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Kofi: Pure clinical conditions 2 > Applied Head, Neck, Neuroanatomy. > Flashcards

Applied Head, Neck, Neuroanatomy. Flashcards

1
Q

What are the 3 layers of the deep cervical fascia from superficial to deep?

A

From superficial to deep

  • Investing layer
  • Carotid sheath
  • Pre tracheal layer
  • Pre vertebral layer
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2
Q

Which structures are enclosed by the investing layer?

A

Sternocleidomastoid
Trapezius
Submandibular
Parotid salivary glands?

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3
Q

What are the complications of an infection that develops in the retropharyngeal space?

A

Can potentially spread from the neck into the thorax as far down as the posterior mediastinum risking development of a mediastinitis

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4
Q

Where does the retropharyngeal space lie?

A

Between the Pre-vertebral layer of fascia and the fascia surrounding the pharynx.

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5
Q

Impingement of which nerve leads to loss of mastication?

A

Cranial Nerve 5 - Trigeminal nerve

Mandibular division supplies the muscles of mastication

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6
Q

Impingement or damage of which nerve leads to loss of facial expression?

A

Facial nerve

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7
Q

What is Bell’s palsy?

A

Inflammation of the facial nerve. Inflammation causes oedema and compression of the facial nerve as it runs through the internal acoustic meatus in the petrous part of the temporal bone

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8
Q

What can be used to examine the sternocleidomastoid?

A

Put hand on the patients neck and ask them to look over their shoulder

(Lateral flexion of head is by the action of sternocleidomastoid)

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9
Q

What can be used to test the accessory nerve?

A

Shrug against resistance to test damage to nerve that supplies the trapezius

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10
Q

What are the borders of the anterior triangle?

A

Superiorly: inferior border of the mandible
Laterally: Medial border of the sternocleidomastoid
Medially: Imaginary saggital line down the midline of the body

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11
Q

What are the borders of the posterior triangle?

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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12
Q

What does inserting surgical airways carry the risk of?

A

Infection of the pre tracheal space

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13
Q

What are the 3 branches of the trigeminal nerve?

A
  • Opthalmic division
  • Maxillary division
  • Mandibular division
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14
Q

Loss of sensation in the scalp correlates with which nerve?

A

Trigeminal nerve

Provides main sensory innervation to scalp and face

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15
Q

What is the main arterial supply of the head and neck?

A

-Common carotid artery which is the main arterial supply via its terminal branches

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16
Q

What are the main venous drainage from the face, head and neck?

A
  • Internal jugular vein which is the main venous drainage of head and neck structures.
  • External jugular vein which also receives veins draining the scalp and face and runs more superficially than the IJV
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17
Q

What are the branches of the common carotid artery?

A
  • Internal carotid artery

- External carotid artery (facial artery branch supplies the face)

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18
Q

Why is swallowing, movement of thence typically difficult and painful for a patient with a retropharyngeal abscess?

A

Compression of oesophagus causes pain to be elicited when moving the neck or swallowing

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19
Q

What are the extra-cranial branches of the facial nerve?

A

Superior to inferior

  • Temporal (above the eyes at side of head)
  • Zygomatic (nose region)
  • Buccal (mouth region above the lip)
  • Mandibular (mouth region below lip)
  • Cervical (neck region)
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20
Q

How can the trigeminal nerve be tested?

A
  • Movement of the jaw

- Sensory of the face

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21
Q

How can the facial nerve be tested?

A
  • Smile
  • Frown
  • Closing eyes
  • Raising eyebrows
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22
Q

How can the orbicularis be tested?

A

-CLose the eyes tightly and resist me trying to open them

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23
Q

How can the levator palpebrae superioris be tested?

A

Elevation of the upper eyelid

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24
Q

What nerve damage results in loss of elevation of the eyelid?

A

Oculomotor nerve

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25
Q

What is the examination for for occipitofrontalis muscle?

A

Raise the eyebrow against resistance

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26
Q

What is the examination for the orbicularis oris?

A

Purse lips and try to pull it up

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27
Q

What is the examination for the buccinator?

A

Blow out cheeks and resist expulsion of air

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28
Q

What is the action of the Buccinator?

A
  • Keeps food from spilling into the cheek.
  • Flattens cheek and holds the cheek close to the teeth when chewing.
  • Prevents food pooling between cheek and gums
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29
Q

Which muscles are innervated by the mandibular branch of the trigeminal nerve?

A
  • Medial pterygoid
  • Masseter
  • Temporalis
  • Lateral pterygoid
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30
Q

What is the examination for the temporalis?

A

Palpation during jaw clench

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31
Q

What layers would the scalpel penetrate before it reached the bone?

A
  • Skin
  • Dense Connective tissue
  • Epicranial aponeurosis
  • Loose areolar connective tissue
  • Periosteum
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32
Q

How is spread of bleeding within the subperiosteal layer limited?

A

There are membranous gaps in the sutures which the blood goes into which limits the spread of bleeding within the sub-periosteal layer.

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33
Q

Which suture can be found between the parietal bones?

A

Sagittal Suture

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34
Q

Which suture can be found between the frontal bone and parietal bones?

A

Coronal Suture

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35
Q

What suture can be found between the occipital bone and parietal bone?

A

Lambdoid suture

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36
Q

What are the 3 bowl shaped depression formed on the cranial floor?

A
  • Anterior Cranial Fossae
  • Middle Cranial Fossae
  • Posterior Cranial Fossae
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37
Q

What is the trilaminar arrangement of the calvaria?

A 
Outer Table (compact bone)
Diploeic Cavity (spongy bone)
Inner table (compact bone)
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38
Q

When does growth at sutures stop?

A

Puberty

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39
Q

Why are the edges of the bones of the skull serrated?

A

To prevent slippage and movement

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40
Q

Periosteum covering the outer table is continuous through to the periosteum covering the inner table. True/False

A

True

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41
Q

Where does a cephalohaematoma occur?

A

Occurs between the periosteum and outer table of bone

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42
Q

Can bleeding in a cephalohaematoma pass the suture lines?

A

It cannot cross the suture lines

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43
Q

What are the purposes of fontanelles?

A
  • To allow for altering of the skull size and shape during child birth
  • To permit growth of infant brain
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44
Q

When do the fontanelles fuse?

A

Posterior - 1 month to 3 months

Anterior - 18 months to 2 years

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45
Q

What is early fusion of fontanelles and sutures called?

A

Craniosyntosis

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46
Q

What is the shape of the fontanelles?

A

Slightly convex shape in a healthy baby

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47
Q

What should be performed in all partients with known or suspected skull fractures?

A

CT scanning should be performed to identify intra cranial injuries

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48
Q

Why is the pterion particularly at risk of fracture?

A

It is the thinnest area of the skull. Fusion between parietal, temporal, frontal and sphenoid

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49
Q

What are the two main types of fractures?

A

Linear - pass full thickness of skull. It is failed strains and involve no bone displacement

Depressed - Fragment is displaced inwards towards the brain

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50
Q

What are basilar skull fractures and what are their risks and signs?

A

Fractures involving the cranial base

Risks

  • Associated with cranial nerve injuries
  • Prone to causing cerebrospinal fluid leaks

Signs

  • Raccoon eyes
  • Battle signs
  • Haemotympanum
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51
Q

What is the risk with the pterion?

A

Intracranial Haemorrhage due to the injury to the middle meningeal artery. Extradural haematoma

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52
Q

What the 3 sacs around the brain and their properties?

