Anatomy clinical Flashcards
Cutting of the facial nerve would result in loss of muscles including. What gland would not be affected?
Muscles of facial expression:
temporal, zygomatic, buccal, marginal mandibular, cervical
Posterior belly of digastric muscle
Stylohyoid muscle
Stapedius muscle
Also orbicularis oculi and lacrimal gland
Parotid gland wouldn’t be affected
Craniosynostosis
premature closer of the sagittal, lambdoid, and coronal (pinhead/oxycephaly) sutures leading to deformities and impaired brain growth
Le fort fractures:
I
II
III
I: separated maxillary teeth from the rest of the face (John Waters)
II: separated upper maxillary teeth and nose from the rest of the face
(Hannibal Lecter)
III: fracture through the upper portion of the orbits separating the face from rest of the skull (Riff Raff sunglasses)
Artery that could cause epidural hem
Middle meningeal artery.
blood between dura and bone
Subdural hem
deep to dura but outside the arachnoid layer
Subarachnoid hem could present with?
Severe headache
Stiff neck
LOC
Paralytic strokes from intracerebral hem
blood in CSF
What could cause a herniation of the brain through the tentorial incisure?
pathological increased intracranial presure
arachnoid villi hypertrophy could lead to
arachnoid granulations
Whiplash affects what ligament in front of the vertebral bodies and the anterior neck muscles can be torn/stretched
Anterior longitudinal ligament
Whiplash/hyperextension of the neck could result in breakage of the posterior arch of the axis (C2) which is referred to as
Hangman’s Fracture
Orbital blow out involves which bone
Maxillary bone
Papilla edema
Excessive CSF from increased intracranial pressure because optic nerve is covered in dura therefore brain pressures are reflected in the central artery of the retina before it enters the fundus of the eye.
Optic disc can swell and blood (venous) can pool in the veins of the surface of the retina
Internal sty (hordeolum)
meibomian gland infection (staph aur)
External sty
hair follicle cyst
Periorbital puffiness
normal fat that migrates into lower lid
Chalazion is a lump as a result of chronic blockage of what glands?
Tarsal glands
Allergic conjunctivitis vs bacterial
Allergic is itchy bacterial has marked grittiness and irritation, stringy and opaque mucopurulent discharge
prophylactic silver nitrate drops in newborns
If you lose facial nerve innervation to the orbicularis oculi for some reason what wouldn’t you be able to do and what would be at risk?
The OO Closes the eyelid so the corneal would be at risk of dryin out
a patient has just been punched and cant look up above the horizon due to trapping of the inferior rectus muscle. This could be what tyoe of fracture
Orbital blow out, fracture to the maxillary bone and protrusion of orbital contents into the max sinus
Exophthalmos seen in
Graves disease
Exophthalmos could be due to increased size of ____ muscles which could be due to____
Extraocular muscles.
to autoimmune reaction to TSH R Ag expressed in retro-orbital tissues including extraocular muscles
What is the more common form of strabismus?
Esotropia. Both eyes turn inward.
One eye deviating outwards is known as
Exotropia strabismus
Oculomotor CNIII lesion can lead to 4 things. What are they?
Lateral strabismus from unopposed Lateral Rectus and seperior Oblique
Ptosis from levator palpebrae superioris paralysis
Mydriasis (dilation of the pupil)
Loss of the Accomodation of the lens
What could cause sudden CN III palsy?
Aneurysm within the posterior communicating artery
cavernous sinus thrombosis
CN IV (Trochlear lesion) the patient will tilt head slighly to what side? And what muscle is affected?
Superior oblique muscle is affected and the patient will tilt head to unaffected side to help accommodate
Abducens nerve palsy is a lesion that paralyzes what muscle which causes eye to turn inwards? Is this common?
Lateral rectus affected, increased intracranial pressure.
This is most common esp w/ DM pts.
Glaucoma is excessive pressure of the eye and is due to the blockage of fluid draining from the eye at _______
Canal of Schlemm
2 different classes of glaucoma?
Open-Angle
Closed-Angle (iris bulges forward)
Why is it so easy to transplant corneaS?
It is avascular so WBCs that would reject the transplant are unlikely to get to that area
The ciliary muscle contracts and does what?
Rounds up the lens
old age: Presbyopia caused by lens getting less elastic and less able to round up
The corneal reflex tests the sensory fibers of the
Ophthalmic (V1) branch of the Trigeminal Nerve (V)
The corneal reflex tests the motor fibers of the
Facial Nerve (CN VII)
Acoustic Neuromas grows on CN
CN VIII within the interal acoustic meatus
This can block the CN VII which runs in the same area
Unilateral hearing loss, depression of ipsilateral direct closing of the eyelid
Acoustic Neuroma growing on Vestibulocochlear CN VIII
Unilateral hearing loss, depression of ipsilateral direct closing of the eyelid
Acoustic Neuroma growing on Vestibulocochlear CN VIII
Jaw Dislocation from excess contraction of what muscle causing the head of the mandible to slide too far over what tubercle?
Lateral Pterygoid muscle
head of the mandible slides over the articular tubercle
Inferior Alveolar Nerve block. Why would the chin and lower lip feel numb?
anesthestize the teeth around the opening of the mandibular foramen to target the inf alveolar nerve.
