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

Anatomy of the Head, Neck and Spine Flashcards

1
Q

What is a suture?

A

A fibrous joint permitting little or no movement.

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2
Q

What happens to the periosteal dura at the foramen magnum?

A

It fuses with the skull.

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3
Q

What is a fontanelle?

A

A large membranous and unossified gap between the bones of the skull in foetuses and newborns. Fontanelles allow the head to deform through the birth canal and allow postnatal growth.

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4
Q

Relate the positions of the fontanelles to the positions of suture intersections.

A 
Bregma = position of the anterior fontanelle
Lambda = position of posterior fontanelle.
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5
Q

Which meningeal layer contains the meningeal arteries.

A

The periosteal layer of the dura mater - which is firmly attaches to the inner surface of the skull and serves as the periosteum of the cranial cavity.

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6
Q

At what locations is the periosteal dura mater continuous with the periosteum on the outer-surface of the skull?

A

At the foramen magnum and other intracranial foramina.

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7
Q

What 2 types of structure are formed by the separation of the periosteal and meningeal dura mater.

A

Intracranial venous structures; dural partitions.

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8
Q

Detail the 4 dural partitions.

A

Falx cerebri is between the 2 cerebral hemisphere.

Tentorium cerebelli is a horizontal projection of meningeal dura mater which covers the cerebellum in the posterior cranial fossa from the posterior parts of the cerebral hemispheres.

Falx cerebelli is a small midline projection in the posterior cranial fossa.

Diaphragma sellae is small horizontal shelf of meningeal dura which covers the hypophyseal fossa in the sella turcica of the sphenoid bone. Infundibulum passes through an opening in the centre of the diaphragma sellae.

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9
Q

What are diploic veins?

A

Diploic veins run between the internal and external tables of compact bone in the roof of the cranial cavity, and drain into venous sinuses.

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10
Q

What are emissary veins?

A

Veins which drain from outside the cranial cavity to the dural venous sinuses. These veins are important as they can be a conduit through which infections can enter the cranial cavity because they have no valves.

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11
Q

Which venous sinus connects the superior and inferior sagittal sinuses?

A

The straight sinus.

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12
Q

Which sinuses drain to and from the confluence of sinuses?

A

Superior sagittal sinus, straight sinus, right and left transverse sinuses.

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13
Q

How is venous blood drained from the brain?

A

Left and right transverse sinuses continue as sigmoid sinuses to the internal jugular vein.

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14
Q

Describe the circle of Willis.

A

Basilar artery (formed by the convergence of the 2 vertebral arteries) bifurcates into 2 posterior communicating arteries (which give off posterior cerebral arteries). After the merger of the internal carotids, which continue as middle cerebral arteries, the arteries continues as anterior cerebral arteries, with the circle completed by a small anterior communicating artery.

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15
Q

Name the cranial base foramina from anterior to posterior.

A

Cribriform plate, optic canal, superior orbital fissure, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, internal acoustic meatus, jugular foramen, hypoglossal canal, foramen magnum.

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16
Q

What is the only groove which the arachnoid mater enters?

A

Longitudinal fissure.

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17
Q

What passes through the jugular foramen?

A

Glossopharyngeal, vagus, spinal accessory nerves and sigmoid sinuses (continuing to the internal jugular vein).

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18
Q

What structures pass through the internal acoustic meatus?

A

Facial and vestibulocochlear nerves and labyrinthine artery.

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19
Q

What passes through the foramen spinosum?

A

Middle meningeal artery and vein.

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20
Q

Which foramina do each of the branches of the trigeminal nerve pass through?

A

Ophthalmic branch passes through the superior orbital fissure.
Maxillary division passes through the foramen rotundum.
Mandibular division passes through the foramen ovale.

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21
Q

What passes through the superior orbital fissure?

A

Oculomotor, trochlear, ophthalmic division of trigeminal and abducens nerves and superior ophthalmic vein.

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22
Q

Define primary and secondary curvatures of the vertebral column.

A

A primary curvature is present in the foetal position (concave anteriorly). THORACIC; SACRAL
A secondary curvature is not present in foetuses (concave posteriorly). CERVICAL; LUMBAR

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23
Q

What is a kyphosis, lordosis and scoliosis?

A 
Kyphosis = excessive thoracic curvature ("hunch-back")
Lordosis = excessive lumbar curvature
Scoliosis = lateral curvature.
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24
Q

What is the filum terminale?

A

A continuation of the pia mater from the conus medullaris which anchors the spinal cord. It is a white filament.

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25
Q

What are the features of a typical vertebra?

A

A vertebral body (which is the major weight bearing part).
A vertebral arch.
Pedicles - which anchor the vertebral arch to the vertebral body.

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26
Q

Give the different shapes of the vertebral bodies and arches for different regions of the vertebral column.