A

Dura: tough fibrous membrane

Arachnoid: soft translucent membrane

Pia: microscopically thin, delicate and closely adherent to surface of brain

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53
Q

What are the layers of the dura?

A 
Periosteal = endosteum lining the inner bones of skull 
Meningeal = Layers adjacent to arachnoid
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54
Q

What is the purpose of the dural folds?

A

Helps to stabilise the brain and act as Rigid dividers

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55
Q

What can a rise in pressure inside the skull lead to?

A

Compression and displacement of the brain against the rigid folds and/or through foramen magnum. (herniation)

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56
Q

What are the effect of a rise in pressure on the cranial nerves?

A

Their roots have a close relationship with the dural folds so they can get squashed

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57
Q

What are dural venous sinuses?

A

Venous blood filled spaces created by separation of meningeal from periosteal layer of the dura.

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58
Q

Where does venous blood from the brain drain to?

A

Venous sinuses via the cerebral veins

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59
Q

Where is the confluence of sinuses found?

A

Deep to the protuberance of the occipital bone

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60
Q

How do cerebral veins within the subarachnoid space drain into the dural venous sinuses?

A

Bridging veins

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61
Q

What is a common cause of extradural haemorrhage and where does it occur?

A

Arterial bleed via the middle meningeal artery.

Bleeding occurs between the inner table of bone and periosteal

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62
Q

What is a common cause of subdural haemorrhage?

A

Venous bleed through the bridging veins.

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63
Q

What is subdural haemorrhage?

A

-Bleeding between the meningeal layer of the dura and the arachnoid mata.

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64
Q

Why doesn’t the bleed frimm a subdural haemorrhage spread across the brain?

A

Falx cerebri (dural folds) stops the spread across the side of the brain

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65
Q

Why are older people more susceptible to subdural haemorrhage?

A
  • The Brian gets smaller as you get older
  • Increase tension of the bridging veins
  • A slight knock could cause the veins to rupture as a result
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66
Q

What usually cause a subarachnoid haemorrhage?

A

-Usually a branch of the circle of willis

Secondary to trauma or spontansous rupture of the blood vessel

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67
Q

What is the path of the vetebral arteries?

A
  • Arise from the subclavian arteries on the right and left
  • Ascend in the neck through transverse foramina in cervical vertebrae 6-1 and pass through the foramen magnum
  • Form the basilar artery
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68
Q

Where does the internal jugular vein lie?

A

Lateral to the common carotid and mostly under the sternocleidomastoid

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69
Q

Where does the common carotid artery bifurcate?

A

-C4 at the level of the superior border of the thyroid cartilage

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70
Q

What commonly forms at the birfurcation of the carotid artery and what is the effect?

A

Atheromas. This causes stenosis of the artery. Also rupture of the clot can cause an embolus to travel to the brain. Leading to a transient ischameic attack

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71
Q

Why is the swelling more bulbous at the region of the bifurcation?

A

Carotid Sinus at the region of the bifurcation

Baroreceptors for detecting changes in arterial blood pressure.

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72
Q

What is located in the carotid body?

A

Peripheral chemoreceptors which detect arterial O2.

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73
Q

What are the borders of the carotid triangle?

A

Superior: Posterior belly of the digastric muscle.
Lateral: Medial border of the sternocleidomastoid muscle.
Inferior: Superior belly of the omohyoid muscle.

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74
Q

What is the importance of the carotid triangle?

A
  • Important for surgical approach to the carotid arteries or internal jugular vein
  • Access the vagus and hypoglossal nerves
  • Carotid pulse can felt in just below the birfurcation
  • Carotid sinus massage
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75
Q

How can you terminates a supraventricular tachycardia at the carotid sinus?

A
  • A carotid massage increase pressure in the artery
  • This means that the glossopharyngeal nerve is stimulated and send signal to the brain.
  • The efferent signal to slow the heart down from the brain is transmitted by the vagus nerve
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76
Q

What are the contents of the cavernous sinus?

A
  • Plexus of extremely thin-walled veins on upper surface of sphenoid
  • Internal carotid artery
  • Oculomotor nerve
  • Trochlear nerve
  • Abducent nerve
  • Opthalmic and Maxillary nerve of the trigeminal nerve
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77
Q

What is the blood supply to the scalp and their roots?

A

From internal carotid artery

  • Supra-orbital artery
  • Supratrochlear artery

From external carotid artery

  • Superficial temporal artery
  • Posterior auricular artery
  • Occipital artery
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78
Q

Where do the blood vessels in scalp lie?

A

In subcutaneous connective tissue layer

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79
Q

How is constriction of the blood vessels limited in dense connective tissue layer and what are the issues of this?

A
  • Walls of the arteries are closely attached to dense connective tissue.
  • You can get profuse bleeding as a result of an open scalp wound
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80
Q

The Loss of the scalp results in bone necrosis. True/False

A

False. Blood supply to the skull is mostly via the middle meningeal artery

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81
Q

Where can the facial artery pulse be felt?

A
  • Inferior border of mandible

- Anterior to the masseter muscle

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82
Q

What is the clinical relevance of the Kiesselbach area?

A

Common site of nose bleeds.

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83
Q

What are the most important branches of the kiesselbach area?

A
  • Septal branch of sphenopalatine artery

- Anterior ethmoidal arteries

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84
Q

What are the shapes of the extradural and subdural haemorrhage?

A
  • Extradural: Pear

- Subdural: Banana shape. Slim

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85
Q

What is the venous drainage of the scalp?

A
  • Superficial temporal veins
  • Occipital vein
  • Posterior auricular veins
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86
Q

What is the connection between the venous drainage of the scalp and dural venous sinuses?

A

Several emissary veins connect the veins of the scalp then to the dural venous sinuses. Can act as a potential route for infection to spread.

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87
Q

What is the effect of the spread of infection from the scalp to the cranial cavity?

A

It can affect the Meninges

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88
Q

What is special about emissary veins and the veins of the face?

A

They are valveless

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89
Q

What are the contents of the cavernous sinus?

A
  • Internal carotid artery
  • Oculomotor nerve
  • Trochlear nerve
  • Abducent nerve
  • Opthalmic and maxillary branch of the trigeminal nerve
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90
Q

Which is a better indicator of the pressure of the right atrium? IJV or EJV

A

Internal Jugular Vein is better indication pressure in the right atrium

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91
Q

How do you measure the jugular venous pressure?

A
  • Use the right Internal jugular vein
  • PAtient at a 45 degree angle with the head slightly to the left
  • Pulsations are observed through the sternocleidomastoid muscle which hide the internal jugular vein
  • The height measured in 5cm from the sternal angle
  • MEasured in cmH2O
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92
Q

What are some important branches of the maxillary artery?

A
  • Middle meningeal

- Sphenopalatine

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93
Q

What is the function lymphatic vessels?

A
  • Continuous removal of remaining tissue fluid and proteins from extracellular space back to blood circulation.
  • It is also a route for spread of infection and malignant disease
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94
Q

What is uni-directional flow of lymph?

A
  • Tissue fluid
  • Lymphatic Capillary
  • Lymphatic vessels
  • Lymph nodes
  • Lymphatic vessels
  • Lymphatic trunks
  • Lymphatic ducts
  • Venous system
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95
Q

How does the fluid flow thorough the lymphatic systems?

A
  • Passive constriction
  • Intrinsic constriction
  • Fluid goes through valves
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96
Q

What are the causes of lymphoedema?

