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Y2 LCRS > Anatomy of the Head, Neck and Spine > Flashcards

Anatomy of the Head, Neck and Spine Flashcards

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11
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12
Q

How many bones make up the skull?

A
  • 22
  • 8 cranial bones and 14 facial bones
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13
Q

What is in the neurocranium?

A
  • the brain
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14
Q

What is the facial skeleton also called?

A
  • the viscerocranium
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15
Q

State the bones of the cranium.

A
  • unpaired bones: frontal, occipital, sphenoid, ethmoid
  • paired bones: parietal (x2), temporal (x2)
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16
Q

State the bones of the cranium.

A
  • unpaired bones: vomer, mandible
  • paired bones: maxilla (x2), zygoma (x2), nasal (x2), lacrimal (x2), inferior conchae (x2), palatine (x2)
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17
Q

What are sutures?

A
  • fibrous joints permitting little or no movement
  • in an infant they are not completely fused -> fusion doesn’t happen until some months after birth
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18
Q

What are fontanels?

A
  • soft spots on the top of a babies head -> have an anterior and posterior fontanelle
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19
Q

At what ages do the fontanelle close/fuse?

A
  • anterior fontanel = closes between 18-24 months of age
  • posterior fontanel = closes during the first 2-3 months
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20
Q

What bones are teeth inserted into?

A
  • maxilla and mandible
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21
Q

What are the nasal conchae?

A
  • sticking out bits of bone in the nasal cavity that are covered by mucous membrane -> help warm air as it is breathed in by humidifying it
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22
Q

What movements are allowed at the temporomandibular joint?

A
  • opening your mouth wide
  • sliding jaw forwards/backwards
  • moving jaw side to side
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23
Q

What is the lambda?

A
  • the point at which the sagittal and lambdoid suture meet
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24
Q

Where does the medulla and spinal cord exit the cranial cavity?

A
  • foramen magnum
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25
Q

Which skull bones are involved in the joint between the first vertebra and the skull?

A
  • the occipital condyles -> sit on top of C1
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26
Q

Which joint allows the nodding?

A
  • joint between the skull (condyles) and the first next vertebra -> the yes joint
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27
Q

Which joint allows shaking of the head?

A
  • the joint between the first and second vertebra -> the no joint
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28
Q

What is housed within the anterior cranial fossa?

A
  • the frontal lobe
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29
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What is housed within the middle cranial fossa?

A
  • the temporal lobe
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30
Q

What is housed within the posterior cranial fossa?

A
  • cerebellum and indirectly the occipital lobe
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31
Q

Describe the path of the internal carotid artery.

A
  • first enters the skull through the carotid canal in the petrous part of the temporal bone -> then passes through the foramen lacerum, to enter the middle cranial fossa
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32
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33
Q

What are the 3 layers of the meninges?

A
  • dura mater
  • arachnoid mater
  • pia mater
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34
Q

How does the epidural space differs in the brain and spinal cord?

A
  • brain = lack of epidural space
  • vertebral column = large epidural space -> can beu sed for spinal anaesthia and block as well as lumbar puncture
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35
Q

Describe the dura mater around the brain.

A
  • the dura is composed of two layers, largely stuck together over the surface of the brain -> outer layer = periosteal dura and inner layer = meningeal dura
  • fused over most of the surface, except in certain places (inner layer peels away to create structures filled with blood -> the sinuses
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36
Q

What happens to the dura mater as it emerges from the foramen magnum?

A
  • as the meningeal layer of dura emerges from the foramen magnum, the layer closest to the skull (periosteum) is lost at the foramen magnum (it fuses with the outside of the skull) -> the inner (meningeal) layer continues down the vertebral column surrounding the spinal cord -> hence, there is a large space between the dura and the bone in the vertebral column
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37
Q

Where does the inner layer of the dura peel away from the outer?

A
  • down the longitudinal fissure
  • towards the back, to form a shelf between the cerebellum and the occipital lobe
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38
Q

What are the points of the dural folds?

A
  • help stop movement of the brain
  • provide spaces in which blood can drain back to the venous system
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39
Q

What is the sagittal sinus?

A
  • blood filled cavity/sinus whihc runs from front to back
  • many great veins drain into the venous system by it
  • there is a penetration of the arachnoid mater into the sinus to allow CSF to be rebasorbed
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40
Q

What is the major donwnside of dural folds?

A
  • any swelling can cause parts of the brain to pushed down and through which can cause damage to the brain sitting close to it
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41
Q

What is tonsillar herniation, also state its consequence?

