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Q1 > Anatomy exam 2 > Flashcards

Anatomy exam 2 Flashcards

1
Q

list the muscles of facial expression and their actions

A

occipitofrontalis=elevates eyebrows
orbicularis oculi=palpebral part for blinking and sleeping and orbital part for squinting
orbicularis oris=closes and protrudes lips for speech and mastication
buccinator=sucking and whistling and mastication
zygomaticus major=elevates corners of mouth when smiling
zygomaticus minor=elevates corners of mouth when smiling
platysma=depresses lower lip and angle of mouth when pouting
depressor angularis oris=moves corners of mouth downwards
nasalis= controls shape of nostrils

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2
Q

what nerve innervates the facial muscles?

A

facial nerve

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3
Q

path of facial nerve through cranium

A

in through internal acoustic meatus then to facial canal then out through stylomastoid foramen

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4
Q

what are the motor facial nerve branches

A

ten zebras bit my cheek
temporal
zygomatic
buccal branches
mandibular
cervical
posterior auricular

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5
Q

what part of trigeminal nerve runs through the supraorbital notch?

A

V1-ophthalmic

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6
Q

what part of the trigeminal nerve runs through the infraorbital foramen?

A

V2-maxillary

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7
Q

what part of the trigeminal nerve runs through the mental foramen?

A

V3-mandibular

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8
Q

what are the branches of V1

A

supraorbital
supratrochlear
lacrimal
infratrochlear
external nasal

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9
Q

what are the branches of V2

A

zygomatic temporal
infraorbital
zygomatic facial

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10
Q

what are the branches of V3

A

auriculotemporal
mental
buccal
lingual*
*inferioralveolar

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11
Q

what infection typically affects V1 (ophthalmic portion of trigeminal nerve)

A

herpes zoster (shingles around eye)

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12
Q

what nerve does trigeminal neuralgia affect?

A

V2
sudden and intense pain
tic douloureux

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13
Q

describe bells palsy

A

muscles of facial expression paralyzed, drooping eyelid and mouth, corneal ulceration, weakend lips

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14
Q

arteries of the face

A

facial artery
*branches from external carotid
*superior and inferior labial arteries
*terminates as angular artery
superficial temporal artery
*terminal branch of external carotid
internal carotid artery
*supraorbital branch
*supratrochlear branch
external carotid BRANCHES
*mental arteries

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15
Q

arteritic anterior ischemic optic neuropathy

A

also known as giant cell arteritis, is caused by an ischemia of the posterior ciliary arteries and/or the ophthalmic artery. *associated with superficial temporal artery

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16
Q

veins of the face

A

facial vein
*continuation of ANGULAR VEIN
*receives blood from SUPERIOR AND INFERIOR LABIAL VEINS
*joins COMMUNICATING BRANCH of RETROMANDIBULAR VEIN and drains into the INTERNAL JUGULAR VEIN

superficial temporal vein
*joins MAXILLARY vein to form RETROMANDIBULAR vein
*RETROMANDIBULAR joins POSTERIOR AURICULAR VEIN to form the EXTERNAL JUGULAR VEIN

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17
Q

what passes through the parotid gland?

A

the facial nerve, retromandibular vein and external carotid artery

*remember postauricular FN branch doesnt go thru

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18
Q

what emerges anterior out of the parotid galnd?

A

-5 terminal branches of facial nerve
-parotid duct
-transverse facial artery

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19
Q

what emerges SUPERIOR of parotid gland?

A

-V3 auriculotemperol nerve
-superficial temporal vessels

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20
Q

discuss parasympathetic innervation of parotid gland (preganglionic cell bodies, preganglionic fibers, postganglionic cell bodies, post ganglionic fibers)

A

preganglionic cb=brain
preganglionic fibers=lesser petrosal nerve, branch of CN 9 (glossopharyngeal)
postganglionic cb=otic ganglion
postganglionic fibers=track along auriculotemporal nerve (branch of V3)

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21
Q

SCALP

A

s-skin
c-connective tissue
a-aponeurosis
l-loose connective tissue
p-pericranium

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22
Q

what is the considered the danger area of the scalp?

A

the loose connective tissue layer because it is continuous with the root of the nose and fluid can spread in these areas

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23
Q

why do scalp wounds bleed heavily and gape widely?