A
  • Removal or enlargement of lymph nodes
  • Infections
  • Damage to lymphatic system such as cancer treatments
  • Lack of limb movement
  • Congenital issues (such as Milroy’s syndrome)
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97
Q

What is the key role of the lymph nodes?

A

-Immune surveillance and defence

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98
Q

How does the lymph node achieve its roles?

A

Highly organised centres of immune cells such as lymphocytes and macrophages. This helps it deal with the pathogens if they are present in the lymph fluid due to transfer from an infected tissue

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99
Q

What the common causes of an enlarged lymph node?

A
  • Infection

- Malignancy

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100
Q

What does an enlarged lymph node as a result of infection feel like?

A
  • Tender

- Mobile

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101
Q

What does an enlarged lymph node as a result of malignancy feel like?

A
  • Hard
  • Matted
  • Non-tender
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102
Q

Where are specific regions in the body where lymph nodes are palpable?

A
  • Neck (cervical)
  • Armpit (axillary)
  • Diaphragm
  • Spleen
  • Abdominal
  • Pelvic
  • Groin
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103
Q

What separates the deep and superficial lymph nodes in the neck?

A

Terminal node lie deep to Investing layer of deep cervical fascia

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104
Q

Where are lymph nodes located?

A
  • Submental
  • Sub-mandibular
  • Pre-auricular
  • Post auricular
  • Occipital
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105
Q

What is waldeyer’s ring?

A

Annular collection of lymphatic tissue surrounding the entrance to the aerodigestive tracts

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106
Q

What are the tonsils that form Waldeyer’s ring?

A
  • Pharyngeal tonsil
  • Tubal tonsil
  • Palatine tonsils
  • Lingual tonsils
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107
Q

Where do lymphatics from tonsils draining the upper pharynx drain into?

A

Retropharyngeal Lymph Nodes

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108
Q

What forms the myelin sheath in the CNS and PNS?

A
  • Oligodendrocyte in the CNS

- Schwaan cells in the PNS

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109
Q

What does the midbrain do?

A
  • Eye movements

- Reflex responses to sound and vision

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110
Q

What does the pons of the brain control?

A
  • Feeding

- Sleep

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111
Q

What does the medulla of the brain control?

A
  • Cardiovascular and respiratory centres of the brain

- Contains a major motor pathway called the medullary pyramids

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112
Q

How is the body controlled by the brain?

A

Contralateral side of the brain control the body

Left side of the cortex control the right side of the body

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113
Q

What is an important sulcus and what are the structures lieing anterior and posterior to it?

A

Central sulcus

  • Precentral gyrus - control of motor function
  • Post central gyrus - control somatosensory functions
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114
Q

What is the purpose of the frontal lobe?

A
  • Higher cognition
  • Motor function
  • Speech
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115
Q

What is the purpose of the parietal lobe?

A
  • Sensation

- Spatial awareness

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116
Q

What is the purpose of the temporal lobe?

A
  • Memory
  • Smell
  • Hearing
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117
Q

What is the purpose of the occipital lobe?

A

Vision

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118
Q

What is the clinical significance of the uncus?

A

-Part of the temporal lobe that can herniate compressing the midbrain

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119
Q

What are the medullary pyramids?

A

-Location of descending motor fibres

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120
Q

What is the corpus callosum?

A

-Fibres connecting the two cerebral hemispheres

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121
Q

What is the function of the thalamus?

A

-Sensory relay station projecting to sensory cortex

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122
Q

What is the function of the hypothalamus?

A

-Essential centre for homeostasis

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123
Q

Where is the common site of atherosclerosis in the common carotid artery?

A

Near the bifurcation of the arteries into the external and internal carotid artery

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124
Q

How can an atheleorscelrotic plaque in the internal carotid artery cause transient vision loss?

A

Ophthalmic artery is given of the internal carotid artery which result in vision loss due to lack of blood supply

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125
Q

What do the ventricles in the brain appear as in a CT scan?

A

-Appears black

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126
Q

Damage to the right cerebellum results in what on which side of the body?

A
  • Right side
  • Loss of sensory function
  • Loss of motor function
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127
Q

What is anosmia?

A

Loss of sense of smell. Commonly caused by a loss of smell

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128
Q

Damage to what nerve results in a loss of smell.

A

Olfactory nerve. Secondary to shearing forces or basilar skull fracture. Intracranial tumours at the base of the frontal lobes can interfere with olfaction

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129
Q

What results in issues in both eyes?

A

-Involvement of optic chiasm or further back results in issues with both eyes as optic nerve fibres cross at the optic chiasm. Pituitary tumours can cause these issues

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130
Q

What can results in vision loss in the eye?

A

-Lesions involving the retina or optic nerve can cause visual disturbance affecting only one eye

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131
Q

What are the effects of impingement of the oculomotor nerve?

A
  • Pathology can cause pupillary dilation and/or double vision
  • Down and out position with severe ptosis
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132
Q

What can cause impingement/damage to the oculomotor nerve?

A
  • Raised intracranial pressure
  • Aneurysms
  • Vascular
  • Cavernous thrombosis
  • Oculomotor nerve runs on the tentorium cerebelli can be squashed unchus due to increased intracranial pressure.
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133
Q

What are the effects of impingement of trochlear nerve?

A

-Diplopia (rare and often subtle)

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134
Q

What can damage/impinge the trochlear nerve?

A
  • Head injury is the most common cause
  • Raised intracranial pressure
  • Congenital palsies
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135
Q

What is a blow out fracture?

A
  • A punch in the orbit which leads to increased pressure in the orbital cavity
  • Floor of the orbit can crack and infraorbital nerve(maxillary branch) is very vulnerable
  • Leads to reduced sensation in the lower eyelid and lower cheek
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136
Q

What is the effect of local anaesthetic injected in the mandibular foracment?

A
  • Loss of sensation in the chin and lip due to the inferior alveolar nerve
  • Loss of sensation at the side of the tongue due to lingual nerve
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137
Q

What does the inferior alveolar nerve becomes as it exits the inferior mandibular canal?

A

Mental nerve

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138
Q

What is trigeminal neuralgia?

A

Shingles of the trigeminal nerve

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139
Q

What do patients with injury to the cranial nerve 6 present with?

A

Dipoplia

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140
Q

What is the common cause of injury to cranial nerve 6?

A
  • Raised intracranial pressure due to bleed or tumour
  • Nerve easily stretched due to emerging anteriorly at point-medullary junction before running under the surface of the pons upwards towards the cavernous sinus
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141
Q

What is the facial nerve closely related to?

A
  • Cranial nerve 8 as both run in posterior cranial fossa and enter the internal acoustic meatus
  • Close relationship to the middle ear as it travels through the petrous part of the temporal
  • Close relationship to the parotid but doesn’t supply
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142
Q

What is affected with injury to the vestibocochlear nerve?

A

-Dysfunction in balance and hearing

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143
Q

What is an acoustic neuroma?

A

Benign tumour involving the vestibocochlear nerve. It impinges the nerve. Schwaan cells mostly.

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144
Q

What is presbyacusis?

A

Old age related hearing loss

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145
Q

Which nerve can be affected by inflammation at the back of the throat?

A

Glossopharyngeal which gives referred pain

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146
Q

What does deviation of the uvula indicate?

A

Uequal rise in the soft palate due to weakness so therefore the uvula is drawn towards a direction. This can be due to vagus nerve damage

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147
Q

What are the sign of damage to recurrent laryngeal nerve?

A

Hoarseness and dysphonia

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148
Q

Where does the accessory nerve run in the neck?

