (capillary walls) with tight junctions
2. Basement membrane
3. **Astrocytes

Function:
1. Provides neurons with a relatively constant biochemical and metabolic environment
2. Protects against toxins and infective agents.

73
Q

What is the name of the nucleus involved in pupillary light reflex?

A

Edinger Westphal

74
Q

Describe the pupillary light reflex

A

Bright light -> photoreceptors on retina -> pretectal nucleus in midbrain

On ipsilateral side:
Pretectal nucleus -> Edinger Westphal nucleus -> ciliary ganglion -> constriction of sphincter pupillae

On contralateral side:
Pretectal nucleus -> **posterior commissure -> Edinger Westphal nucleus -> ciliary ganglion -> constriction of sphincter pupillae

75
Q

What is the name of the nucleus involved in accommodation for near objects?

A

Superior colliculus in midbrain

76
Q

Describe the accommodation for near objects

A

Primary -> secondary visual cortex -> superior colliculus in midbrain

CN 3,4,6 nuclei -> extra ocular muscles -> eyes converge

Edinger westphal nucleus -> ciliary ganglion -> constriction of sphincter pupillae & ciliary muscle relax -> lens thickens

77
Q

What nerve is the patellar reflex testing for? Nerve root?

A

Femoral
L2-4

78
Q

What nerve is the Achilles tendon reflex testing for? Nerve root?

A

Tibial (branch of sciatic)
S1

79
Q

**Name some signs of cerebellar dysfunction

A
  1. Nystagmus
  2. Finger nose dysmetria
  3. Dysdiadochokinesis
  4. Heel shin test positive - unable to carry out the movements
  5. Ataxic gait
  6. Inability to maintain posture
80
Q

Which lobe in the cerebellum is responsible for motor?

A

Spinocerebellum

81
Q

Which lobe in the cerebellum is responsible for balance, posture, coordination?

A

Vestibulocerebellum

82
Q

Which lobe in the cerebellum is responsible for speech?

A

Cerebrocerebellum

Neuro (7 decks)

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