A

blead heavily because-anastomosis in layer 2

gape widely because-pull of 2 bellies of occipitofrontalis

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24
Q

nerves of the scalp

A

spinal nerves
-greater auricular nerve (c2, c3) *anterior rami
-lesser occipital nerve (c2, c3) *anterior rami
-third occipital nerve (c3) *posterior rami
-greater occipital nerve (c2) *posterior rami

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25
Q

what connects sinuses to scalp and is a route for infections?

A

emissary veins

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26
Q

mumps

A

swelling of the parotid gland, parotiditis, aggravated by chewing

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27
Q

parotidectomy

A

partial or complete removal of the parotid gland, 80% of salivary gland tumors are in parotid

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28
Q

what type of joint is the temperomandibular joint?

A

TMJ is a synovial, condylar and hinge-type joint. The joint involves fibrocartilaginous surfaces and an articular disc which divides the joint into two cavities.

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29
Q

what are the articular surfaces that interact in the TMJ joint?

A

head of mandible, articular tubercle of temporal bone, mandibular fossa

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30
Q

what are the movements fo the TMJ joint?

A

elevation, depression, protrusion, retrusion, lateral mvmts

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31
Q

what are the muscles of mastication?

A

masseter, temporalis, lateral and medial pterygoid

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32
Q

origin, insertion and action of temporalis muscle

A

origin- neurocranial fossa
insertion- coronoid process of mandible
action- elevates and retrudes mandible

*CN V3= motor innervation

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33
Q

origin insertion and action masseter muscle

A

origin- zygomatic arch
insertion- ramus of mandible
action- elevates mandible and closes mouth

*CN V3= motor innervation

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34
Q

origin, insertion, and action of lateral pterygoid

A

origin-spehnoid
insertion-condylar process of mandible and joint capsul and articular disc of TMH
action– bilaterally protrudes mandible and unilaterally moves side to side

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35
Q

origin, insertion, and action of medial pterygoid

A

origin-sphenoid
insertion- ramus of mandible
action- bilaterally elevates and protrudes mandible and unilaterally side to side mvmt

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36
Q

what divides TMJ into anterior and posterior sections?

A

articular disc of TMJ

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37
Q

what are the somatic sensory branches of V3 ?

A

auriculotemporal
-ear region
buccal
-maxillary gingivae, cheeks
lingual
-mandibular gingivae, floor of mouth, anterior 2/3 tongue
inferior alveolar*terminates into mental nerve
-mandibular teeth and gingivae, chin, lower lip

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38
Q

chorda tympani

A

-afferent special sensation from the anterior two-thirds of the tongue via the lingual nerve
- parasympathetic innervation to the submandibular and sublingual glands

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39
Q

what makes up the pterygoid venous plexus?

A

superficial temporal vein, maxillary vein, retromandibular vein

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40
Q

Regarding the cheeks what is the innervation of the buccinator muscle and the mucosa linin?

A

buccinator= facial nerve 7
mucosa lining= buccal branch V3, sensory

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41
Q

what is gingivae and what nerves innervate it?

A

-fibrous tissue lined w mucosa AKA gums
-upper teeth/gingivae innervated by maxillary sensory V2 *infraorbital and superior alveolar branches
-lower teeth/gingivae innervated by mandibular sensory CN V3 *mental and lingual branches

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42
Q

how many quadrants are the teeth divided into and what is in each quadrant?

A

4 quadrants
in each quadrant:
-2 incisors
-1 canine
-2 premolars
-3 molars *3rd molar is wisdom tooth

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43
Q

blood supply of maxillary teeth and mandibular teeth

A

maxillary=superior alveolar vessels which are branches of maxillary vessels

mandibular= inferior alveolar vessels which are branches of maxillary vessels also

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44
Q

lingual tonsil

A

lymphatic tissue in root of tongue

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45
Q

terminal sulcus

A

divides root and body of tongue

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46
Q

lingual papillae

A

taste buds in body of tongue

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47
Q

what are the extrinsic muscles of the tongue and their actions

A

-genioglossus=bilaterally protrudes tongue and unilaterally does side to side mvmt
-styloglossus=retrudes tongue
-hyoglossus=depresses tongue

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48
Q

what is the vasculature of the tongue?

A

lingual artery and lingual vein

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49
Q

somatic motor of tongue

A

CN 12 hypoglossal

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50
Q

somatic sensory of tongue

A

CN V3=lingual nerve, anterior 2/3
CN 9=glosspharyngeal, posterior 1/3

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51
Q

special sensory of tongue

A

CN 10=taste internal laryngeal near epiglottis (when taste goes down back of throat
CN 7=chorda tympani, taste anterior 2/3
CN 9=taste posterior 1/3

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52
Q

where does the parotid duct open?