A

Posterior triangle

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149
Q

What is the significance of the region that the accessory nerve run in the neck?

A

-Susceptible to damage in the area e.g lymph node, biopsies, surgery and stab wound

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150
Q

What are the effect of damage to hypoglossal nerve?

A

Weakness and trophy of muscles of the tongue

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151
Q

What are the effect of the sympathetic innerveatin to the head and neck?

A
  • Pulpillary dilation (dilator palpillae)
  • Assits in eyelid retraction
  • Vaso-constrciton of blood vessls
  • Sweating
  • Fight or flight
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152
Q

What are the effector tissues affected by the sympathetic nervous system?

A
  • Eye
  • Eye lid (superior tarsal muscle)
  • Blood vessels
  • Sweat glands
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153
Q

Where does the sympathetic nervous system emerge from?

A

T1-L2

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154
Q

How do the sympathetic fibres get to the head and neck?

A

Hitch hike on blood vessels such as the internal and external carotid then onto the trigeminal nerve

155
Q

Why does partial ptosis occur when the sympathetic fibres are impinged?

A
  • Loss of supply to the surperior tarsal muscle

- Occulomotor nerve supplies the rest of the eyelid so only partial ptosis

156
Q

What is the path taken by the autonomic fibres?

A
  • Arise from brainstem
  • Hitch hike onto one of 4 cranial nerves
  • Pass to the ganglia
  • Hitch hike on cranial nerve 5
  • Target tissue
157
Q

What are the target tissue of the parasympathetic innervation ?

A

Both muscle in iris for constriction and ciliary muscle

  • Lacrimal glands
  • Mucosal lands
  • Salivary glands
158
Q

What is the action of the parasympathetic innervation when a light is shone in the left eye?

A

Direct Constriction of the left pupil

Consensual constriction of the right eye

159
Q

What is the effect of decreased parasympathetic innervation from the facial nerve?

A
  • Reduced effect on sublingual and submandibular glands
  • Reduced effect on the lacrimal gland
  • Reduced effect on nasal and oral mucosal glands
  • Can cause dry eyes and mouth if interrupted
160
Q

What gland is parasympathetically innervated by the glossopharyngeal nerve?

A

Parotid gland

161
Q

What is parasympathetically innervated by the vagus nerve?

A
  • Glands in the laryngopharynx
  • Larynx
  • Glands and smith muscle of the oesophagus and trachea
  • Heart
  • Smooth muscle and land with respiratory and GI tract
162
Q

What can pathology involving apex of the lung and internal carotid artery cause?

A

Autonomic dysfunction in the eye and face

163
Q

What are the signs of a pancoast tumour?

A

Horner’s syndrome

  • Partial ptosis
  • Miosis
  • Anhydrosis
164
Q

Outline the pupillary light reflex?(start from the left eye)

A
  • Sensory afferent from left retina
  • Some branches leave CNII to enter midbrain
  • Connection with edinger westphal nuclei
  • Parasympathetic fibres from EDW leave the brainstem
  • Hitch hike on the oculomotor nerve
  • Passes via ciliary ganglion
  • Reach the sphincter papillae
  • Direct light reflex and consensual light relex
165
Q

What are the two main branches of the facial nerve arising inside the petrous bone?

A
  • Greater petrosal nerve

- Chorda tympani nerve

166
Q

What is the parasympathetic route to the submandibular and sublingual glands?

A
  • Facial nerve emerges from brainstem
  • Hitchhikes the pre-ganglionic parasympathetics (CN VII) into petrous bone
  • COntinues along facial nerve
  • JOins chorda tympani nerve
  • Crosses the middle ear cavity
  • Exits base of the skull
  • Submandibular ganglion
  • Leaves via Post ganglionic (CN V) to the submandibular and sublingual salivary glands
167
Q

What is the parasympathetic route to the lacrimal, nasal and mucosal glands?

A
  • Facial nerve emerges from brainstem
  • Hitchhikes the pre-ganglionic parasympathetics (CN VII) into petrous bone
  • At geniculate ganglion, greater petrosal nerve leaves to pterygopalatine fossa
  • Interacts with the pterygopalatine ganglion
  • Hitch hikes the trigeminal nerve to Lacrimal gland and nasal and oral mucosal glands
168
Q

What is the path of the parasympathetic to the parotid gland?

A
  • Pre-ganglionic parasympathetics arise from the brainstem with Cranial nerve 9 and into the jugular foramen
  • Leaves via the Tympanic nerve
  • Joins tympanic plexus
  • Leaves the tympanic plexus via the lesser petrosal nerve through the foramen ovale
  • Interacts with the otic ganglion
  • Post ganglionic parasympathetics then with hike on branch of mandibular branch of trigeminal nerve
  • Parotid gland
169
Q

What is the route of parasympathetic innervation of the vagus nerve?

A
  • Medulla of the Brainstem
  • Parasympathetic fibres hitch hikes on CN X and its branches
  • Meets ganglion at or in target tissue
170
Q

Which bone are parts of the ear found?

A

-Temporal bone

171
Q

What is Ramsay hunt syndrome?

A
  • Chicken pox of the facial nerve

- Geniculate ganglion affected by reactivation of the chicken pox virus

172
Q

What is cauliflower ear?

A
  • Secondary to blunt injury to the pinna
  • Accumulation of blood between cartilage and perichondrium
  • Ischaemia of the cartilage leading to necrosis due to lack of blood supply
  • If untreated or poorly treated it can lead to fibrosis and new asymmetrical cartilage development leading to cauliflower ear
173
Q

How can cauliflower ear be treated?

A
  • Prompt drainage of the haematoma and measures to prevent re-accumulation and re-apposition of two layers are necessary
  • Provides the cartilage back its blood supply
174
Q

What is the purpose of the arrangement of hairs and production of wax in the ear canal?

A
  • Prevent objects entering deeper into ear canal

- Aids in desquamation and skin migration out of canal

175
Q

How long is the external acoustic meatus?

A

-2.5 cm

176
Q

What is the effect of facial nerve lesion on the middle ear?

A
  • Tensor tympani and stapedius are no longer innervated
  • Excessive vibrations are no longer impeded
  • Patient presents with hyperacousis
177
Q

What is otosclerosis?

A
  • Ossicles fused at articulations in particular between base plates of stapes and oval window
  • Sound vibrations cannot be transmitted
  • Causes deafness
178
Q

What is glue ear?

A
  • Build of fluid and negative pressure in middle ear
  • Due to Eustachian tube dysfunction and can predisposes to infection as the fluid is the ideal growth medium for bacteria
  • Decreases mobility of TM and ossicles affecting hearing
179
Q

How is glue ear treated?

A
  • Most resolve spontaneously in 2-3 months but some may persist
  • May require grommets to ventilate middle ear. Equilibriation of pressure is the purpose of the grommet
180
Q

What is acute otitis media?

A
  • Acute middle ear infection

- More common in infants, children than in adults

181
Q

What is the symptoms of acute otitis media?

A
  • Otalgia
  • Temperature
  • Red +/- bulging TM and loss of normal landmarks
182
Q

Why is acute otitis media more common in children?

A
  • Pharygotympanic tube is shorter and more horizontal in infants
  • Easier passage for infection from nasopharynx to the middle ear
  • Tube can block more easily, compromising ventilation and drainage of middle ear, increasing risk of middle ear infection
183
Q

What are some complication of acute otitis media?

A
  • Tympanic membrane perforation
  • Facial nerve involvement
  • Mastoiditis

Intracranial complications

  • Meningitis
  • Sigmoid sinus thrombosis
  • Brain abscess
184
Q

What is mastoiditis?