A

a type of cerebral herniation characterised by the inferior descent of the cerebellar tonsils below the foramen magnum which affects the medulla and lower brainstem -> cardiorespiratory failure

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42
Q

What is uncal herniation, also state its consequences?

A
  • a subtype of transtentorial downward brain herniation, usually related to cerebral mass effect increasing the intracranial pressure -> affects the midbrain -> causes unconsciousness
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43
Q

What is the main blood supply to the meninges?

A
  • middle meningeal artery
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44
Q

What is the major consequence of a pterion fracture?

A
  • the middle meningeal artery runs past the pterion (very soft spot of the brain) -> fracture results in a large epidural bleed
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45
Q

What are the functions of the vertebral column?

A

o support and protection of the spinal cord

  • vertebra hold the body weight
  • transmit forces
  • supports the head and upper limbs (and aid movements)

o movement

  • upper limbs and ribs (extrinsic muscles)
  • postural control and movement (intrinsic muscles)
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46
Q

Define primary curvature.

A
  • curvatures that are in the direction that you’d expect in the foetal position -> their concave side is facing anteriorly
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47
Q

Define secondary curvature.

A
  • curvatures are in the opposite direction that you’d expect in the foetal position -> their concavity facing posteriorly
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48
Q

Which vertebral sections have primary curvature?

A
  • thoracic
  • sarcal
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49
Q

Which vertebral sections have a secondary curvature?

A
  • cervical
  • lumbar
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50
Q

What is excessive kyphosis?

A
  • excessive thoracic curvature
  • elderly people tend to have a pronounced kyphosis
  • in exaggerated kyphosis, the thoracic organs are squeezed
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51
Q

What is excessive lordosis?

A
  • big curvature in the lower back, in the lumbar spine
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52
Q

What is scoliosis?

A
  • laterally curvatures of the spine
  • cause severe pain and aesthetic problems
  • organs of the thorax and abdomen can become compressed with really severe angles of curvature
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53
Q

When is scoliosis most common?

A
  • not uncommon -> especially to a slight degree
  • most common in females around puberty
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54
Q

What part of the vertebra is the major weight bearing section?

A
  • the vertebral body
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55
Q

What movements are permitted by the articular processes?

A
  • with articular facets of vertebrae that are vertical -> is difficult to turn the vertebrae sideways -> able to move these vertebrae forwards and backwards if the facets when in the sagittal plane
  • with articular facets that are horizontally located -> can be rotated sideways
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56
Q

Describe the structure of the intervertebral discs.

A
  • water-filled structures with cartilage/collagen rings around them, with some gel in the middle
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57
Q

What is the function of the intervertebral discs?

A
  • helps transmit forces
  • helps with allowing flexibility between vertebrae
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58
Q

What happens over time?

A
  • discs lose water and become dehydrated -> happens throughout the day and as you get older
  • if the gaps betwen vertebrae get smaller, nerves can get impinged -> this is degenerative disc disease
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59
Q

What is the shape of the vertebral bodies of thoracic vertebra?

A
  • heart-shaped
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60
Q

What is the shape of the vertebral bodies of lumbar vertebra?

A
  • kidney shaped as well as being much bigger
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61
Q

Where does soinal anaesthesia or lumbar puncture occur?

A
  • below the level of L2 there is no spinal cord -> just a bundle of nerves (the caudal equina)
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62
Q

What are prolapsed intervertebral discs?

A
  • disc can rupture and the contents of the disc can emerge into the space occupied by the nerves or the spinal cord -> causes severe pain and paraesthesia due to nerve compression
  • disc contents will take the path of least resistance -> will herniate through ready made holes for nerves trying to emerge
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63
Q

Which regions are most likely to suffer from a prolapsed intervertebral disc?

A
  • all regions can be affected, however slipped discs (prolapse) are more likely to happen down the spine -> because more weight being transmitted by the disc
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64
Q

What movements of the spine can occur?

A
  • extension and flexion
  • lateral flexion
  • rotation
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65
Q

What muscles are classified as sheet muscles?

A
  • oblique muscles
  • rectus addominus
  • transversus abdominus
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66
Q

What is the function of the sheet muscles?

A
  • aid flexion of the spine
  • help with increasing abdominal pressure -> expulsion, coughing, sneezing, breathing etc
  • oblique muscles also aid lateral flexion and rotation
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67
Q

What are the roles of the erector spinae muscles?

A
  • straighten the spine
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68
Q

What is the role of the sternocleidomastoid?

A
  • on the front of the neck -> help turn the head
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69
Q

Describe the range of motion of the regions of the spine?