A

2nd upper molar

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53
Q

parasympathetics of submandibular and sublingual glands

A

pregang bodies=brain
pregang fiber=CN 7/chorda tympani *track along LINGUAL NERVE (v3)
post gang bodies=wihing submandibular ganglion

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54
Q

pterygopalatine fossa

A

connects to nasal cavity and orbit, located between pterygoid plats of sphenoid and maxilla

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55
Q

nerves of the pterygopalatine fossa

A

CN V2-maxillary nerve
*goes from infraorbital nerve to maxillary teeth via superior alveolar nerves
*nasopalatine nerves
*posterior lateral nasal nerves
*greater/lesser palatine nerves

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56
Q

what nerves are responsible for muscular contraction of oropharynx (gag)

A

CN 9 and 10

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57
Q

genioglossus paralysis

A

-tongue shifts posteriorly
-why airway is inserted during general anesthesia

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58
Q

hypoglossal nerve injury

A

-possibly due to fractured mandible
-atrophy of ipsilateral side of tongue and tongue goes toward paralyzed side
***opposite if stroke
-lower motor neuron injury

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59
Q

what bones are on the roof of the nasal skeleton?

A

nasal bones, ethmoid and frontal bone

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60
Q

what bones make up the floor of the nasal skeleton

A

maxillae and palatine bones

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61
Q

what bones make up the lateral walls of the nasal skeleton?

A

maxillae, lacrimal bones, palatine bones, ethmoid, and inferior nasal conchae

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62
Q

what two conchae are in ethmoid bone

A

superior and middle concha

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63
Q

what drains into sphenoethmoidal recess?

A

sphenoidal sinus

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64
Q

what drains in superior meatus?

A

sphenopalatine foramen, ethmoid air cells

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65
Q

what drains into middle meatus?

A

semilunar hiatus; frontal, maxillary, anterior and middle ethmoid air cells

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66
Q

what drains into inferior meatus?

A

nasalacrimal duct and incisive canal
*which drains into oral cavity and why when you cry liquid comes out nose

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67
Q

function of sinuses

A

-air filled spaces lines w mucous membrane
-humidify air
-make skull lighter
-voice resonance

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68
Q

where does frontal sinus drain?

A

opens into semilunar hiatus via frontonasal duct

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69
Q

where do sphenoidal sinuses drain?

A

open into sphenoidal recess

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70
Q

where do ethmoidal sinuses drain?

A

they open into middle meatus and superior meatus

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71
Q

where do maxillary sinuses drain?

A

they open into semilunar hiatus of midle meatus

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72
Q

what sinuses are most commonly infected and why?

A

maxillary sinuses due to their superior position of their opening into the nasal cavity *can only drain when head is tilted to one side

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73
Q

somatic sensory of the nasal mucosa

A

V1
-anterior part
V2
-middle and posterior part
-nasopalatine nerve
-posterior lateral nasal nerves

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74
Q

what CN innervates smell in nasal mucose

A

CN 1 (cribiform foramina)

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75
Q

parasympathetics of the nasal mucosa

A

Preganglionic CB
-CN 7 (greater petrosal nerve) joins the DEEP PETROSAL NERVE (symp) to form NERVE OF PTERYGOID CANAL (mixed s and ps fibers)
Postganglionic CB= in pterygopalatine ganglion
Postganglionic fibers= hitch ride with V2

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76
Q

what is the blood supply of the nasal cavity?

A

-anterior and posterior ethmoidal arteries *branches of ophthalmic a
-facial artery
-sphenopalatine arteries *branches of maxillary artery via sphenopalatine foramen

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77
Q

Kiesselbach area

A

anastomosing arteries that are in nasal cavity; lots of nose bleeds here

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78
Q

venous drainage of nasal cavity

A

-facial vein
-sphenopalatine vein
-ophthalmic vein

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79
Q

what is the incisive fossa and what nerve innervates it?

A

-it is a pathway in the hard palate for nerves and blood supply to get into the oral cavity
-somatic sensory= nasopalatine nerve V2

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80
Q

what arteries/vessel are coming out of greater palatine foramina and what innervates it?

A

-greater palatine nerves V2 (somatic sensory)
-greater palatine vessels of maxillary artery

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81
Q

what arteries/vessel are coming out of lesser palatine foramina and what innervates it?

A

-lesser palatine nerves V2 (somatic sensory)
-lesser palatine vessels of maxillary artery

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82
Q

what movements occur in the soft palate?