A
  • Middle ear cavity communicates with mastoid air cells via mastoid antrum and auditus.
  • Provides a potential route for middle ear infections to spread to mastoid bone
185
Q

Which nerve can be affected by middle ear pathology?

A
  • Facial nerve

- Chorda tympani branch may be involved as it runs through the middle ear cavity

186
Q

What is cholesteatoma?

A
  • Abnormal skin growth growing into the middle ear eroding strructures such as ossicle, mastoid bone, cochlea
  • Not malignant
  • Usually secondary to chronic ear infections or secondary to Eustachian tube dysfunction
187
Q

What are the symptoms of choleastoma?

A
  • Painless
  • Often Smelly otorrhea
  • Sometimes Hearing loss
188
Q

Which regions normally lead to sensorineural hearing loss?

A

Inner ear

189
Q

Which regions normally lead to conductive hearing loss?

A
  • Middle ear

- External Ear

190
Q

How can we hear?

A
  • Auricle and external auditory canal focuses and funnels sound waves towards tympanic membrane which vibrates
  • Vibration of ossicles sets up vibrations in cochlear fluid
  • Sensed by sterocilia in cochlear duct
  • Movement of the stereo cilia in organ of Corti trigger action potentials in cochlear part of cranial nerve VIII
  • Primary auditory cortex
191
Q

What are examples of diseases of middle ear?

A
  • Merniere’s disease
  • BPPV
  • Labrynthitis: inner ear infection
192
Q

What are the symptoms and signs of inner ear?

A
  • Vertigo
  • Hearing loss and tinnitus
  • Nystagmus
193
Q

What are some causes of sensorineural hearing loss?

A
  • Presbyacusis
  • Meniere’s disease
  • Acoustic neuroma
  • Ototoxic medications
194
Q

What is transmitted through the apex of the orbital cavity?

A
  • Superior orbital fissure
  • Inferior orbital fissure
  • Optic canal
195
Q

What protect the eye ball from injury?

A

Tough orbital rim

196
Q

What are the important anatomical reactions of the orbit?

A
  • Paranasal air sinuses
  • Nasal air cavity
  • Anterior cranial fossae
197
Q

What are the implications of the anatomical relation of the orbit?

A
  • Orbital trauma

- Spread of infection

198
Q

What are the weakest parts of the orbital cavity?

A
  • Medial wall

- Floor of the orbit

199
Q

What are the features of an orbital blow out fracture?

A
  • History of trauma to the eye
  • Painful periorbital swelling
  • Double vision
  • Impaired vision
  • Anasthesia over affected cheek on affected side
200
Q

How does an orbital blow-out fracture occur?

A

-Sudden increase in intra-orbital pressure fractures floor of the orbit

201
Q

What are the effects of an orbital blow out fracture?

A
  • Orbital contents and blood can prolapse into maxillary sinus
  • Structures can be trapped at the fracture site such as extra orbital muscle near floor or orbit
202
Q

What separates the eyelid fat and orbicularis oculi muscle?

A

Orbital septum

203
Q

What is the function of the orbital septum?

A

Acts as a barrier against infection spreading from the pre-septal space to post-septal

204
Q

What is peri-orbital cellulitis?

A
  • Cellulitis of orbital structures.
  • Can be pre-septal or post-septal
  • Increasing degrees of severity
205
Q

What are the precursors to periorbital cellulitis?

A
  • Bites
  • Periorbital trauma
  • Sinuses (fronto-ethmoidal)
206
Q

What are the complication of periorbital cellulitis?

A
  • Abscess formation
  • Spread of infection intracranially
  • Cavernous sinus thrombosis
207
Q

Which veins can infection of the orbit spread through?

A
  • Opthalmic veins
  • Pterygoid venous plexus
  • Facial vein
208
Q

What is a meibomian cyst?

A
  • Blockage of a meibomian gland.

- Prevention of evaporation of tear film and spillage is affected

209
Q

What is a stye?

A

-Infection of the eyelash follicles

210
Q

Is the cornea covered by the conjunctivae?

A

No. The conjunctivae extends to the limbus which is the edge of the cornea and reflected on the inner surface of upper and lower eyelid.

211
Q

What is conjunctivitis?

A

When the conjunctiva become inflamed, blood vessels dilate and eye appears red.

212
Q

What is a subconjuctival haemorrhage?

A

-Haemorrhage from blood vessels in conjunctiva that is readily visible

213
Q

Where does the blind spot lie on the opthalmascope?

A

Medially on optic disc. Where the optic nerve is transmitted

214
Q

What is glaucoma?

A

-Drainage of aqueous humour from anterior chamber can be blocked. Can lead to irreversible damage and death of the optic nerve

215
Q

What is an open angle glaucoma?

A
  • Deteriorton of trabecular meshwork
  • Aqueous humour cannot drain to the canal of Schlemm
  • Present with visual field loss and cupping of the optic disc

-Chronic (age)

216
Q

What is a closed angle glaucoma?

A
  • Narrowing of iridocorneal angle
  • Rapid rise in the intra-ocular pressure
  • Presents with sudden onset of painful red eye, blurred vision, fixed or sluggish semi dilated oval shaped pupil, nausea, vomiting
  • Acute
217
Q

What is the effect of the glaucoma?

A
  • Rise in intra-ocular pressure and damage to optic nerve
  • Optic disc cupping occurs
  • Sight threatening
218
Q

What is the accommodation reflex?

A
  • Light rays from near-objects are more divergent and require greater refraction to being them into focus on retina
  • Autonomic constriction of the pupil
  • Eyes converge
  • Lens becomes more biconcave due to contraction of the ciliary muscle
219
Q

Which extra-ocular muscles are not supplied by the oculomotor nerve?

A
  • Lateral rectus by the abducens nerve

- Superior oblique by Trochlear

220
Q

How do we isolate the action of superior oblique?

A
  • Move the eyeball to a medial position

- Move the eyeball down

221
Q

How do we isolate inferior rectus?

A
  • Move the eyeball into the lateral position

- Move the eyeball down

222
Q

How do we isolate the action of inferior oblique?

A
  • Move the eyeball into the medial position

- Move the eyeball up

223
Q

How do we isolate the action of superior rectus?

A
  • Move the eyeball into the lateral portion

- Move the eyeball up

224
Q

What is sialolithiasis?

A
  • Salivary stones.
  • Most are located in the submandibular glands
  • Leads to dehydration and reduced salivary low
225
Q

What are the symptoms of sialolithiasis?

A
  • Pain in gland
  • Swelling
  • Infection
226
Q

What is used to investigate salivary stones?

A

Sialogram

227
Q

What are the symptoms of tonsillitis?

A
  • Fever
  • Sore throat
  • Pain/difficulty swallowing
  • Cervical lymph nodes
  • Bad breath
228
Q

How do peritonislar abscesses form?

A
  • Can follow on from tonsillitis

- Can arise on its own

229
Q

What are the symptoms of peritonsillar abscess?

A
  • Severe throat pain
  • Fever
  • Bad breath
  • Drooling
  • Difficulty opening mouth
230
Q

What is found in the oropharynx?

A

Palatine tonsils between Palatoglossus and Palatopharyngeal

231
Q

What is found in the laryngopharynx?

A

Piriform fossa

232
Q

What is Killian’s dehiscence?

A

Weakness found between the thyropharyngeal and cricopharyngeal muscle. These 2 are parts the inferior constrictor muscle

233
Q

What is a pharyngeal pouch?