A
  • cervical spine is flexible in extension, rotation and lateral flexion
  • thoracolumbar spine is slightly less versatile due to the presence of ribs
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70
Q

Describe the path of the vertebral meninges.

A
  • dura mater and arachnoid mater travel further down the vertebral column than the spinal cord whereas the pia mater is adherent to the spinal cord -> ends essentially surrounding the spinal cord at L2
  • a small filament extends down from the base of the spinal cord - know as the filum terminale -> proceeds downward from the apex of the conus medullaris
  • pia mater also has a pair of denticulate ligaments, attaching it to the arachnoid and dura mater
  • arachnoid and dura extend past L2 down to S2 – this forms the subarachnoid space (for CSF)
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71
Q

What is the difference between epidural and spinal anaesthesia?

A
  • epidural = around the dura
  • spinal = inside the subarachnoid space
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72
Q

What is spondylolysis?

A
  • stress fracture of pars interarticularis (part of a vertebra located between the inferior and superior articular processes of the facet joint)
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73
Q

What is sciatica?

A
  • a prolapsed disc that traps a nevre that supplies the feet and legs
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74
Q

What is spondylolisthesis?

A
  • forward displacement of vertebra
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75
Q

What is spondylitis?

A
  • inflammation of vertebrae
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76
Q

What are the functions of the neck?

A
  • structural -> support and move head (inside prevertebral fascia)
  • visceral functions (inside or associated with pretracheal fascia)
  • conduit for blood vessels and nerves (inside or associated with carotid sheaths)
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77
Q

What are the 4 compartments of the neck?

A
  • the vertebral compartment
  • the visceral compartment
  • two vascular compartments
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78
Q

What is contained within the vertebral compartment of the neck?

A
  • cervical vertebrae and associated postural muscles
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79
Q

What is contained within the visceral compartment of the neck?

A
  • thyroid
  • parathyroid glands
  • trachea
  • oesophagus
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80
Q

What surrounds the visceral compartment?

A
  • deep fascia called the pretracheal fascia
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81
Q

What is contained within the vascular compartments of the neck?

A
  • internal jugular vein
  • carotid artery
  • vagus nerve
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82
Q

What are the strap muscles?

A
  • muscles attached to the hyoid bone (free-moving bone)
  • are concerned with elevation, depression of the larynx during swallowing and opening of the mandible
  • are in an area of vulnerability -> some of the big vessels ascending and descending through the head and neck can be damaged by trauma
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83
Q

What lies at the C2 levels?

A
  • superior cervical ganglion
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84
Q

What lies at the C3 levels?

A
  • body of the hyoid
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85
Q

What lies at the C4 levels?

A
  • upper border of the thyroid cartilage
  • bifuraction of common carotid artery
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86
Q

What lies at the C6 levels?

A
  • cricoid cartilage
  • middle cervical ganglion
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87
Q

What lies at the C7 levels?

A
  • inferior cervical ganglion
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88
Q

What nerve supplis the sternocleidomastoid and the trapezius?

A
  • spianl accessory nerve
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89
Q

What are the borders of the anterior triangle of the neck?

A
  • superior = inferior border of the mandible
  • laterally = anterior border of the sternocleidomastoid
  • medially = sagittal line of the neck
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90
Q

What are the borders of the posterior triangle of the neck?

A
  • anterior = posterior border of the sternocleidomastoid
  • posterior = anterior border of the trapezius muscle
  • inferior = middle 1/3 of the clavicle
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91
Q

What lies within the anterior triangle of the neck?

A

o mainly muscles

  • platysma -> sheet muscle slung underneath the chin to the clavicles
  • mylohyoid
  • digastric
  • infrahyoid (strap) muscles

o carotid arteries (goes in through the carotid canal)

o internal jugular veins (emerges through skull via jugular foramen along with CN IX, X and XI)

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92
Q

What lies within the posterior triangle of the neck?

A

o blood vessels

  • external jugular vein
  • subclavian artery
  • subclavian vein

o nevres

  • trunks of the brachial plexus
  • phrenic nerve
  • vagus nerve
  • spinal accessory nerve
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93
Q

What is can the external jugular artery be used for?

A
  • functionality of the right side of the heart -> is the main drainage vessel of the face
  • stands out when someone is angry or holding their breath
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94
Q

Describe lymph nodes in the neck.