A

elevation and depression

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83
Q

what are the muscles of the soft palate and what are they innervated by?

A

1 levator veli palatini (CN 10); ELEVATE PALATE
2 tensory veli palatini (CN V3); TENSE PALATE
3 palatoglossus (CN 10); DEPRESS PALATE AND ELEVATE TONGUE
4 palatopharyngeus (CN 10); TENSE PALATE

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84
Q

what is the blood supply to the palatine tonsils?

A

facial artery that branches into ascending pharyngeal artery

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85
Q

describe structure of oropharynx

A

bound by soft palate superiorly and epiglottis inferiorly, laterally it is bound by palatoglossal and palatopharyngeal arches

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86
Q

how does the nasopharynx communicate with the nasal cavity?

A

choanae

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87
Q

how does the nasopharynx connect with the middle ear?

A

the auditory tube which the muscles of the soft palate open and close during swallowing

88
Q

where are the pharyngeal tonsils located and what are they called when they are inflamed?

A

nasopharynx, adenoids

89
Q

what is the external acoustic meatus made up of?

A

1/3 cartilage
2/3 temporal bone

90
Q

what structure seperates the external and middle ear?

A

tympanic membrane

91
Q

describe the tympanic membrane through an otoscope

A

cone shaped, has cone of light that reflects when looking with otoscope, you can see impression of malleus

92
Q

what are the 3 structures of the malleus?

A

lateral process, handle, umbo

**umbo forms center of eardrum

93
Q

what is the sensory innervation for the internal and external surface of the tympanic membrane?

A

internal= glossopharyngeal nerve
external=auriculotemporal nerve V3 and SMALL portion is vagus

94
Q

what structures make up the middle ear?

A

epitympanic cavity, auditory tube, tympanic cavity

95
Q

boundaries of the middle ear

A

anterior =carotid canal and auditory tube
posterior=mastoid antrum/air cells
medial=promontory, oval, and round windows
lateral=tympanic membrane
roof= middle cranial fossa
floor=internal jugular vein

96
Q

mastoiditis

A

occurs when otitis media spreads to mastoid air cells

97
Q

what are the auditory ossicles?

A

malleus, incus, stapes

98
Q

malleus ‘hammer’

A
99
Q

Your pt comes in experiencing hyperacusis, which cranial nerve is involved?

A

CN V3- innervates tensor tympani muscle

100
Q

what are the two parts of the malleus and what muscle is involved?

A

handle (attached to tympanic membrane) and head; tensory tympani is innervated by CN V3

tensor tympani stops handle from shaking too much

101
Q

what is the function of the incus?

A

transfers motion from tympanic membrane

102
Q

what is the muscle that controls the stapes and what is it innervated by?

A

the stapedius muscle, innervated by CN VII

103
Q

what are the nerves of the middle ear?

A

FACIAL NERVE
3 branches:
1-greater petrosal nerve PS=LACRIMAL GLAND, GLANDS IN NASAL AND PALATINE MUCOSA
*deep petrosal nerve
*nerve of pterygoid canal
2-nerve to stapedius
3-chorda tympani *TASTE ANTERIOR 2/3 *PS-SUBMANDIBULAR AND SUBLINGUAL GLANDS

GLOSSOPHARYNGEAL NERVE
3branches
-tympanic nerve (gives rise to tympanic plexus)
-lesser petrosal nerve (pregang PS fibers synapse in otic ganglion before innervating parotid gland)
-other branches of CN 9 which go to posterior 1/3 tongue, pharynx (gag) and stylopharyngeus muscle

104
Q

what is the function of the stapes?

A

transmits sound vibrations from the incus to the oval window

105
Q

where are the cell bodies for the special sensory taste of the chorda tympani (CN 7)

A

geniculate ganglion; taste to anterior 2/3 of tongue

106
Q

tympanic plexus

A

-middle ear
-somatic sensory= surface tympanic membrane; mucosa of auditory tub

**how we get somatic sensory to middle ear

107
Q

what are the 3 parts of the inner ear

A

petrous part of temporal, auditory apparatus, vestibular apparatus

108
Q

what is the function of the round window in the inner ear?

A

allows fluid in the cochlea to move

109
Q

what are the semicircular canals and what parts are they seperated into?