A

CERVICAL: ‘rectangular’ body with triangular vertebral foramen.
THORACIC: heart-shaped body with relatively small circular vertebral foramen.
LUMBAR: kidney-shaped body with triangular, intermediate-sized vertebral foramina.

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27
Q

What is atypical about C1 (atlas)?

A

It doesn’t have a vertebral body. Instead, the axis (C2) has a dens of axis which slots through the foramen for dens of axis in the atlas. This allows rotation.

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28
Q

Between which structures are the atlanto-occipital and atlanto-axial joints?

A 
Atlanto-occipital = between skull and C1
Atlanto-axial = between C1 and C2
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29
Q

Briefly describe the different ligaments of the vertebral column.

A

Anterior and posterior longitudinal ligaments on the vertebral bodies.
Supraspinous ligament connects the spinous processes.
Interspinous processes between the spinous processes.
Ligamentum flavum between the laminae.

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30
Q

Why is C7 called the vertebra prominens?

A

Because of its long spinous process, it is usually the first spinous process one can visualise and easily palpate.

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31
Q

What is the usual number of anterior spinal arteries and veins and posterior spinal arteries and veins?

A

1 anterior spinal artery: 2 posterior spinal arteries.

3 anterior and posterior spinal veins.

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32
Q

Describe the ligamenta flava.

A

Each ligamentum flavum runs between the POSTERIOR SURFACE of the lamina on the vertebra below to the ANTERIOR SURFACE of the lamina on the surface above.
Ligamenta flava resist separation of the laminae in flexion.

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33
Q

Describe the ligamentum nuchae.

A

A triangular, sheet-like structure in the median sagittal plane. The base of the triangle is attached to the skull from the external occipital protuberance to the foramen magnum. The apex is attached to the tip of the spinous process of C7. The deep side of the triangle is attached to the posterior tubercle of vertebra C1 and the spinous process of other cervical vertebrae.
The ligamentum nuchae supports the head and resists flexion. It facilitates returning the head to the anatomical position.

34
Q

How do you test cranial nerves III, VIII, X and XI?

A

III (oculomotor) = look for pupillary light reflex
VIII (vestibulocochlear) = whisper a number in their ear and ask them to enunciate it.
X (vagus) = ask them to say “aah” and observe the uvula rise.
XI (accessory) = ask them to shrug their shoulders. Move head from side to side.

35
Q

How do you test trigeminal nerve function, CN V?

A

Sensory divisions: get them to close their eyes and gently touch each of the 3 dermatomes bilaterally with cotton wool.
Motor function: palpate masseter and temporalis as they clench their teeth.

36
Q

How do you test facial nerve function (CN VII)?

A

Ask the patient to raise their eyebrows (look for creasing of forehead as frontalis contracts); keep eyes closed against resistance (orbicularis oculis) and bare their teeth (risorius).

37
Q

How do you test the hypoglossal nerve, CN XII?

A

Only motor nerve to tongue: ask them to stick their tongue out.

38
Q

How do you test CN I?

A

Olfactory nerve tested by presenting olfactory stimuli to a patient with their eyes closed, such as an orange or coffee, and asking them to identify the smell.

39
Q

The loss of taste sensation over the tongue indicates damage to which cranial nerves?

A

Anterior 2/3 indicates facial nerve defect.

Posterior 1/3 indicates glossopharyngeal (CN IX) defect.

40
Q

Other than the posterior 1/3 of the tongue, where is CN IX the main sensory nerve?

A

Oropharynx.

Test by eliciting gag reflex.

41
Q

What are the 2 openings of the oral (buccal) cavity?

A 
Anterior = oral fissure
Posterior = oropharyngeal isthmus.
42
Q

What passes through the foramen magnum?

A

Vertebral arteries, medulla of brainstem, spinal roots of accessory nerve.

43
Q

What major structures are at each level of the C-spine?

A 
C1 = open mouth
C2 = Superior cervical ganglion
C3 = Body of hyoid
C4 = Upper border of thyroid cartilage, bifurcation of common carotid artery.
C6 = Middle cervical ganglia, cricoid cartilage
C7 = inferior cervical ganglia.
44
Q

Describe the borders of the 2 triangles of the neck.

A

Anterior triangle: base = mandible. Hypotenuse = sternocleidomastoid.
Posterior triangle: base = middle 1/3 of clavicle, hypotenuse is also the sternocleidomastoid and the trapezius is the posterior border.

45
Q

What structures are in the anterior triangle of the neck?

A

Mainly muscles: platysma, mylohyoid, digastric, infrahyoid.

Also carotid arteries, internal jugular vein, accessory nerve.

46
Q

What structures are in the posterior triangle of the neck?