A
  • should not be able to palpate lymph nodes in healthy people
  • to palpate lymph nodes, you use your hands standing behind the patient.
  • lymph nodes in the neck can receive lymph from structures in the chest and abdomen means that metastases are feasible
  • the vocal cords are an area which has no lymphatic drainage
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95
Q

What are the sections of the pharynx?

A
  • nasopharynx -> posterior to the nasal cavity
  • oropharynx -> posterior to the tongue -> contains lymphoid tissue
  • laryngopharynx -> after the epiglottis
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96
Q

What is the sensory input into the pharynx?

A
  • sensory IX and X supply to the pharyngeal plexus
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97
Q

What is the motor input into the pharynx?

A
  • largely due to X innervation but a small supply from XI too
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98
Q

Describe the process of swallowing.

A
  1. oral preparatory phase -> food and liquid chewed to form a bolus -> is a voluntary task
  2. oral transit phase -> bolus propelled to back of mouth, palate seals entrance to nasal cavity -> is a voluntary task
  3. pharyngeal phase I -> triggered when bolus reaches faucial arch, palate stays elevated, tongue retracts, to push bolus to pharynx -> is a reflex control
  4. pharyngeal phase II -> bolus propelled through pharynx -> reflex -> the airway is closed during this by the epiglottis, vocal cords & arytenoid action
  5. oesophageal phase -> oesophagus opens, airway closed, breath held -> bolus propelled through oesophagus -> a reflex -> respiration then resumes with an exhalation, to clear any food particles from airway entrance
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99
Q

Name the 3 pairs of salivary glands.

A
  • parotid
  • submandibular
  • sublingual
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100
Q

What is prodcued in the parotid glands?

A
  • mainly thin, serous salvia -> is the biggest gland
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101
Q

What is produced in the submandibular glands?

A
  • mainly serous
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102
Q

What is produced in the sublingual glands?

A
  • mainly mucous
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103
Q

What is the nervous supply to the parotid glands?

A
  • parasympathetic fibres of CN IX
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104
Q

What is the nervous supply to the submandibular glands?

A
  • innervation from CN VII -> facial nerve parasympathetic fibres
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105
Q

What is the nervous supply to the sublingual glands?

A
  • innervation from CN VII -> facial nerve parasympathetic fibres
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106
Q

Name the muscles of the tongue.

A
  • styloglossus -> helps to RETRACT the tongue
  • hyoglossus
  • genioglossus -> from the tongue to the mandible -> contraction protudes the tongue
  • intrinsic muscles
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107
Q

What nerve supplies the motor component to the tongue?

A
  • CN XII -> hypoglossal
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108
Q

State a test for the hypoglossal nerve.

A
  • ask the patient to stick his or her tongue out -> when this happens, the genioglossus contracts on either side
  • If there is deviation of the tongue, there is a dysfunction of the hypoglossal in the SAME side of the direction of deviation (tongue deviates towards lesional side)
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109
Q

What is the lingual nerve?

A
  • a nerve which has mixed cranial nerve components
  • supplies the tongue with touch sensation and taste perception
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110
Q

What nerve supplies the sensation and taste to the anterior 2/3 of the tongue?

A
  • normal sensation is the trigeminal nerve (V3)
  • taste fibres are from the facial nerve
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111
Q

What nerve supplies the sensation and taste to the posterior 1/3 of the tongue?

A
  • both sensation and taste fibres are carried in the glossopharyngeal nerves
  • is a very little innervation from the vagus
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112
Q

Where is taste percevied?

A
  • taste fibres go back to the nucleus solitaries in the brainstem
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113
Q

What are the muscles of mastication?

A
  • massaeter -> superficial
  • temporalis -> superficial
  • lateral pterygoid -> deep
  • medial pterygoid -> deep
  • buccinator muscle -> deep
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114
Q

What muscles are supplied by the mandibular division of the trigeminal nerve?

A
  • masseter
  • temporalis
  • lateral pterygoid
  • medial pterygoid
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115
Q

Where does the masseter attach?

A
  • from the zygomatic arch to lateral surface of ramus and angle of mandible
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116
Q

Where does the temporalis attach?

A
  • from the temporal fossa to the coronoid process of the mandible
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117
Q

Where does the lateral pterygoid attach?

A
  • the sphenoid/lateral pterygoid plate of the neck of the mandible
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118
Q

Where does the medial pterygoid attach?

A
  • lateral pterygoid plate/maxilla/palate to the angle of mandible
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119
Q

What nerve supplis the buccinator muscle?

A
  • the facial nerve -> CN VII
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120
Q

What is the role of the masseter?

A
  • elevates the mandible and allows forced closure of mouth
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121
Q

What does the masseter do?