A

fluid filled ducts in the middle ear seperated into anterior, posterior, and lateral

110
Q

what is the special sensory of the inner ear

A

hearing innervated by the vestibulocochlear nerve that exits through the internal acoustic meatus

*cochlear nerve is hearing
*vestibular nerve is balance

111
Q

explain sound sound transmission through the ear

A

sound goes in external acoustic meatus and then hits tympanic membrane which activates stapes to hit oval window and vibrate fluid in cochlea which then travels out through cochlear nerve

112
Q

what is the fibrous outer layer of the eye

A

sclera and cornea

113
Q

what is the vascular middle layer of the eye

A

choroid, ciliary body, and iris

114
Q

what is the inner layer of the eye

A

retina

115
Q

functions of the sclera

A

-provides attachment for extraocular muscles
-keeps shape of the eye
-continuous with optic sheath (dura mater)

116
Q

what are the chambers of the eye

A

anterior- between cornea and iris
posterior-between iris and lens
vitreous chamber- between lens and retina

117
Q

cornea

A

-aids in light refraction
-innervated by CN V1 (ophthalmic)
-avascular
-nutrients and stuff go to cornea via fluids bc avascular

118
Q

choroid

A

-the red layer
-blood supply to outer layers of retina
-branches of ophthalmic artery

119
Q

ciliary body

A

-connects choroids with circumference of iris
-muscular and vascular function
-attaches to lens via ZONULAR FIBERS
-CILIARY PROCESSES secrete aqueous humor

120
Q

zonular fibers

A

attach ciliary bodies to lens

121
Q

how does the lens change shape and accomodate

A

the lens is flat when the ciliary muscle relaxes and it becomes spherical (or accomodates) when ciliary muscle contract *works with zonular fibers

innervated by CN 3- parasympathetic

122
Q

what is accomodation?

A

change in curvature of lens to allow for focusing on objects as they approach the eye

123
Q

describe the state of the zonular fibers for distant vision and for near vision

A

distant- zonular fibers under tension
near- zonular fibers relaxed

124
Q

what is presbyopia?

A

cant focus on near objects bc inability for lens to accomodate due to it being less elastic with age

125
Q

lens

A

avascular
no innervation
refracts light

126
Q

what causes cataracts?

A

clusters of proteins build up in lens causes opacity of the lens

127
Q

how do we get changes to pupil size?

A

iris sphincter pupillae and iris dilator pupillae

sphincter=PS CN 3
dilator=symp superior cervical ganglion

128
Q

retina

A

-visual retina and non visual retina

129
Q

blood supply of retina

A

inner retina=central retinal artery
outer retina=choroid

130
Q

what structures are included in the retina?

A

optic disc (blind spot) fovea and macula

131
Q

what part of the eye has the sharpest vision?

A

fovea/macula

132
Q

detached retina

A

seperation of inner neural and outer pigemented layers

*retina will detach if vitreous humor leaks also

133
Q

what is the function of aqueous humor?

A

-produced by ciliary processes
-nourishment to cornea and lens

**circulates posterior to anterior chamber and drained through canal of schlemm into scleral venous plexus

134
Q

glaucoma

A

-generally caused by failure to drain aqueous humor via canal of schlemm
-this increases intraocular pressure

135
Q

vitreous humor

A

-acellular viscous gel
-99% water
-fills space between lens and retina

136
Q

what are the muscles of the EYELIDS

A

-orbicularis oculi (palpebral part)
-superior tarsal muscle
-levator palpebrae superioris

137
Q

what cranial nerves open and close the eye?

A

CN 3- opens eye
CN 7- closes eye

138
Q

what nerve transmits somatic sensory info through the upper and lower eyelid?

A

upper eyelid- CN V1
lower eyelid- CN V2

139
Q

what muscle closes the eyelids

A

the orbicularis oculi
*palpebral part=blinking
*orbital part=squeezing

140
Q

what muscles open the eyelids?

A

levator palpebrae superioris- CN 3
mullers (superior tarsal)-sympathetic

141
Q

Ptosis

A

-drooping eyelid
-can happen if mullers is intact still
-CN 3 damage

142
Q

Horner’s syndrome

A

ptosis and pupil constriction

*can happen from stroke, tumor, or spinal chord injury

143
Q

tarsal gland

A

responsible for lipid secretion on the eyelids

*eye boogers come from overactive tarsal glands

144
Q

what are the 4 parts of the conjunctiva

A

bulbar conjuctiva (covering sclera), lateral angle, medial angle, palpebral conjunctiva (covering eyelid)

145
Q

lacrimal appratus(what is it, where does it drain, innervation)

A

-drains into lacrimal sac and then nasal cavity
-tear system
-innervated by CN 7 (parasympathetic)

146
Q

extraocular muscles

A

LR6, SO4, AO3
lateral rectus CN 6
superior oblique CN 4
all other CN 3

147
Q

what are the actions of the extraocular muscles?

