Anatomy 19 (Neuro 2)

Question 1

What is raised intracranial pressure caused by?

Answer 1

Space occupying lesions (SOLs)
Idiopathic intracranial hypertension (IIH)

Question 2

What are signs and symptoms of raised intracranial pressure?

Answer 2

Headaches
Nausea
Visual disturbance
Later, altered consciousness
Papilledema
Increased blind-spot on visual field testing

Question 3

Where is the trochlear nerve located?

Answer 3

At the medial edge of the superior orbital fissure

Question 4

Where does the trochlear nerve terminate?

Answer 4

On the superior oblique muscle

Question 5

Where is the lateral rectus muscle located?

Answer 5

Runs along the length of the lateral walls of the orbit on a deeper plane to the lacrimal gland

Question 6

Where is the oculomotor nerve located?

Answer 6

Deep to levator palpebrae superioris

Question 7

Where does the superior oblique originate?

Answer 7

At the posterior of the orbit

Question 8

What does the superior oblique insert onto?

Answer 8

The posterior part of the eyeball

Question 9

Where is the medial rectus muscle located?

Answer 9

Runs along the length of the medial aspect of the orbit on a deeper plane than the superior oblique muscle

Question 10

What does the inferior oblique muscle insert onto?

Answer 10

The sclera behind the equator of the eyeball

Question 11

What is the lacrimal puncti?

Answer 11

Small medial holes in the upper and lower eyelids

Question 12

Which cranial nerves are involved in the parasympathetic outflow from the CNS?

Answer 12

Occulomotor
Facial
Glossopharyngeal
Vagus

Question 13

Which sacral spinal segments are involved in the parasympathetic outflow from the CNS?

Answer 13

Sacral spinal segments 2,3 and 4

Question 14

Where do the parasympathetic fibres in the oculomotor nerve originate from?

Answer 14

Edinger-Westphal nucleus in the mid brain

Question 15

Where do the parasympathetic fibres in the oculomotor nerve travel into?

Answer 15

Branch to the inferior oblique muscle

Question 16

What does the ciliary ganglion do?

Answer 16

Gives fibres that innervate the ciliary muscle (accommodation) and the sphincter pupillae

Question 17

What do the parasympathetic fibres in the facial nerve do?

Answer 17

Leave the nerve in the middle ear to synapse in a ganglion in the pterygopalatine fossa

Question 18

What do the parasympathetic fibres in the facial nerve supply?

Answer 18

Lacrimal gland

Question 19

What spinal segments is the sympathetic outflow from the CNS from?

Answer 19

Spinal segments thoracic 1 to lumbar 2 (T1 - L2)

Question 20

Where do the sympathetic trunks run from?

Answer 20

Base of the skull to the bottom of the sacrum

Question 21

Where do sympathetic fibres to the orbit arise from?

Answer 21

Segment T1

Question 22

Where do sympathetic fibres to the orbit pass through before entering the base of the skull?

Answer 22

Stellate ganglion

Question 23

What do the sympathetic fibres to the orbit supply?

Answer 23

The dilator pupillae muscle, and blood vessels

Question 24

What nerve innervates the medial rectus?

Answer 24

Oculomotor nerve (Cn3)

Question 25

What movement does the medial rectus cause?

Answer 25

Moves the eye inward, toward the nose (adduction)

Question 26

What nerve innervates the lateral rectus?

Answer 26

Abducens nerve (Cn6)

Question 27

What movement does the lateral rectus cause?

Answer 27

Moves the eye outward, away from the nose (abduction)

Question 28

What nerve innervates the superior rectus?

Answer 28

Oculomotor nerve (Cn3)

Question 29

What movement does the superior rectus cause primarily?

Answer 29

Primarily moves the eye upward (elevation).

Question 30

What movement does the superior rectus cause secondarily?

Answer 30

Secondarily rotates the top of the eye toward the nose (intorsion)

Question 31

What movement does the superior rectus cause tertiarily?

Answer 31

Tertiarily moves the eye inward (adduction)

Question 32

What nerve innervates the inferior rectus?

Answer 32

Oculomotor nerve (Cn3)

Question 33

What movement does the inferior rectus cause primarily?

Answer 33

Primarily moves the eye downward (depression)

Question 34

What movement does the inferior rectus cause secondarily?

Answer 34

Secondarily rotates the top of the eye away from the nose (extorsion)

Question 35

What movement does the inferior rectus cause tertiarily?

Answer 35

Tertiarily moves the eye inward (adduction)

Question 36

What nerve innervates the superior oblique?

Answer 36

Trochlear nerve (Cn4)

Question 37

What movement does the superior oblique cause primarily?