A
  • elevates the mandible to allow forced closure of the mouth
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122
Q

What does the temporalis do?

A
  • elevates and retracts the mandible
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123
Q

What does the lateral pterygoid do?

A
  • depresses and protracts the mandible to open the mouth
124
Q

What does the medial pterygoid do?

A
  • elevates, protracts and allows lateral movement of the mandible for chewing
125
Q

What does the buccinator muscle do?

A
  • contraction of the buccinator -> pushes food into the middle of the mouth -> aids chewing
126
Q

What are the 8 branches of the external carotid artery?

A
  • superior thyroid arteries
  • ascending pharyngeal arteries
  • lingual arteries
  • facial artery
  • occipital artery
  • posterior auricular artery
  • maxillary artery
  • superficial temporal artery
127
Q

What are the 5 branches of the facial nerve?

A
  • temporal
  • zygomatic
  • buccal
  • marginal mandibular
  • cervical
128
Q

Describe the path of the facial nerve.

A
  • the facial nerve exits the cranial cavity via the internal acoustic meatus (along with the vestibulocochlear nerve)
  • it then passes through the skull (via IAM) and emerges from the stylomastoid foramen at the base of the skull
  • after it passes underneath the parotid
129
Q

What are the branches of the trigeminal nerve?

A
  • ophthalmic nerve (V1)
  • maxillary nerve (V2)
  • mandibular nerve (V3)
130
Q

What are the branches of the mandibular nerve (V3)?

A
  • inferior alveolar
  • mental nerve
  • lingual nerve
131
Q

Is the trigeminal nerve sensory or motor?

A
  • sensory
  • the mandibular division has motor activity as well
132
Q

Describe the path and role of the inferior alveolar nerve.

A
  • the inferior dental nerve -> is a branch of the mandibular nerve (V3)
  • comes downwards and passes into the back of the mandible
  • is a sensory nerve -> mediates toothache
133
Q

What is the mental nerve?

A
  • an inferior branch of the inferior alveolar nerve
134
Q

How is the mandibular (V3) nerve tested?

A
  • via sensation in/of the chin
135
Q

What is the origin of the chorda tympani?

A
  • a branch of the main facial nerve which emerges in the temporal bone
  • after passing through the petrotympanic fissure and joins the lingual nerve
136
Q

Describe the dermatomes of the face.

A
  • V1 = forehead
  • V2 = cheek
  • V3 = side of the face and chin
137
Q

What are the full numbers of teeth in a typical permanent set?

A

o 36 teeth

  • 8 incisors
  • 4 canines
  • 8 premolars
  • 12 molars
138
Q

How does this differ from a complete deciduous set?

A

o 20 teeth

  • 8 incisors
  • 4 canines
  • 4 premolars
  • 4 molars
139
Q

Describe the blood supply pathway to the brain.

A
  • external carotid artery -> maxillary artery -> middle meningeal artery
140
Q

How is swallowing impaired by a cerebellar haematoma?

A
  • ataxic swallowing
  • uncoordinated tongue retraction to propel food -> delayed airway closure -> food enters airway -> delayed and ineffective cough to clear airway -> food aspirated to lungs
  • treated by flexing neck during swallowing and exercises to increase swallowing speed and strength
141
Q

How is swallowing impaired by an excised acoustic neuroma (lower motor neurone disease)?

A
  • ipsilateral paresis of the pharynx, larynx, tongue
  • weak bolus propulsion -> pharyngeal & oral residue
  • failed airway closure -> aspiration
  • treated by head rotation to direct bolus down strong side of pharynx and ­airway closure as well as exercises to ­increase tongue and laryngeal muscle strength for 9 months
142
Q

How is swallowing impaired by Parkinson’s disease?

A
  • difficulty initiating swallow -> typical repetitive tongue movements -> linked with muscle rigidity, unable to lower the back of the tongue
  • treated with a range of motion exercises of the lips and tongue
143
Q

How is swallowing impaired by a severe head injury?

A
  • spastic pharynx and tongue -> decreased movement -> infrequent swallowing (1 per 17 mins)
  • ineffective swallow -> residue in pharynx -> aspiration of saliva -> ineffective cough -> unable to clear saliva from airway
  • treated witha long-term NBM and tracheostomy
144
Q

What makes up the upper airway?

A
  • trachea
  • bronchi
  • bronchioles
145
Q

What holds the walls of the larynx, trachea and bronchi open?

A

-plates/crescents of cartilage -> a non-mineralised connective tissue, it is supporting but flexible

146
Q

What holds the nasal cavities and pharynx open?