A

superior rectus=elevation, adduction, intorsion
inferior rectus=depression, adduction, extortion
medial rectus=adduction
inferior oblique=elevation, extortion, abduction
lateral rectus=abduction
superior oblique=depression, intorsion, abduction

148
Q

what nerves and vessels go through the superior orbital fissure?

A

CN 3
CN 4
CN V1 and branches
CN 6
ophthalmic veins
sympathetic fibers

149
Q

what nerves and fibers go through the optic canal?

A

CN 2
ophthalmic artery
central retinal artery

150
Q

what nerves and fibers go through the inferior orbital fissure?

A

-infraorbital nerve (CN V2)
-infraorbital artery
-inferior ophthalmic vein ( PS branch from CN 7)

151
Q

what is the superficial nerve supply of the orbit?

A

-supraorbital
-frontal (CN V1)
-CN 4

152
Q

what is the deep nerve supply of the orbit?

A

-lacrimal
-CN 6
-CN V1
-CN 3
-nasociliary
- CN 2

cut part of trochlear (4) and frontal

153
Q

what is the arterial supply of the orbit and where do the arteries branch from ?

A

*branch from internal carotid

-supratrochlear
-supraorbital
-ciliary
-lacrimal
-ophthalmic
-central artery of retina

154
Q

what is the venous drainage of orbit?

A

-supraorbital vein
-vorticose veins
-superior ophthalmic vein
-inferior ophthalmic vein
-infraorbital vein
-angular vein
-facial vein

** blood leaves orbit via cavernous sinuses, facial vein, and pterygoid plexus

155
Q

what happens to eyesight if there is a blockage of central retinal artery?

A

-Anterior ischemic optic neuropathy (AION) is a sudden loss of vision
-unilateral
-older individuals

156
Q

what happens to eye sight if there is a blockage of the central retinal vein?

A

-thrombophlebitis of cavernous sinus
-slow and painless vision loss

157
Q

what is often the 1st sign of oculomotor nerve compression?

A

ipsilateral slowness of pupillary light response

158
Q

oculomotor nerve palsy

A

-affects most of ocular muscles
-eye droops down and out
-dilated/nonreactive pupil

159
Q

abducent nerve palsy

A

-lateral rectus paralyzed
-eye gets stuck inward

160
Q

when eye ABducted what is elevation and depression achieved by?

A

superior (elevation) and inferior (depression) rectus

161
Q

when eye is ADducted what is elevation and depression achieved by?

A

inferior (elevation) and superior (depression) oblique

162
Q

what is clinically significant about the hyoid bone?

A

if hyoid broken it usually means someone was strangled or hung themself

163
Q

what is in the superficial cervical fascia?

A

-fat
-cutaneous nerves
-superfiical vessels
-superficial lymph nodes
-platysma

164
Q

what are the 3 layers of the deep cervical fascia?

A

-investing layer
-pretracheal layer
-prevertebral layer

*note the investing layer is what wraps around abs

165
Q

what structures does the investing layer invest?

A

-trapezius
-SCM
-submandibular glands
-parotid glands

166
Q

what does the pretracheal layer invest?

A

muscular part: infrahyoid muscles
visceral part:
-thyroid gland
-trachea
-esophagus and pharynx

167
Q

what regions does the VISCERAL part of the pretracheal layer connect?

A

provides connections from the cervical region to the mediastinum

168
Q

what regions does the prevertebral layer connect?

A

extends into the axillary sheath connecting the cervical region to the axillae

169
Q

what structures does the prevertebral layer invest?

A

scalenes and intrinsic back muscles

*tp question about this
*know the prevertebral layer invests erector spinae

170
Q

what does the carotid sheath connect?

A

cranial cavity to mediastinum

171
Q

what does the carotid sheath invest?

A

-common/internal carotid arteries
-internal jugular vein
-VAGUS NERVE
-deep cervical lymphnodes

172
Q

what does the retropharyngeal space connect?

A

cranial cavity to mediastinum
*like carotid sheath

173
Q

what happens if there if an infection in you retropharyngeal space and why?

A

difficulty speaking and swallowing because infection swells the space and pushes up against structures

174
Q

what might you see in a pt with a condition affecting their anterior triangle?

A

difficulty swallowing, goiter (enlargement of thyroid)

175
Q

what is responsible for motor innervation to infrahyoid muscles?