A

A posteriomedial (false) diverticulum. Could be due to

  • Failure of the upper oesophageal sphincter to relax
  • Abnormal timing of swallowing
  • Essentially there is higher pressure in laryngo pharynx
  • Weakness between muscle belly of the inferior constrictor muscle produces out pouching of pharyngeal mucosa
234
Q

What are the symptoms of pharyngealal pouches?

A
  • Dysphagia
  • Bad breath
  • Regurgitation of food
  • Occasional choking on fluids
  • General difficulty swallowing
235
Q

What are the symptoms of pharyngeal pouches related to?

A

Food material collecting in pouch or disruption of swallow

236
Q

What are some causes of dysphagia?

A

Stroke
Progressive neurological disease
COPD
Dementia

237
Q

What are signs and symptoms of dysphagia?

A
  • Coughing and choking
  • Sialorrhoea
  • Recurrent pneumonia
  • Change in voice/speecj
  • Nasal regurgitation
238
Q

Which bones in the facial skeleton are more susceptible to fracture?

A
  • Nasal bone due to prominence
  • Zygomatic bone
  • Mandible
239
Q

How the pituitary gland be accessed?

A

Through the nasal cavity through the sphenoid

240
Q

What is a septal hematoma?

A
  • Cartilaginous part of the septum takes blood supply from the overlying perichondrium
  • Trauma to nose can lead to buckling of the septum and shearing of blood vessels
  • Blood accumulates between the perichondrium and cartilage
241
Q

What is the effect of untreated septal haematoma?

A
  • Avascular necrosis of cartilaginous septum
  • Saddling of nasal dorsum
  • Can develop infection in the collecting haematoma
  • Septal abscess formation further increases likelihood of avascular necrosis of septum
242
Q

What are nasal polyps?

A
  • Swelling of nasal mucosa
  • Usually bilateral
  • Pale or yellow in appliance/fleshy and reddened
243
Q

What are the symptoms of nasal polyps?

A
  • Blocked nose and watery rhinorrhoea
  • Post nasal drip
  • Decreased smell and reduced taste
  • Unilateral polyp +/- blood tinged secretion may suggest tumour
244
Q

What is rhinitis?

A

-Inflammation of the nasal mucosal lining

245
Q

What are symptoms of rhinitis?

A
  • Nasal congestion
  • Rhinorrhoea
  • Sneezing
  • Nasal irritation
  • Post nasal drip
246
Q

What are common causes of rhinitis?

A
  • Acute infective rhinitis (common cold)

- Allergic rhinitis

247
Q

What is epistaxis?

A

Nose bleed

-Mucosa and blood vessels easily injured

248
Q

Which branches does the arterial supply to the nasal cavity arise from?

A
  • Ophthalmic artery

- Maxillary artery

249
Q

What is formed in the anterior septum?

A 
Arterial anastomoses (Kiesselbach's area)
-Most common source of bleeding in epistaxis
250
Q

What is the relevance of the venous drainage from the nasal cavity?

A
  • Pterygoid venous plexus
  • Cavernous sinus
  • Facial vein

This means infection can spread intracranially

251
Q

Which type of epistaxis is potentially more serious?

A
  • Bleeding from the sphenopalatine artery

- Potentially more serious and difficult to treat

252
Q

What are paranasal sinuses?

A
  • Air filled extensions of nasal cavity which are lined by respiratory mucosa
  • Helps to humidify and warm inspired air
  • Drain into the nasal cavity via mall channels called Ostia into the meatus
253
Q

What is acute sinusitis?

A

-Acute inflammation of lining of sinus. Commonly infective and often secondary to viral infection of nasal cavity

254
Q

What are symptoms of acute sinusitis?

A
  • Non resolving cold or flu like illness
  • Pyrexia
  • Blocked nose and rhinorrhoea (yellow/green discharge)
  • Headache/facial pain
255
Q

What is the pathophysiology of acute sinusitis?

A
  • Primary infection leads to reduced ciliary function, oedema of nasal mucosa and sinus Ostia and increased nasal secretions
  • Drainage from sinus is obstructed
  • Stagnant secretion within the sinus become ideal breading ground for bacteria (secondary infection)
  • Caused by dental infections and respiratory infections.
256
Q

How can the cricothyroid membrane be used in an emergency?

A

-Emergency access to provide patent airway for the patient

257
Q

What forms the vocal and vestibular ligament?

A
  • Quadrangular membrane forms the vestibular ligament

- Upper free border of cricothyroid ligament-thickened edge forming the vocal ligament

258
Q

What is found between the vestibular and vocal folds?

A

Ventricle which leads laterally and upwards into the saccule. Contains mucus glands that keep vocal folds moist

259
Q

What is the epithelium lining of the larynx?

A

Pseudo-stratified ciliated columnar epithelium

-Stratified squamous epithelium on the true vocal cord lining

260
Q

What is the purpose of the laryngeal muscles?

A
  • Closing of the larynx during swallowing to protect the respiratory tract
  • Act to open larynx and allow movement of air during inspiration and expiration
  • Control movement of vocal cords in phonation and in cough reflex
261
Q

Which intrinsic muscle isn’t supplied by the recurrent laryngeal nerve of the vagus?

A

-Cricothyroid muscle which is supplied by external branch of superior laryngeal nerve

262
Q

What is the position of the vocal cords in deep breathing?

A

-Widely abducted

263
Q

What is the position of the vocal cords during phonation?

A

-Adducted

264
Q

What leads to hoarseness of voice especially when attempting high pitched sounds?

A
  • Injury to the external branch of superior laryngeal nerve

- Closely related to the superior thyroid artery

265
Q

What does the recurrent laryngeal nerve supply?

A
  • Sensory to subglottic

- Motor to the intrinsic muscles (except cricothryoid)

266
Q

What does the superior laryngeal nerve supply?

A
  • Sensory to the supraglottic

- Motor to the Cricothyroid

267
Q

What is the path of the recurrent laryngeal nerve?

A
  • Arises distally
  • Loops under the right Subclavian artery on the right
  • Loops under the arch of aorta on the left
  • Ascends the tracheo-oesophaageal groove
  • Close relationship with inferior thyroid arteries supplying thyroid gland
268
Q

What are the causes of vocal cord palsies?

A
  • Thyroid Surgery causes damage to the nerve due to reaction with he inferior thyroid artery
  • Aortic arch aneurysm (LRLN)
  • Cancer involving the apex of the lung (RRLN)
  • Disease or surgery involving larynx, oesophagus or thyroid
269
Q

What is the effect of unilateral lesion of the RLN?

A
  • Paralysed vocal cord assumes a paramedian position between fully abducted and fully adducted
  • Unilateral palsies may lead to hoarseness of voice and sometimes ineffective cough
  • Often the contralateral sides compensates in time
270
Q

What is the effect of bilateral lesion of the RLN?

A
  • Both vocal cords paralysed and in paramedic position
  • Narrow glottis
  • Significant airway obstruction. Needs an emergency surgical airway
271
Q

What are the signs of bilateral vocal cord palsies?

A
  • Cyanosis
  • Hypoxia
  • Distress
  • Raised respiratory rate
  • Stridal breathing
  • Often more acute and dangerous
272
Q

What are other conditions affecting the larynx?

A
  • Laryngitis
  • Laryngeal nodules
  • Laryngeal cancer
  • Croup
  • Epiglottittis
  • Laryngeal oedema
273
Q

What are the common risk factors of head and neck cancers?