A
  • attachments to nearby bones
147
Q

What is the function of the larynx?

A
  • protects the airway during ingestion of food
  • not its function but it is used in phonation and speech
148
Q

Describe the structure of the nasal cavities.

A
  • fairly smooth medial and inferior walls
  • an elaborate lateral wall in which the respiratory epithelium with hairy mucosa covers three scroll-like plates of bones called the conchae
  • have a complex and important vascular and nerve supply
149
Q

Describe the function of the nasal cavities.

A
  • inspired air becomes warmed and humidified on the way through then -> protects the lower parts of the respiratory tract from cold shock and drying
  • nasal mucus and hairs help exclude a range of airborne particles -> does mean narrow passages of the nasal cavity have a high resistance to airflow
  • secondary role = sense of olfaction -> olfactory tract has a specialised epithelium with specialised nerve supply
150
Q

Describe nasal flow during exercise.

A
  • during exercise the nasal resistance to flow means nasal airflow isn’t fast enough -> open-mouth breathing takes over -> increased loss of water and exposure to airborne particles
151
Q

What is the innervation of the nasal cavities?

A
  • olfactory nerve (I) = olfaction
  • trigeminal nerve (V) = V1 -> anterior region and V2 -> posterior region
  • facial nerve (VII) = glands (e.g. lacrimal gland, orbit)
  • sympathetic nerves (from T1) = vascular smooth muscle
152
Q

What is the blood supply to the nasal cavities?

A
  • mostly ethmoidal branches of the internal and exterbal carotid arteries
153
Q

Name the four paranasal sinuses.

A
  • frontal
  • maxillary
  • sphenoid
  • ethmoidal
154
Q

What are the functions of the paranasal sinuses?

A
  • reducing the weight of the facial bones -> MAIN FUNCTION
  • providing a “crumple zone” in facial trauma -> protects the brain
  • acting as resonators for the voice
  • insulating sensitive structures such as dental roots and eyes from the rapid temperature fluctuations in the nasal cavities
155
Q

What supplies the sensory innervation to the paranasal sinuses?

A
  • the trigeminal nerve
156
Q

Where do sinuses drain into?

A
  • the nasal cavity via meatuses (spaces between conchae)
157
Q

What is the drainage of lacrimation?

A
  • produced tears drain into the nasal cavity via the nasolacrimal duct
158
Q

Where does ethmoidal air cells drain into?

A
  • ethmoidal bulla (lies between the middle and inferior conchae)
159
Q

What is the arytenoid cartilage?

A
  • cartilage that is attached to vocal ligaments that open and close the larynx -> act as a sphincter preventing entry into the lower airways
  • are open during inspiration and closed during phonation
160
Q

Describe the role of the larynx in sound modulation.

A
  • when the vocal folds are partially open, and air is passed through, sound is made -> this is the mechanism of vocalisation in the mouth -> this is done by the larynx
  • without the larynx, voice would be monotonous, low pitch
161
Q

How is the larynx aid sneezing

A
  • closure of the vocal folds increases the pressure in the thorax and abdomen -> leads to expulsive force -> helps with sneezing, vomitng and childbirth
162
Q

How is tension in the vocal folds altered?

A
  • the thyroid cartilage (which is superior to the cricoid cartilage) rocks backwards and forwards -> assisted by the cricothyroid membrane
  • it rocks by the action of many muscles at the cricothyroid joint
164
Q

Name the tensor of the vocal folds.

A
  • cricothyroid muscle
165
Q

Name the relaxer of the vocal folds.

A
  • thyroarytenoid muscle
166
Q

What is the overall nervous supply to the larynx?

A
  • the vagus via its branches
  • > the superior laryngeal nerve -> internal and external
  • > recurrent laryngeal nerve
167
Q

What nerves supply the motor input to the larynx?

A
  • everything in the larynx has motor innervation from the recurrent laryngeal nerve -> EXCEPT the criothyroid muscle which is from the external laryngeal nerve
168
Q

What nerves supply the sensory input to the larynx?

A
  • everything above vocal cords = recurrent laryngeal
  • everything below vocal cords = internal laryngeal
169
Q

What is the difference between the left and right recurrent laryngeal nerves?

A
  • the recurrent laryngeal nerve is longer on the left side than on the right side
  • the left laryngeal nerve loops around the junction between the aortic arch and pulmonary trunk -> around the ligamentum arteriosum that used to be a patent vessel (ductus arteriosus) -> vagus nerve continues down to form the oesophageal plexus
  • right RLN winds around the right subclavian artery
  • is a discrepancy of the function of the larynx, more in one side than the other -> more likely to damage the left RLN.
170
Q

What is the consequence of a lesion to the internal laryngeal nerve?

