Anatomy [Week 3] Flashcards
The primary position (of gaze) and long axis of orbit are _____ degrees apart. What is the implication of this?
23 degrees; must look off to the side in order to alight eyes with a muscle to test that muscle
Which 7 bones make up the orbit?
- frontal 2. zygomatic 3. maxilla 4. palatine 5. sphenoid 6. ethmoid 7. lacrimal
What foramen is in the lateral part of the orbit?
superior orbital fissure
What foramen is in the floor of the orbit?
inferior orbital fissure
Why when people break their nose, why is it that they can also get a black eye?
anastamoses between blood vessels in the “dangerous area”
Which two muscles in the eye are smooth (involuntary)?
- superior tarsal muscle 2. ciliary muscle
What are the 4 layers of the eye?
- skin/little fat 2. muscle 3. tarsal plates and orbital septum 4. conjunctiva
What are the SUPERIOR/INFERIOR CONJUNCTIVAL FORNIX?
where palpebral conjunctival (fascia layer), lining the eyelid, doubles back on itself to form the bulbar conjunctiva, lining the eye
What structure receives ducts of the lacrimal gland? (emptying)
the superior fornix
What are in the TARSAL PLATES?
-superior/inferior tarsals -levator palpebrae m. (CN III) -superior tarsal m (CN III) -tarsal glands
What do the TARSAL GLANDS do?
spreads oily layer to reduce evaporation over the eye; spreads when you blink
What are the 3 type of CONJUNCTIVITIS? What are the characteristics of each?
- viral = watery discharge and photophobia 2. bacterial = discharge of pus (pink eye) 3. allergic reaction = itching/redness/edema
How are TARSAL PLATES linked to bone of orbit?
via the medial and lateral palpebral ligaments
What are 3 characteristics of the lens of the eye?
- transparent, bicovex 2. made of lens fibers = cells that have eliminated all organelles and are crystalline 3. zonule fibers of zin connect lens to ciliary muscles (capsule)
What fills the anterior chamber of the eyeball?
aqueous humor (made by epithelium of the ciliary body)
What fills the posterior chamber of the eyeball?
vitreous humor, made up of liquid and glycoaminoglycans
When the ciliary muscles contract, the lens widens and focuses. What is this process called?
accommodation
If someone has CATARACTS, what is the clinical problem with the patient? What can be done to fix this problem?
-has a cloudy lens -surgery to remove lower part of lens and put in artificial lens
What is the SCLERA and what is its importance?
posterior 5/6 of eyeball (opaque, white) and it is where extra ocular muscles insert
Which structure has the most focusing capability?
CORNEA! (lens also has focusing capability, but not as much as cornea)
Name 3 characteristics of the CORNEA.
- major refractive structure for focusing 2. transparent 3. avascular
Why are CORNEA TRANSPLANTS rarely rejected?
because they are avascular!
What is the purpose of the CHOROID in the eye?
gives nutrients to the retina; it is highly pigmented
What is the most vulnerable area of the eye to mechanical torsion?
the origin of of the optic nerve on the back of the eye
Suppose a patient has an increase in CSF surrounding their eye. What will this due regarding the optic nerve?
-cause it to bulge out; can see upon clinical examination
What is GLAUCOMA?
glaucoma = too much pressure can block CN II can lead to blindness due to lack of drainage of aqueous humor
How is the DILATOR MUSCLE OF THE PUPIL arranged? What does it do?
-radially -dilates pupil
How is the SPHINCTER MUSCLE OF THE PUPIL arranged? What does it do?
-circumferentially arranged -close aperature
If you think of the lens of the eye as a trampoline, what are the springs and what is the frame?
springs = zonule fibers of zin frame = ciliary muscle
When the lens is slack, what kind of focus are you doing?
close
When the lens is pulled tight, what kind of focus are you doing?
distance
Where is the LACRIMAL GLAND located?
superiolaterally in lacrimal fossa
Describe the path of tears from the lacrimal gland to the pharynx.
Palpebral part of lacrimal gland–>excretory ducts–>medial/inferior on cornea–>lacrimal lake–>lacrimal caruncle–>lacrimal canaliculi (with lacrimal papillae)–>lacrimal sac—>nasolacrimal duct–>inferior nasal meatus–>nasal cavity–>PHARYNX!
Which two arteries pierce the ethmoid bone near the superior oblique fissure?
anterior/posterior ethmoidal arteries
Which vessels are involved in the anastamosis between the internal and external carotid arteries?
ECA–>facial—>angular—>Ant. ethmoidal/post ethmoidal arteries–>opthalmic artery—>ICA
Name 7 branches of the OPHTHALMIC ARTERY.