A

ansa cervicalis (c1-c3)

176
Q

what are the infrahyoid muscles and their actions?

A

-sternohyoid (depress hyoid)
-omohyoid *note inferior belly in posterior triangle
-sternothyroid (depresses hyoid and LARYNX)
-thyrohyoid (depresses hyoid and can ELEVATE LARYNX)

177
Q

what part of neck are the infrahyoid and suprahyoid muscles located?

A

anterior triangle

178
Q

what are the suprahyoid muscles innervated by?

A

mylohyoid= CN V3
digastric= CN V3 and 7
stylohyoid= CN 7
geniohyoid= cervical plexus

179
Q

what are the suprahyoid muscles and what is their action?

A

elevate hyoid
-mylohyoid
-digastric
-stylohyoid
-geniohyoid

180
Q

what is a subdivision of the anterior triangle and its significance?

A

-subdivision of anterior triangle
-bifercation of carotid artery
-this is where you can feel carotid pulse

181
Q

what might you see clinically if a pt has something affecting posterior triangle?

A

neck pain, numbness, and tingling in upper extremities

182
Q

what muscles are within the posterior triangle?

A

trapezius, SCM, spelinius capitis, levator scapulae, scalenes, omohyoid (inferior belly)

183
Q

what is the action and innervation of the scalenes?

A

action=laterally flex neck or elevate ribs
innervation=cervical plexus

184
Q

what nerve innervates the SCM and traps?

A

CN XI (spinal accesory)

185
Q

cervical plexus

A

ventral rami c1-c4 (ansa cervicalis is part of this)

BRANCHES
-lesser occipital nerve
-greater auricular nerve
-transverse cervical nerves
-supraclavicular nerves

186
Q

where would you inject a nerve block in the lateral cervical region?

A

a cervical plexus block would involved anesthetic being injected into several points along SCM

187
Q

what nerve does the ansa cervicalis hitchike on to?

A

hypoglossal CN XII (not a branch of it tho)

188
Q

phrenic nerve

A

C3-C5
-innervateds diaphragm, parietal pleura, fibrous pericardium, and parietal layer of serous pericardium

189
Q

what would happen if c4 was damaged?

A

diaphragm could be paralyzed bc damages phrenic nerve

190
Q

what makes up the brachial plexus and list the roots and trunks and branches

A

roots=ventral rami C5-T1
trunks=superior, middle inferior
branches=
musculocutatneous
axillary
radial
medial
ulnar

*posteiror triangle

191
Q

what structures are the roots of the brachial pelxus location between?

A

middle and anterior scalene

192
Q

what are the branches of the superior trunk of the brachial plexus?

A

suprascapular nerve

Army over Navy
-artery over ligament and nerve under ligament

193
Q

veins of the neck

A

Anterior jugular veins (empty into external jugular veins)
EXTERNAL JUGULAR VEINS*know its superficial to SCM
-Posterior auricular and retromandibular
*Receive blood from scalp and face
-Transverse cervical, suprascapular, anterior jugular
*Receive blood from neck and shoulder

INTERNAL JUGULAR VEINS
*Within carotid sheath
-Receive blood from face/neck via facial and lingual vein
-Join subclavian veins at venous angle to form brachiocephalic veins

194
Q

where would you insert a need to perform an internal jugular vein puncture (IJ)

A

insert need between sternal and clavicular head of SCM

*do on right side bc bigger and straighter

195
Q

where is a central line placed? aka subclavian vein puncture

A

between rib 1 and the clavical where the sublcavian vein goes to the axillary vein

*risk of subcalvian artery or pleura puncture

196
Q

ateries of the neck

A

-On right side= brachiocephalic trunk bifurcates and forms right subclavian artery and right common carotid artery

-On left side= arch of aorta breaks into left subclavian artery and left common carotid artery

COMMON CAROTID ARTERIES- you can feel carotid pulse here
**Divides into internal and external carotid artery
-External carotid artery branches
*Occipital artery, facial artery, lingual artery, ascending pharyngeal artery, superior thyroid artery
**Carotid body and sinus in carotid veins; carotid body has chemoreceptors for blood composition and carotid sinus has baroreceptors for blood pressure

SUBCLAVIAN ARTERIES
-Internal thoracic artery
-Vertebral artery
-Thyrocervical trunk
*Inferior thyroid artery, transverse cervical artery, suprascapular artery

*transverse cervical artery also has branches

197
Q

cartoid sinus massage

A

*NEVER DO BILATERALLY

-mechanical stimulation that lowers heart rate
-body fixes BP by sending signals through CN 9 to brainstem and then to CN 10 which lowers HR and therefore blood pressure

198
Q

your pt is on meds that suppress PS activity, how might this affect the heart?