A
  • Heavy alcohol use
  • Heavy tobacco use
  • Age
  • Dental hygiene
  • Males more than women
  • EBV infection
  • Chewing betel quid (Paan)
  • Occupational/Environemntal exposure to certain inhalants
  • Long term exposure to sunlight or sunbeams (lip)
  • HPV
274
Q

What is the common malignancy seen in head and neck cancers?

A

Squamous cell carcinomas

275
Q

What is the general presentation of head and neck cancers?

A
  • Unexplained painful and/or mucosal ulceration or lesion within the oral cavity (leukoplakia, eythroplakia, lump)
  • Unexplained hoarseness of voice
  • Dysphagia or Odynophagia
  • Otalgia
  • Cervical lymphadenopathy
276
Q

What are the the typical investigations required to determine diagnosis and severe of HNC or thyroid cancer?

A
  • Clinical examination
  • Biopsy
  • Imaging
  • Endoscopic investigation
277
Q

What are common causes of neck lumps?

A
  • Thyroid cancer
  • Hyperthyroidism
  • Hypothyroidism
278
Q

How is the severity of the HNC determined?

A

-TMN staging used (stage 1-4)

279
Q

What is contained in the superficial cervical fascia?

A

Loose connective tissue containing

  • Adipose tissue
  • External jugular vein
  • Cutaneous nerves
  • Superficial lymph nodes
  • Platysma muscle
280
Q

Which structures are contained within the pretracheal fascia?

A
  • Infrahyoid muscles
  • Thyroid gland
  • Trachea
  • Oesophagus
281
Q

What strutures are invested by the buccopharyngeal fascia?

A
  • Muscles of pharynx

- Muscles of oesophagus

282
Q

Which structures are found within the carotid sheath?

A
  • Common carotid artery
  • Internal jugular vein
  • Vagus nerve
283
Q

Which structures are enclosed by the prevertebral fascia?

A
  • Axillary vessels

- Brachial plexus of nerves

284
Q

What are the advantages provided by the deep cervical fascia?

A
  • Allow structures to move and pass over one another with ease
  • Allow separation of tissues during surgery
  • Determine the direction and extent to which any infection occurring within the neck may spread
285
Q

What are symptoms of a retropharyngeal abscess?

A
  • Visible bulge in the oropharynx
  • Sore throat
  • Difficulty swallowing
  • Stridor
  • Reluctance to move neck
  • High temperature
286
Q

Why does the thyroid goitre move upon swallowing?

A
  • Enclosed by pre-tracheal fascia which is attached to hyoid bone
  • Hyoid bone and pharynx rise on swallowing so therefore any pathology swelling involving the thyroid moves with the space
287
Q

What can retrosternal extension thyroid goitre lead to ?

A
  • Compression of the structures running through the root of the neck such as the trachea and venous blood vessels
  • Can lead to symptoms of stridor and breathlessness
288
Q

What is the action of the muscles of mastication?

A

Move the mandible at the temperomandibular joint

289
Q

What are the branches of the external carotid artery?

A
  • Superficial thyroid artery
  • Ascending cervical artery
  • Lingual artery
  • Facial artery
  • Occipital artery
  • Posterior auricular artery
  • Maxillary artery
  • Superficial temporal artery
290
Q

How can infections spread intracrnailaly from the facial vein?

A
  • Facial vein is connected to the pterygoid venous plexus and the ophthalmic vein
  • Infection can track back into the dural venous sinuses
  • Thrombophlebitis of facial vein involves infected clot
291
Q

Which vein does the facial vein drain into?

A

Facial vein drains into the Internal Jugular vein

292
Q

Where does an extradural haematoma form?

A

Between:

  • Inner table
  • Periosteal layer of dura
293
Q

What does the vertebral arteries supply?

A
  • Posterior parts of the brain

- Posterior neck

294
Q

What are the origin of the left and right common carotid arteries?

A
  • Right Common Carotid Artery originates from Brachiocephalic Artery
  • Left Common Carotid Artery arises from the arch of the Aorta (longer)
295
Q

Where is the carotid sheath derived from?

A

Fusion of:

  • Prevertebral fascia
  • Investing layer
  • Pretracheal fascia

Arteries run behind the sternocleidomastoid. Thin shath over veins and thicker sheath over arteries

296
Q

What are the terminal branches of the external carotid artery?

A
  • Superficial temporal artery

- Maxillary artery

297
Q

What are some complications of a septic thrombi in the facial vein?

A
  • Superior and Inferior ophthalmic vein connected to the facial vein
  • Septic thrombi can travels to cavernous sinus
  • Can cause a cavernous sinus thrombosis
298
Q

Which blood vessels are more likely to be affected if damage affects the dense connective tissue and what are the implications of this?

A
  • Artery
  • If open wound, there will be profuse bleeding. Blood vessels are adhered to the dense connective tissue so less ability to vasoconstrict.
  • If close wound, well localised lump form. The dense connective tissue stop spread of bleeding beyond the confines of the area of damage
299
Q

Why might an incised scalp gape open if injury affects the aponeurosis?

A
  • Aponeurosis is attached to frontalis anteriorly and occipitalis posteriorly.
  • The pull of these muscles causes wound to gape open
  • Profuse bleeding
300
Q

Which blood vessels are likely to be damaged in the loose connective tissue and why does it spread?

A
  • Veins

- Loose connective tissue allows the blood spread within the layer.

301
Q

Which nodes is often enlarged in tonsillitis?

A

Jugulo digastric

302
Q

What does the jugulodigastric node drain and where does it lie?

A
  • Palatine tonsil
  • Oral cavity
  • Tongue

Below angle of mandible

303
Q

What does the jugulo-omohyoid nodes drain and where do they lie?

A
  • Tongue
  • Oral cavity
  • Trachea
  • Oesophagus
  • Thyroid gland

Any infection affecting these areas results in the nodes swelling

304
Q

What is trosier’s sign?

A

Enlarged, hard, left supraclavicular lymph nodes secondary to metastatic abdominal malignancy

305
Q

Which tonsil is readily seen on routine examination of a patient?

A

Palatine tonsils

306
Q

Which tonsils are known as adenoids?

A
  • Pharyngeal tonsils

- Located in roof of nasopharynx behind the uvula

307
Q

How can pharyngeal tonsils contribute to ear infections?

A
  • Close to the Eustachian Tube

- Can block the tube when enlarged thereby contributing to middle ear infection

308
Q

Which region is responsible for motor function for one half of the body?

A

-Primary motor cortex in the pre-central gyrus in the fontal lobe

309
Q

What is region gespoble for general sensory perception of one half of the body?

A

-Primary somatosensory cortex in the parietal lobe

310
Q

What connective tissue is located in the longitudinal fissure?

A

-Falx cerebri

311
Q

What is found running between inferior part of the occipital lobes and the cerebellum below?

A

-Tentorium cerebelli

312
Q

How does a corpus callostomy benefit patients with epilepsy?

A

Prevents severe epilepsy occurring as the lobes of the brain cannot communicate with each other which can prevent muscles on each side working together

313
Q

Between which meningeal layers can the CSF be found?

A

-Arachnoid and Pia

314
Q

Where within the brain is CSF?

A

Ventricles

315
Q

How do the pre ganglionic sympathetic fibres synapse with the post ganglionic sympathetic fibres?

A
  • Pre ganglionic fibres ascend from the thorax and synapse with one of the upper cervical ganglia of the chain in the superior and middle cervical ganglia.
  • Post ganglionic fibres reach their target tissues in the head and neck by hitch hiking onto blood vessels
316
Q

What are the parts of the temporal bone?