- central artery of retina 2. lacrimal a. 3. supraorbital a. 4. supratrochlear a. 5. dorsal nasal a. 6. post. ethmoidal a. 7. ant. ethmoidal a.
Which artery pierces the optic nerve and supplies the retina?
CENTRAL ARTERY OF THE RETINA
Which foramen does the OPHTHALMIC ARTERY travel?
optic canal (with optic nerve)
What are the 3 main veins of the orbit?
- central v. of the retina 2. superior ophthalmic v. (goes through sup. orbital fissure) 3. inferior opthalmic v. (goes through inf. orb. fissure)
Where do the superior/inferior opthalmic veins drain? Why is this significant?
pterygoid plexus–>cavernous sinus; sig. for infections (danger triangle!)
Describe the route of the OPTIC NERVE.
[sensory = vision] from retinal ganglion—>pierces sclera medial to posterior pole of eyeball—>exits orbit through optic canal of sphenoid to form optic chiasm (medial nerves cross to contralateral side)–>optic tracts terminate in lateral geniculate nucleus (in thalamus)—>to cortex
What does injury to optic nerve cause?
visual field defects
Describe the route of GVA of CN V1.
from sensory receptors (pain, temperature, pressure, etc.)—>through superior orbital fissure—>cavernous sinus—>neuron cell bodies in trigeminal ganglion–>sensory nucleus of cortex/spinal nucleus of CN V
Which branches of CN V1 are important (3)? Where are they located??
1.Lacrimal n. 2. Frontal n. = supratrochlear, supraorbital, n. to frontal sinus 3. Nasociliary n. = ant/post ethmoidal, infratrochlear, meningeal, long/short ciliary) -Located on top of levator palpebrae superioris/lateral rectus muscle; superior aspect of eye
Describe the GSE (motor) innervations of the muscles of the orbital region. Which foramen do they travel from the brainstem?
-CN III = all muscles except: 1. CN IV = superior oblique m. 2. CN VI = lateral rectus m. -superior orbital fissure
What structures receive GVE (PNS) innervation in the orbit?
- Lacrimal gland 2. Sphincter pupillae and ciliary m. 3. Dilator pupillae and superior tarsal m.
Describe the path of PNS innervation of the lacrimal gland.
superior salivary nucleus—>travels with VII to —>geniculate ganglion (NO synapse)—>travels with greater petrosal n. through pterygopalatine fossa, joins with deep petrosal to form nerve of pterygoid canal—>PTERYGOPALATINE GANGLION (SYNAPSE!!!!)—>travels with zygomaticotemporal n./lacrimal n.—>Lacrimal gland (secrete tears)
Describe the SNS innervation of the LACRIMAL GLAND.
lateral horn of spinal cord—>ventral root/spinal nerve/ventral ramus/white ramus communicantes–>SUPERIOR CERVICAL GANGLION (SYNAPSE!!!)–> internal carotid n., deep petrosal n. thru carotid canal/joins greater petrosal n (PNS)—>nerve of pterygoid canal —>lacrimal n.—>Lacrimal gland (vasoconstricts BVs)
Describe the GVE (PNS) route of the SPHINCTER PUPILLAE/CILIARY MUSCLES.
edinger-westphal nucleus—>with CN III—>CILIARY GANGLION (SYNAPSE!!!)–>short ciliary nn (V1)—>spincter pupillae/ciliary m. contract
Describe the SNS route of the DILATOR PUPILLAE/SUPERIOR TARSAL MUSCLES.
Spinal cord (lateral horn)–>SUPERIOR CERVICAL GANGLION (SYNAPSE!!!)–>via int. carotid plexus/ciliary ganglion/long ciliary nn (V1)–>dilator pupillae/superior tarsal mm.
What will an injury to CNS III (including SNS) look like?
-person cannot open eyelid (ptosis) -pupil will be pinpoint (miosis)
What does the SUPERIOR LEVATOR PALPEBRAL m. do? Which CN does this?
raise upper eyelid; CN III
What does the MEDIAL RECTUS m. do? Which CN does this?
turn eyeball medially (adduction); CN III
What does the LATERAL RECTUS m. do? Which CN does this?
turn eyeball laterally (ABduction); CN VI
What does the SUPERIOR RECTUS m. do? Which CN does this?
ADduction, elevation, intorsion of eyeball; CN III
What does the INFERIOR RECTUS m. do? Which CN does this?
ADduction, depression, extorsion; CN III
What does the SUPERIOR OBLIQUE m. do? Which CN does this?
aBduction, depression (LOOK DOWN), intorsion; CN IV
What does the INFERIOR OBLIQUE m. do? Which CN does this?
aBduction, elevation (LOOK UP), extorsion; CN III
You tell someone to look to their right and up. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R = superior rectus L = inferior oblique
You tell someone to look to their left and up. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R = inferior oblique L = superior rectus
You tell someone to look to their right and down. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R = inferior rectus L = superior oblique
You tell someone to look to their left and down. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R = superior oblique L = inferior rectus
You tell someone to look to their right. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R = lateral rectus L = medial rectus
You tell someone to look to their left. Which muscle are you testing on their RIGHT eyeball? LEFT eyeball?