A

Mainly blood vessels and nerves: external jugular vein, subclavian artery and vein, trunks of brachial plexus; phrenic, vagus and accessory nerves.

47
Q

Briefly describe swallowing and the muscles involved.

A

Lift and retract tongue (styloglossus)
Bolus into oropharynx (palatoglossus).
Close off nasopharynx by raising soft palate
Raise the larynx, close off trachea by epiglottis
Peristaltic wave of constrictor muscles (sensory CN IX, motor CN X).
Relax cricopharyngeus, open oesophagus.

48
Q

Describe the 3 main salivary glands.

A

Parotid (mainly serous) - CN IX - travels via parotid duct which opens next to 2nd upper molar.
Submandibular (mainly serous) - CN VII
Sublingual (mainly mucous) - CN VII

49
Q

Describe the musculature of the tongue.

A

3 extrinsic: styloglossus (retracts tongue, to move the bolus into the pharynx), hyoglossus (tongue –> hyoid, depresses the tongue), genioglossus (tongue –> mandible, protrudes the tongue).
Intrinsic muscles.

50
Q

Describe innervation of the tongue.

A

All muscles with “glossus” in their names supplied by XII for motor function, except palatoglossus (X).
Sensation: anterior 2/3 is trigeminal (CN V) via LINGUAL nerve. Taste for anterior 2/3 is facial (CN VII) via CHORDA TYMPANI.
Both taste and sensation of posterior 1/3 of tongue is supplied by glossopharyngeal nerve (CN IX).

51
Q

Give the muscles of mastication.

A

Superficial: masseter and temporalis elevate mandible
Lateral pterygoid depresses and protracts mandible to open mouth.
Medial pterygoid elevates, protracts and lateral movements of mandible for mastication.

52
Q

The internal carotid artery has no branches once it bifurcates from the common carotid artery at C4. What are the branches of the EXTERNAL carotid artery?

A 
Superior thyroid
Ascending pharyngeal.
Lingual
Facial
Occipital
Posterior auricular
Maxillary
Superficial temporal. 
"Some anatomists like freaking out poor medical students"
53
Q

What are the branches of the facial nerve from superior to inferior?

A

Temporal, zygomatic, buccal, mandibular, cervical.

54
Q

How many of each type of tooth are in each quadrant of the buccal cavity?

A

2 incisors (central and lateral incisors), 1 canine, 2 premolars and 3 molars.

55
Q

Describe the structure of the nasopharynx.

A

3 conchae, with 3 meatuses between them (inferior).
Conchae warm and humidify air, help trap pathogens.
Frontal sinus superior to superior concha.
Sphenoidal sinus posterior to conchae.
Sinuses reduce the weight of the skull, provide crumple zones and help with resonance (project the voice).

56
Q

What are the 2 vocal cords called?

A

The 2 medial “true” vocal cords are called vocal folds.

The 2 lateral “false” vocal cords are called vestibular folds.

57
Q

Describe the innervation of the larynx.

A

Vagus. Gives off a superior branch called the superior laryngeal nerve. Splits into internal and external laryngeal nerves. Internal branch supplies sensation above vocal cords. External branch supplies cricothyroid.
Gives off an inferior branch: the recurrent laryngeal nerve. Left recurrent laryngeal loops round the ligamentum arteriosum. The right recurrent laryngeal loops around the right subclavian artery. Both travel with inferior thyroid arteries.
The inferior branch supplies all muscles except the cricothyroid muscle, which tenses the vocal cords. Sensation below vocal cords.

58
Q

How do we cough?

A

Afferents via vagus nerve.
Inspiration - intrathoracic pressure raised (epiglottis closed, abdominal muscles contract)
Soft palate raised and tenses against posterior wall of pharynx.
Sudden abduction of vocal folds to release intrathoracic pressure through mouth.

59
Q

How do we sneeze?

A

Afferents via V2 (Maxillary nerve).
Inspiration - intrathoracic pressure raised (epiglottis closed, abdominal muscles contract)
Soft palate depressed against tongue.
Sudden abduction of vocal folds to release intrathoracic pressure through nose.

60
Q

What structure of the auricle overlaps the external acoustic meatus?

A

The tragus.

61
Q

What does the facial nerve supply and what does it pass through?

A

Passes through internal acoustic meatus and then parotid gland (without innervating it) - except chorda tympani which goes through petrotympanic fissure to supply taste to the anterior 2/3 of the tongue.
Motor (large) - muscles of facial expression, stapedius, posterior belly of digastric, stylohyoid.
Parasympathetic sensory = lacrimal glands, mucous glands, hard and soft palates, sublingual and submandibular glands. General sensation from external acoustic meatus and deeper parts of auricle.

62
Q

What are the bones of the orbit?