A
  • loss of sensation above the vocal folds on the lesion side
171
Q

What is the consequence of a lesion to the external laryngeal nerve?

A
  • paralysis of the cricothyorid muscle on the lesion side
172
Q

What is the consequence of a lesion to the recurrent laryngeal nerve?

A
  • paralysis of all muscles of the larynx except the cricothyroid and loss of sensation below the vocal folds on the lesion side
173
Q

State the 4 protective mechanisms for the airway.

A
  • swallowing
  • gag reflex
  • sneezing
  • coughing
174
Q

Describe the process of sneezing.

A
  • afferents are via the V2 nerve
    1. inspiration occurs and is followed by an intrathoracic pressure rise (glottis closed and the abdominal muscles contract)
    2. soft plate is depressed against the tongue
    3. sudden abduction of vocal folds to release intrathoacic pressure through the nose
175
Q

Describe the process of coughing.

A
  • afferents are via the vagus nerve
    1. inspiration occurs and is followed by an intrathoracic pressure rise (glottis closed and the abdominal muscles contract)
    2. soft plate is raised and tensed against the posterior wall of the pharynx
    3. sudden abduction of vocal folds to release intrathoacic pressure through the mouth
176
Q

Name 5 methods of intubation of a patient/management of the airway.

A
  • chin lift and jaw thrust
  • oropharyngeal or nasopharyngeal airway intubation
  • endotracheal intubation
  • cricothyroidotomy
  • tracheostomy
177
Q

How many cartilage rings hold the trachea open?

A
  • 20 horseshow shaped cartilage rings
178
Q

What is the difference between the anterior and posterior surfaces of the trachea?

A
  • anterior surface is lined with epithelium
  • posterior surface consists of trachealis muscle, which is anterior to oesophageal muscle -> required for swallowing
  • posterior surface is where cartilage ring is not continuous
179
Q

How does otoscopy technique differ when examining an adult and a child?

A
  • adult = pull pinna upwards and backwards to straighten the ear
  • children = pull pinna downwards and backwards
180
Q

State the bones of the orbit.

A
  • roof = orbital plate of the frontal bone
  • floor = orbital plate of the maxilla
  • lateral wall = zygoma and greater wing of sphenoid
  • medial wall = front process of maxilla, lacrimal bone, orbital plate of ethmoid and lesser wing of sphenoid
181
Q

What runs through the optic canal?

A
  • optic nerve (II)
  • opthalmic artery
182
Q

What is found in the inferior orbital fissure?

A
  • maxillary division of the trigeminal nerve (V2)
  • infraorbital vessels
183
Q

What runs through the superior orbital fissure?

A
  • ophthalmic division of the trigeminal nerve (V1)
  • oculomotor nerve (III)
  • trochlear nerve (IV)
  • abducens nerve (VI)
  • ophthalmic vessels and Sympathetic fibres (tend to run with the vessels)
184
Q

Name the 3 orbital foramina.

A
  • optic canal
  • inferior orbital fissure
  • superior orbital fissure
186
Q

State the 4 recti muscles.

A
  • inferior rectus
  • superior rectus
  • medial rectus
  • lateral rectus
187
Q

Where do the recti muscle originate from and insert into?

A
  • from the back of the orbit in the common tendinous ring
  • the recti muscles insert into the sclera (5mm behind the corneal margin)
188
Q

What is the nervous supply to the recti muscles?

A
  • inferior, superior and medial recti = oculomotor (III)
  • lateral rectus = abducens (VI)
189
Q

State the 2 extrinsic muscle of the eye?

A
  • inferior oblique
  • superior oblique
190
Q

Where does the superior oblique muscle originate from and insert into?

A
  • from the body of the sphenoid
  • insert into the globe in the posterior/superior quadrant via the trochlear
191
Q

What is the nervous supply to the superior oblique muscle?

A
  • trochlear (IV)
192
Q

Where does the inferior oblique muscle originate from and insert into?

A
  • originates in the orbital surface of the maxilla and insert into the globe of posterior/inferior quadrant
193
Q

What is the nervous supply to the inferior oblique muscle?

A
  • oculomotor (III)
194
Q

What is the muscle of the upper eyelid?

A
  • levator palpebrae superioris
195
Q

Where does the levator palpebrae superioris originate and insert into?