A

could make tachycardic bc vagus slows down HR and this is being supressed

199
Q

which vessel directly supplies the rhomboids?

A

dorsal scapulary artery

200
Q

arterial supply of the shoulder

A

the subclavian artery branches into thyrocervical trunk which branches into transverse cervical artery and suprascapular artery

transverse cervical artery has 2 branches
1-superficial branch (trap)
2- deep branch aka dorsal scapular artery (rhomboids, levator scapulae)

Suprascapular artery
*army over navy like suprascapular nerve

201
Q

thoracic outlet syndrome

A

compression of subclavian artery that leads to edema, slow capillary refill, and distended superficial veins

202
Q

lymphatics of the neck

A

-Right lymphatic duct
o Entering right venous triangle
-Thoracic duct
o Entering left venous angle; this is where most things drain

203
Q

nodes of the neck

A

*Superficial cervical nodes
-Submental and submandibular nodes
*Deep cervical nodes
-Along internal jugular vein

204
Q

blood supply of the thyroid gland

A

*Superior thyroid artery (branches from external carotid artery)
*Inferior thyroid artery (from thyrocervical trunk)
*10% of ppl have thyroid ima artery that branches from brachiocephalic trunk

205
Q

drainage of the thyroid gland

A

-Superior thyroid vein (to IJV)
-Middle thyroid vein (to IJV)
-Inferior thyroid vein (to brachiocephalic vein)

206
Q

what are the different parts of the pharynx?

A

 Nasopharynx
 Oropharynx
 laryngopharynx

207
Q

what is the thyroid gland invested by?

A

visceral part of the pretracheal layer

208
Q

constrictor muscles of the pharynx

A

Constrictor muscles divided into superior, middle, inferior (CN 10)

209
Q

Describe the motor and sensory innervation of the pharynx. Indicate the nerves responsible for the gag reflex (sensory and motor).

A

*Glossopharyngeal nerve
 Sensory=mucosa of oropharynx
 Motor=stylopharyngeus
*Vagus nerve
 Sensory=mucosa of laryngopharynx
 Motor=constrictor muscles of pharynx
 *sensory and motor at piriform recesses
*Gag reflex
 Sensory=CN 9
 Motor=CN 10

210
Q

where do constrictor muscles of the pharynx fuse?

A

posteriorly at the RAPHE

211
Q

what is epiglottitis and why is it life threatening?

A

it is when epiglottis is inflamed, life threatening bc it can block airway

212
Q

what does air go through to produce sound in larynx?

A

it goes through rima glottidis to vibrate the vocal folds

213
Q

where would you perform a tracheotomy and cricothyrotomy?

A

tracheotomy-between tracheal rings

cricothryrotomy-cricothryoid membrane but only for emergency bc it is easier to palpate when you dont have imaging

214
Q

while performing tracheostomy you nick a vessel, where does this vessel branch from?

A

thyroid ima artery that branches from brachiocephalic trunk

215
Q

extrinsic muscles of the larynx (these work to move larynx as a whole)

A

*Suprahyoid muscles= elevate larynx
* Mylohyoid
* Digastric
* Stylohyoid
* geniohyoid
*Infrahyoid muscles= depress OR elevate larynx
* Elevator of larynx=thyrohyoid
* Depressor of larynx=sternothyroid
* Note these move as a whole and are majority motor innervated by ansa cervicalis

216
Q

intrinsic muscles of larynx (these move specific parts of larynx)

A
  • Aryepiglottic= close laryngeal inlet
  • Lateral cricoarytenoid=adduct vocal folds
  • Transverse arytenoid=adduct vocal folds
  • Oblique arytenoid=adduct vocal folds
  • Posterior cricoarytenoid= abduct vocal folds
  • Cricothyroid= stretch/tense vocal folds
  • Thyroarytenoid=relax vocal folds
  • Vocalis= fine control of vocal folds

***most innervated by INFERIOR LARYNGEAL NERVE

217
Q

Horner’s syndrome

A

*Occurs from damage to sympathetic nervous system in cervical or thoracic level
*PAMela (patient presentation)
 Ptosis
 Anhidrosis
 Miosis
*Heterochromia= varied iris pigmentation when occurs in infants

Q1 (15 decks)

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