R= medial rectus L = lateral rectus
A patient comes in and cannot open his right eyelid nor can he look straight with his pupil–it is off to the lateral side of his face. Which nerve is injured?
CN III (superior levator palpebral m. and medial rectus)
You ask a patient to look straight at you and her left eye is looking medially. Which nerve is damaged?
CN VI (lateral rectus) = ABDUCENT PALSY
A patient comes into the ophthalmologist complaining of diplopia (double vision). It is worse when he tilts his head to the left and better when he tilts it to the right. What is your diagnosis?
left superior oblique muscle atrophy (CN IV palsy!!); too much extorsion/not enough intorsion
What is HORNER’S SYNDROME?
injury to SNS fibers: miosis, ptosis, anhidrosis (lack of sweating), erythematosis (blushing of skin–>blood vessels open)
What happens when there is an injury to the PNS fibers with CN III?
-pupil dilation (sphincter cili can’t contract) -loss of accommodation to light reflex (ciliary m. cannot contract–>focus only near)
You ask a patient to follow your finger with his eyes. You slowly go toward his nose but he cannot ADduct his eye or look down. Which nerve/muscle is injured?
CN IV; superior oblique m.
The NASAL CAVITY extends from the ______ to the ______ , where it opens into the nasopharynx
-external nares -choanae
The ORAL CAVITY is the ____ part of the alimentary tract, the oral _____ and oral _____ proper.
-first -vestibule -cavity
Name the 3 divisions of the pharynx.
- nasopharynx 2. oropharynx 3. laryngopharynx
The LARYNX functions in ______; and connects the ______ with the ______.
-phonation -oropharynx -trachea
You find someone on the ground unconscious. After assessing the situation and asking someone nearby to call for help, you _______ by _________.
-assess the airway -tilting head back
What to help someone in a hospital for aspirating, you can place breathing tubes in two places. What are they?
- nasopharyngeal airway 2. oropharyngeal airway
A 27yo obese male comes into the clinic with exertional dyspnea. What is causing this?
Due to resistance in airway because of constriction; too much fat pressing on airway to accommodate extra physical activity
The openings of the _____ are at the second upper molar tooth.
PAROTID GLAND
Where is the submandibular tract opening?
lateral to frenulum, under the tongue
What is the ORAL CAVITY proper bound by?
teeth, gums, palate/floor of mouth; from oropharynx to oropharyngeal isthmus.
What is the Mallampati score?
used to predict the ease of intubation
Name the 4 classes of Mallampati scores:
Class I = soft palate uvula fauces pillars visible
Class II = soft palate, uvula, fauces visible
Class III = soft palate, base of uvula visible
Class IV = only hard palate visible
Where are the palatine glands?
on the hard and soft palates!
In the CN V2 nerve on the hard palate, the ______ innervates the inscisors/canine, the _____ innervates 2 premolars-1/2 molar and _____ innervates 2 1/2 molars.
- anterio superior alveolar
- middle superior alveolar
- posterior superior alveolar
The _______ and _______ come of the Maxillary nerve (V2) to innervate the hard and soft palates, respectively.
- greater palatine nerve
- lesser palatine nerve
What 4 muscles make up the soft palate? Which are on top? Which are on bottom?
- levatory veli palatini = top
- tensor veli palatini = top
- palatoglossus = bottom
- palatopharyngeus = bottom
The ________ hooks under the ______ in the soft palate in order to contract the top of the soft palate.
tensor veli palatini
pterygoid hamulus
The _____ is in the anterior midline of the hard palate.
incisive fossa
Label the structures the black lines are pointing to:
top = incisive fossa
bottom left = horizontal plate of palatine bone
bottom right (top) = greater palatine fossa
bottom right (bottom) = lesser palatine fossa
The tongue has 3 parts. Name them.
- root
- body
- apex
Where is the choana?
behind the nasal turbinates proximal to nasopharyngeal cavity
The body of the tongue has ______ on its surface.
papillae
The root of the tongue contains the _______, _____ and _______
sulcus terminalus, foramen cecum and lingual tonsil
The tonge is attached to the ______ [4 things] by extrinsic muscles.
- mandible
- hyoid bone
- styloid process
- palate
Name these muscles (innervated by CN X). Which muscle is missing? What is that muscle innervated by?