A

Roof = orbital plate of frontal bone
Floor = orbital plate of maxilla
Lateral wall = zygoma and greater wing of sphenoid
Medial wall = frontal process of maxilla, lacrimal bone, orbital plate of ethmoid, lesser wing of sphenoid.

63
Q

What passes through each of the orbital foramina?

A

Optic canal = optic nerve + ophthalmic artery.
Inferior orbital fissure = maxillary nerve (V2) and infraorbital vessels.
Superior orbital fissure = ophthalmic artery (V1), abducens, trochlear, oculomotor, ophthalmic vessels and sympathetic fibres.

64
Q

Detail the extrinsic eye muscles.

A

Inferior, superior, medial and lateral recti, all originating from the common tendinous ring at the back of the orbit and inserting into the sclera, 5mm behind the corneal margin.
All oculomotor (III) except lateral rectus which is abducens (VI).
Inferior and superior oblique. Oculomotor and trochlear (IV) innervation respectively.
LPS (levator palpebrae superioris) innervates upper eyelid. Oculomotor and sympathetic.

65
Q

How do you test the trochlear nerve?

A

Ask the patient to first adduct the eye (medial rectus) and then DEPRESS it.

66
Q

What are the palpebral fissure, limbus, lateral canthus, caruncle and punctum?

A

Palpebral fissure = space between eyelids.
Limbus = delineation between iris and sclera
Lateral canthus = lateral corner of eye
Caruncle = medial corner of eye
Punctum = where tears drain in medial corner of eye.

67
Q

Describe the tear film.

A

Maintains smooth cornea-air surface.
Oxygen supply to cornea (normal cornea is avascular).
Removal of debris (tear film and blinking), bactericide.
3 layers: superficial oily layer to reduce tear film evaporation.
Aqueous tear film (very thick).
Mucinous layer on corneal surface to maintain surface wetting.

68
Q

What is the conjunctiva?

A

The thin, transparent tissue that covers the outer surface of the eye. Begins at outer edge of cornea. Covers visible part of eye and lines insides of eye lids. Nourished by tiny blood vessels.

69
Q

What are the 3 layers that coat the eye?

A

Sclera - the eye’s outer protective layer, high in water content.
Choroid - pigmented and vascular
Retina - neurosensory tissue

70
Q

What is the cornea and what are its layers?

A

The transparent, dome-shaped window covering the front of the eye. It is a powerful refracting surface, providing 2/3 of focusing power.
5 layers: epithelium, Bowman’s membrane, stroma, Descemet’s membrane, endothelium.

71
Q

What is the iris?

A

The coloured ring surrounding the pupil, embedded with tiny muscles which contract and dilate the pupil.

72
Q

What is the lens?

A

A transparent structure which provides 1/3 of the focusing power of the eye. Accommodates vision (is elastic). Loses transparency with age (cataracts). Suspended by a fibrous ring: the lens zonules.

73
Q

How is the anterior chamber of the eye (between the cornea and lens) nourished?

A

Aqueous fluid - secreted by ciliary body. Drained by trabecular meshwork drains (Schlemm’s canals).

74
Q

What is the role of the fovea (the centre of the macula)?

A

Reading, facial recognition, colour vision.

It is the most sensitive part of the retina, with the highest concentration of cones and lowest of rods.

75
Q

What are the layers of the retina?

A

Outer layer = photoreceptors (1st order neuron) which detects light.
Middle layer = bipolar cells (2nd order) - local signal processing to improve contrast sensitivity.
Inner layer = retinal ganglion cells (3rd order) - transmission to brain.

76
Q

Describe dark adaptation.

A

Biphasic process. Cone adaptation in 7 mins. Rod adaptation in 30mins. Regenerates RHODOPSIN.

77
Q

Describe light adaptation.

A

Occurs over 5 mins - bleaching of photo-pigments. Inhibition of rod/cone function.

78
Q

What is emmetropia?

A

Adequate correlation between axial length and refractive power - parallel light rays fall on retina.

79
Q

What is ametropia? Give causes.

A

Mismatch between axial length and refractive power.
Near-sightedness = myopia (parallel rays converge at focal point anterior to retina). Excessive refractive power = refractive myopia (more common) or excessively long globe (axial myopia).
Far-sightedness = hyperopia. Excessively short globe or insufficient refractive power.

80
Q

What is presbyopia?

A

A naturally occurring loss of accommodation - the loss of power means distant vision is preserved but close objects are blurred. Due to hardening of lens or weakening of ciliary muscles, so the lens is less flexible, onset 40Y+ - distant vision intact. Corrected by reading glasses (convex lens).

81
Q

Briefly describe how you test the function of the sternocleidomastoid muscle, and which nerves innervate this muscle?

A

Ask the patient to turn their head right or left against resistance.
Innervated by accessory nerve and C3,4.

Anatomy (8 decks)

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