Answer 37

Primarily rotates the top of the eye toward the nose (intorsion)

Question 38

What movement does the superior oblique cause secondarily?

Answer 38

Secondarily moves the eye downward (depression)

Question 39

What movement does the superior oblique cause tertiarily?

Answer 39

Tertiarily moves the eye outward (abduction)

Question 40

What nerve innervates the inferior oblique?

Answer 40

Oculomotor nerve (Cn3)

Question 41

What movement does the inferior oblique cause primarily?

Answer 41

Primarily rotates the top of the eye away from the nose (extorsion)

Question 42

What movement does the inferior oblique cause secondarily?

Answer 42

Secondarily moves the eye upward (elevation)

Question 43

What movement does the inferior oblique cause tertiarily?

Answer 43

Tertiarily moves the eye outward (abduction)

Question 44

What is the mnemonic used to explain the actions of the superior and inferior muscles of the eye?

Answer 44

RAD SIN Rectus ADducts (therefore oblique abducts) Superior INtorts (inferior extorts)

Question 45

What is the mnemonic used to explain the innervation of the extraocular muscle?

Answer 45

LR6 SO4 3 Lateral rectus (LR) innervated by the abducens nerve (Cn6) Superior oblique (SO) innervated by trochlear nerve (Cn6) All other extraocular muscles are innervated by the oculomotor nerve (Cn3)

Question 46

Where is the retina located?

Answer 46

Posterior of the eyeball

Question 47

Where does the optic disc lie?

Answer 47

Lies level with the point of attachment of the optic nerve

Question 48

Where are the retinal arteries and veins found?

Answer 48

Radiating from the optic disc

Question 49

Where is the macula lutea located?

Answer 49

Lateral to the optic disc

Question 50

Where are the lens located?

Answer 50

In the anterior part of the eyeball

Question 51

Where are the ciliary processes found?

Answer 51

Radiate from the lens

Question 52

Where is the iris located?

Answer 52

Within the anterior chamber, visible after detachment of the lens

Question 53

What is the jugular foramen syndrome?

Answer 53

Compression of multiple lower cranial nerves (Glossopharyngeal (Cn9), Vagus (Cn10) and Accessory (Cn11)

Question 54

What are the signs and symptoms of jugular foramen syndrome?

Answer 54

Dysphonia Loss of gag reflex Unilateral wasting of sternocleidomastoid and trapezius muscles

Question 55

What is the foramen magnum syndrome?

Answer 55

Compression of the spinal cord, lower brain stem or part of the cerebellum

Question 56

What are signs and symptoms of foramen magnum syndrome?

Answer 56

Pain in head, neck, limbs, trunk made worse by straining Cerebellar symptoms e.g., vertigo, gait disturbance Decerebrate posture Cardiorespiratory failure Pyramidal signs Death

Question 57

What is arnold-chiari malformation?

Answer 57

Congenital malformation Displacement of the cerebellar tonsils down through the foramen magnum Sometimes blocks CSF flow causing hydrocephalus

Question 58

What are signs and symptoms of arnold-chiari malformation?

Answer 58

Headaches Fatigue Muscle weakness in the head and face Difficulty swallowing Dizziness Nausea Impaired coordination Patients may also develop syringomyelia

Question 59

Where is the petrous temporal bone located?

Answer 59

In the floor of the middle cranial fossa

Question 60

What is the greater petrosal nerve?

Answer 60

Parasympathetic branch of the facial nerve (Cn7), emerges from the petrous temporal bone and passes anteromedially

Question 61

Where is the tegmen tympani located?

Answer 61

Lies lateral and posterior to the greater petrosal nerve

Question 62

What are the 3 ear ossicles in the middle ear?

Answer 62

Stapes Malleus Incus

Question 63

What ear ossicle is attached to the tympanic membrane?

Answer 63

Malleus

Question 64

What ear ossicle does the tympanic membrane articulate with?

Answer 64

Incus

Question 65

What is the chorda tympani nerve?

Answer 65

Branch of the facial nerve (Cn7), crossing the tympanic membrane

Question 66

What is the function of the internal acoustic meatus?

Answer 66

Transmits the facial (Cn7) and vestibulocochlear (Cn8) nerves

Question 67

What is acoustic neuroma?

Answer 67

A benign tumour of myelin sheath of the vestibulocochlear nerve (Cn8)

Question 68

What are the signs and symptoms of acoustic neuroma?

Answer 68

Unilateral deafness Dizziness Fullness in the ear and tinnitus

Question 69

If undetected what can an acoustic neuroma progress to?

Answer 69

It progresses to include ataxia and paralysis of the facial (Cn7) and trigeminal (Cn5) cranial nerves. This is termed cerebellopontine angle syndrome