The Mental nerve is a continuation of the inf alveolar nerve
Broken jaw
often at the neck. secured with arch bar
Gleek happens when you yawn because the ________ muscle contracts and squeezes part of the submandibular gland against the intrinsic superior tongue muscles
mylohyoid
Why babies shouldn’t be given a bottle while they lay flat within cribs
something about negative pressure and increasing likelihood fluids are pulled into the auditory tube
Mandibular tor are bony protrusions from the medial wall of the mandible. Are these worrisome?
They are benign
Sleep apnea from
dropping of the tongue
enlarge tonsils
soft palate
blocking normal airflow
Deviation of the Uvula to the unaffected side could indicate lesions of the
CN X (vagus)
Febrile patient with inflamed structure in the posterior pharynx most often caused by what bacteria?
Group A Strep most common cause of uvulitis
Bifid Uvula associated with what syndrome that is also associated with aneurysm of the aorta as a child
Loeys-Dietz syndrome
Bifid Uvula associated with what syndrome that is also associated with aneurysm of the aorta as a child
Loeys-Dietz syndrome
Evidence of CHF
JVD from engorged external jugular vein
Placing a central venous line most often placed in what vein to because of its direct path to the SVC
The Internal Jugular Vein on the right side
Needed for administration of caustic drugs to preserve endothelial lining
Typical sites of ectopic thyroid tissue
anywhere along the course of the thyroglossal duct, sometimes in the neck and mediastinum
Erb’s point located midway up the sternoclediomastoid is important for anesthesia of what cutaneous nerves
Lesser occipital
Greater Auricular
Transverse cervical
Supraclavicular Nerves
Carotid Sinus Massage increases parasympathetic outflow by way of what cranial nerve that reflexively causes CN ___ to slow the heart?
CN IX simulates high effective pressure—> CN X
Thryoglossal duct are typically _______ below the _____ bone
Midline masses below the hyoid bone
common in children 2-10
What type of thyroid arteries are responsible for why ER tracheotomies are not frequently done below the isthmus of the thyroid gland?
Thryoid Ima arteries
Bilateral paralysis of the posterior cricoarytenoid mucsles may require ______
surgical cricothyrotomy, cricotomy, tracheostomy, or intubation to allow air in the lungs
vocal cords close too tightly
Bilateral paralysis of the posterior cricoarytenoid mucsles may require ______
surgical cricothyrotomy, cricotomy, tracheostomy, or intubation to allow air in the lungs
vocal cords close too tightly
Why are the vocal cords at increased risk for cancer development?
transition of epithelial type
Abnormal breathing sounds, difficulty swallowing could possibly be
Epiglottitis
Laryngitis can be caused by
Acid reflux or viral infection of the respiratory epithelium
Edema within the submucosa can typically cause increased mass of the vocal cord limiting ability to vibrate
Unilateral paralysis from loss of the superior laryngeal nerve only effects the
cricothyroid muscle
Patients will have a weak, rough, easily fatiguing voice
loss of ALL innervation to laryngeal muscles will cause what that will require endotracheal tube?
Passive closure of the glottis
Tracheostomy vs Tracheotomy
Tracheostomy: emergency airway created below cricoid cartilage to bypass larynx and upper airway
Tracheotomy: incising the trachea, usually temporary; upper (right below cricoid cartilage) and lower
Innervatio for
Ka
La
Ma
Ka: soft palate elevation (CN X Vagus)
La: tongue fx (CNXII Hypoglossal)
Ma: opening mouth with orbicularis oris (CN VII Facial)
Food stuck at what junction can cause reflex closure of the epiglottis?
Junction of the pharynx with esophagus just below the laryngeal pharynx
Food stuck at what junction can cause reflex closure of the epiglottis?
Junction of the pharynx with esophagus just below the laryngeal pharynx
Heimlich increases intrabdominal pressure to aid in expelling stuck food.
Food stuck at what junction can cause reflex closure of the epiglottis?
Junction of the pharynx with esophagus just below the laryngeal pharynx
Heimlich increases intrabdominal pressure to aid in expelling stuck food.
nosebleed as a result of what arteries breaking?
Anterior ethmoidal artery, sphenopalatine artery, greater palatine artery, superior labial artery
Kiesselbach’s area
formation of superficial anastomotic network no nasal septum posterior to the vestibular area
Deviated nasal septum
septum isn’t in the center of the nose
Anosmia can be a result of the olfactory nerves shearing off as they pass through the
cribriform plate
Cribriform plate fracture would result in what draining into the nose
CSF
Sinusitis usually refers to bacterial infection of the sinuses, secondary to viral infections or allergic rhinitis. Frontaland maxillary sinusitis will produc pain upon tapping on the bone superficial to the sinus. Maxiallary sinusitis can have referred pain to the
maxillary teeth
Cribriform plate fracture would result in what draining into the nose
CSF
which arteries can be manually compressed to stop a nosebleed?
Greater palatine artery or the superior labial artery
what do you pinch to stop a nosebleed?
Upper lip and hard palate behind the incisors
Blocks
- septal branch of the superior labial artery
- greater palatine artery
What fossa holds the parasympathetic ganglia that stimulates the nose and paranasal sinuses and lacrimal gland?
Pterygopalatine fossa
Virchow’s node is a firm supraclavicular lymph node that is found especially on the ______ side. It is critical for detecting posibility of metastatic neoplasm
Left
Virchow’s node is a firm supraclavicular lymph node that is found especially on the ______ side. It is critical for detecting posibility of metastatic neoplasm
Left
ddx for Virchow’s node?
lymphoma, non-hodgkins, breast cancer, lung esophageal cancer.