18 = styloglossus
19 = hyoglossus
20 = genioglossus
missing = palatoglossus (CN XII)
In terms of taste, what is the yellow area innervated by? The blue? The red?
yellow = CN IX
blue = chorda tympani (CN VII), lingual n.
red = CN X (internal laryngeal n)
CN IX gives motor innervation to the ______ and _____of the tongue, and taste/sensation to the _____ of the tongue.
- stylopharyngeus m.
- middle constrictor m.
- posterior 1/3
CN X gives motor innervation to the ______ and _____ of the oral cavity, and sensory information from the _____ , _____ and _____.
- soft palate (except tensor veli palatini)
- laryngeal muscles for phonation
- inferior pharynx
- larynx
- epiglottis
Which artery branches off the lingual artery and supplies the glad associated with the inferior part of the tongue? How about the posterior part of the tongue?
- sublingual artery (sublingual gland)
- deep lingual artery
The lingual nerve innervates the tongue from the _______ part.
inferior
______ muscles alter the tongue’s shape whereas _____ muscles alter its position.
- intrinsic
- extrinsic
The picture on the left is lateral. The one on the right is a coronal section. Name these structures.
Name these structures:
9 = hyoid bone
10 = mylohyoid m.
11 = geniohyoid m.
What are the 3 salivary glands and where are they located?
Parotid = in cheek; duct exits through opening near 2nd molar
Sublingual = under the tongue; multiple ducts exiting distal-lateral to the frenulum, lining the floor of the oral cavity
Submandibular = under the mandible; ducts (2) exit proximal-lateral to frenulum
Name the green structure.
Submandibular duct
Name the top nerve and associated ganglion, bottom nerve and green structure.
lingual n. and submandibular ganagion (ANS)
hypoglossal
submandibular duct
Name the 4 functions of the salivary glands.
- keeps mouth moist
- lubricates food
- begins digestion
- cleans
What is the muscle posterior to the mylohyoid? What is it innervated by?
genioglossus m.; CN XII
What are the 4 stages of swallowing?
Stage 1 = bolus in oral cavity
Stage 2 = bolus conveyed into oropharynx
Stage 3 = bolus extends into laryngopharynx
Stage 4 = bolus penetrates opened pharyngoesophageal segment
The nose has a ____ and _____ framework.
bone; cartilage
The septum is made up of _______ [3].
- perpendicular plate of ethmoid
- septal cartilage
- vomer
Label the pink sections of the nose.
Top to bottom:
- frontal sinus
- superior nasal concha
- sphenoidal sinus
- middle nasal concha
- inferior nasal concha
- torus tubarius
Most influenza activity is ______.
widespread
Name the structures between the nasal chochae, begining with the most rostral.
superior meatus, middle meatus, inferior meatus
What is wrong with this image?
deviated septum due to drainage complaints (notice grayish part in right meatuses = fluid)
What structure is this?
cribriform plate
The _____ and _______ of the nose are part of the ethmoid bone.
superior nasal concha
middle nasal concha
Name the nerves shown.
olfactory tract, olfactory bulb, CN I, maxillary nerve V2 (in sphenopalatine foramen), nerve of pterygoid canal (vidian), lesser/greater palatine nerves and pterygopalatine ganglion
What is the name of the artery, coming of the maxillarly artery that dives into a foramen than comes out to form the angular artery?
infraorbital artery
What is the name of the artery that branches off the maxillary artery and dives into a foramen?
superior alvolar arteries (into alveolar foramen)
The ________ artery in the nasal region makes an anastamotic connection with the _______ arteries in the hard palate region.
sphenopalatine
(from descending greater palatine artery) left/right greater palatine
The function of paranasal sinuses are to _______. Name the 4 paranasal sinuses.
make your head lighter
- frontal
- maxillary
- ethmoidal
- sphenoid
What does this person present with, clinically?
sinusitis (in maxillary sinus) and stuffed nose
Why when we cry do our noses get stuffy? Which structure is responsible?
The nasolacrimal duct (meant to drain tears coming from lacrimal sac into nasal cavity)
The _______ are right under the supeior meatus.
posterior ethmoid air cells
The _____ makes up part of the middle meatus and opens to ethmoid air cells. The ____ is another part of the middle meatus and opens to the frontal/maxillary sinuses.
bulla ethmoidalis
hiatus semilunars
The inferior meatus opens to the ________ of the nasolacrimal duct.
ostium
What is the FAUCES?
the passage from the mouth to the pharynx
Label structures.
1 = frontal sinus
2 = maxillary sinus
3 = ethmoidal sinus
4 = sphenoid sinus
Label the pterygopalatine structures:
What is the vallecula of the oral cavity?
depression just behind the root of the tongue between the folds in the throat. These depressions serve as “spit traps”; saliva is temporarily held in the valleculae to prevent initiation of the swallowing reflex