A
  • originates in the lesser wing of the sphenoid
  • inserts at the superior tarsal plate and skin of the eyelid
196
Q

What is the nervous supply for the levator palpebrae superioris?

A
  • oculomotor (III) and sympathetic innervation to smooth muscle
197
Q

What is Horner’s syndrome?

A
  • damage to the sympathetic nerve of the face
  • characterised by ptosis (drooping upper eyelid), miosis (constriction of the pupil) and anhidrosis (absence of sweating from the face)
198
Q

What is the action of the lateral rectus?

A
  • abducts the eyes
199
Q

What is the action of the medial rectus?

A
  • adducts the eye
200
Q

What muscles are involved in depressing the eye?

A
  • inferior rectus
  • superior oblique
201
Q

What muscles are involved in elevation of the eye?

A
  • superior rectus
  • inferior oblique
202
Q

How do you test the action of the superior oblique muscle?

A
  • ask the patient to adduct their eye (right or left) towards the midline, before they look down
203
Q

What are the roles of the extrinsic muscles?

A
  • depression (IO) and elevation (SO)
  • rotational aspect -> intorsion and extorsion
204
Q

What are the 3 branches of the ophthalmic (V1) nerves?

A
  • lacrimal
  • frontal
  • nasociliary
205
Q

What travels through the cavernous sinus?

A
  • the branches of the ophthalmic nerve (lacrimal, frontal and nasociliary)
  • internal carotid artery
  • maxillary branch of the trigeminal
  • trochlear nerve
  • oculomotor
206
Q

Where is the ciliary ganglion located?

A
  • behind the eye
207
Q

What is the ciliary ganglion?

A
  • ganglion of parasympathetic fibres
  • preganglionic fibres are in the inferior ramus of the oculomotor nerve and the postganglionic fibres are in the short ciliary nerves
  • supply the sphincter pupillae muscle and ciliary muscles of the eye
208
Q

What is the blood supply to the eye?

A
  • the ophthalmic artery supplies blood via the:
  • > central artery of the retina
  • > muscular branches
  • > ciliary branch
  • > lacrimal branch
  • > supratrochlear branch
  • > supraorbital branch
209
Q

Describe the venous drainage of the eye?

A
  • superior ophthalmic vein drains back into the cavernous sinus -> potential route of infection
  • inferior ophthalmic vein drains back into the pterygoid plexus -> no passage into cranial cavity
210
Q

Where is the lacrimal gland located?

A
  • anterolateral superior orbit
211
Q

What nerve supplies the lacrimal gland?

A
  • lacrimal nerve - parasympathetic
212
Q

Describe the lacrimal sac?

A
  • located in the medial canthus of the eye
  • drains into the nose via the nasolacrimal duct then into the inferior meatus of the nose
214
Q

What travels through the superior orbital fissure?

A
  • oculomotor nerve
  • trochlear nerve
  • abducens nerve
  • ophthalmic divisional of the trigeminal nerve
  • superior ophthalmic vein
215
Q

What passes through the inferior orbital fissure?

A
  • zygomatic branch of the maxillary nerve
  • ascending branches from the pterygopalatine ganglion
216
Q

What is the first cranial nerve?

217
Q

What is the second cranial nerve?

218
Q

What is the third cranial nerve?

A
  • oculomotor
219
Q

What is the fourth cranial nerve?

220
Q

What is the fifth cranial nerve?

A
  • trigeminal
221
Q

What is the sixth cranial nerve?

222
Q

What is the seventh cranial nerve?

223
Q

What is the eighth cranial nerve?

A
  • vestibulocochlear
224
Q

What is the ninth cranial nerve?

A
  • glossopharngeal
225
Q

What is the tenth cranial nerve?

226
Q

What is the eleventh cranial nerve?

227
Q

What is the twelth cranial nerve?

A
  • hypoglossal
228
Q

What artery supplies the face?

A
  • external carotid
229
Q

What artery supplies the cerenral hemispheres?

A
  • internal carotid
230
Q

What is the path of the vertebral arteries?

A
  • arteries branch off the subclavian arteries and make their way through transverse foramina in the cervical vertebrae and through the foramen magnum into the brain
231
Q

State the 3 keys arteries of the circle of willis.

A
  • middle cerebral artery - biggest
  • anterior cerebral artery -> anterior communicating arteries join the two anterior cerebral arteries
  • posterior cerebral artery -> basilar artery bifurcation and the posterior communicating artery joins the posterior and middle cerebral arteries
302
Q

Musculature of Oesophagus

Y2 LCRS (8 decks)

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