A
  • Squamous part
  • Petromastoid part
  • Tympanic plate
  • Styloid process
317
Q

What is the mastoid process?

A
  • Palpable landmark posterior to the pinna

- Cavity of the mastoid antrum extends into the mastoid process and communicates with air cells

318
Q

What forms the wax in the external auditory meatus?

A

-Cerumen from skin lining and discarded cells of the skin

319
Q

How does the sensation of the ear popping occur?

A
  • Eustachain tube is normally closed
  • Salpingopharyngeus
  • Pull of attached palate muscle when swallowing or yawning cause it to open
  • This is noticed as ears popping
320
Q

What are the ossicles called found in the middle ear?

A
  • Malleus
  • Incus
  • Stapes
321
Q

What equipment is used to examine the external auditory canal inspected?

A
  • Otoscope

- Speculum

322
Q

How is the external auditory canal straightened for examination?

A

-Up, back and out for better visualisation

In children down and back

323
Q

How can the eye be placed at risk with a facial nerve injury?

A
  • Can’t close eye to protect from dust and foreign objects

- Can’t lacrimate the eye

324
Q

Which nerve supplies the carotid sinus?

A

-Afferent nerve is the ‘Glossopharyngeal nerve’

325
Q

What is the purpose of the Weber’s test?

A

Lets you know which side is affected but not whether it is sensorineural or conductive

326
Q

What are the results of a normal person in a Rinner’s and Weber’s test?

A
  • Air Conduction>Bone Conduction

- Centre

327
Q

What are the results of a conductive hearing loss in a Rinner’s and Weber’s test?

A
  • Bone Conduction>Air Conduction

- Louder at the affected ear in Weber’s test

328
Q

What are the results of a sensorineural hearing loss in a Rinner’s and Weber’s test?

A
  • Air Conduction>Bone Conduction

- Louder at the unaffected ear in Weber’s test

329
Q

Describe the theory behind the Weber’s Test

A
  • Normal ambient sounds are conducted
  • The ringing is conducted to the inner ear
  • If the conductive affect the normal ambient sounds aren’t transmitted so the sound from the tuning fork is heard louder
  • If sensorinerual, the ambient sounds are heard more than the tuning fork so the sound in heard louder at the unaffected side
330
Q

What are the 3 layers of the eye?

A
  • Sclera (fibrous and tough)
  • Chorioid (Vascular and muscular)
  • Retina (rods and connes)
331
Q

What connects the choroid and iris?

A

-Ciliary body which is vascular and muscular

332
Q

What is uveitis?

A
  • Inflammation of the choroid layer
  • Presents with a red and painful eye which is worse when focusing or attempting to look at bright lights
  • Autoimmune associated (AS, IBS)
333
Q

What is the purpose of pigment layer and where does it lie?

A
  • Between the choroid and retina
  • Cells contain melanin
  • Plays a role in helping absorb scattered light that has passed into the eye.
  • Reduces reflection and allow us to focus images appropriately on the retina
334
Q

How is vision affected in people with albinism?

A
  • Lack of melanin in pigmented layer

- Wear glasses to prevent the scattering of light

335
Q

What is the macula?

A
  • Concentration of rod cells
  • Cone cells have high visual acuity
  • Centre of the macula is the fovea and has a rich density of only cones
336
Q

What is retinal detachment?

A
  • Pigmented epithelial cell layer can detach from neurosensory cell layer in certain layer
  • Photoreceptors at the site of detachment are no longer able to function resulting in visual disturbance (lack of blood supply)
337
Q

What is the purpose of the rods?

A
  • Vision in low light
  • Doesn’t discern colours.
  • Abundant in the periphery
338
Q

Where is the anterior chamber?

A

-Space between cornea and Iris

Filled with aqueous humour

339
Q

Where is the posterior chamber?

A

-Space between the Iris and lens

Filled by aqueous humour and ciliary body and processes found in this chamber

340
Q

What are cataracts?

A

Degradation of proteins in the lens which can cause it to become clouded and less transparent. Occur gradually

341
Q

Which two muscles are found in the iris and what is their purpose?

A
  • Sphincter pupillae and dilator pupillae

- Acts to control the size of the pupil and are controlled bt the autonomic nervous system

342
Q

What is presbyopia?

A

As we age

  • Lens becomes dense, less elastic and more difficult to change shape
  • Thus, the ability to accommodate and focus on near-objects becomes impaired as well get older
343
Q

What is the hole on the medial side of the lower eyelid and its purpose?

A
  • Puncta

- Collects tears

344
Q

What are the steps to take clinical examination of the eye?

A

IVA FROM

I - Inspection of the eye
VA - Visual acuity tested using Snellen Chart
(V)F - Tested using Confrontation
R - Test te reflex. Direct and consensual reflex and accommodation reflex.
O - Use of an ophthalmoscope to visualise back of the eye.
M - Test the eye movements

345
Q

What does the nasal septum consists off?

A
  • Perpendicular plate
  • Ethmoid bone
  • Septal cartilage
  • Vomer
346
Q

What are the four major paranasal sinuses?

A
  • Maxillary
  • Frontal
  • Ethmoidal
  • Sphenoid

Maxillary narve supply

347
Q

Which sinus is most prone to infection and why?

A

-Maxillary sinus and because of the location of its opening high on the wall of the nasal cavity.

348
Q

What is the purpose of the turbinates?

A

Increase surface area in order to warm, humidify and slow down air

349
Q

Where does the olfactory nerve run in the nasal cavity?

A

Upper part of the nose

350
Q

What are the borders of the oral cavity?

A

Anterior: Oral fissure
Posterior: Oropharyngeal isthmus
Lateral and medial wall: Anterior and posterior pillars of faucet formed by the palatoglossus anteriorly and the palatopharyngeal posteriorly

351
Q

What are the innervations of the extrinsic muscles of the tongue?

A

Hypoglossal nerve

  • Genioglosus
  • Styloglossus
  • Hyoglossus

Vagus nerve
-Palatoglossus

352
Q

Where are the parts of the pharynx located?

A

Nasopharynx - C1
Oropharynx - C2-C3
Laryngopharynx - C3-C6

353
Q

What is located externally on the walls of the pharynx?

A
  • Superior constrictors
  • Middle constrictors
  • Inferior constrictors
354
Q

What innervates the constrictors of the pharynx and what is their action?

A

Vagus nerve

Relax and contrat to propel bolus into the oesophagus

355
Q

Which parts of the pharynx and soft palate are supplied by the vagus nerve?

A

-All the muscles of the pharynx except stylopharyngeus

356
Q

What is the sensory innervation of parts of the pharynx?

A

Nasopharynx - Maxillary Nerve
Oropharynx and Eustachian tube - Glossopharyngeal Nerve
Laryngopharynx - Vagus Nerve

357
Q

What happens to the pharyngeal tonsils in adulthood?

A

They atrophy after puberty

358
Q

What is a potential site for foreign bodies in the larygngopharynx?

A
  • Piriform fossa is a potential site

- Also a site for cancer

359
Q

Where is the larynx found?

A
  • Hyoid bone superiorly

- Trachea below

360
Q

What does the larynx consist of?

A

-Series of cartilages and bone held together by membranes, ligaments and muscles

361
Q

What are the regions of the larynx?

A
  • Supraglottis
  • Glottis
  • Subglottis
362
Q

What joins the hyoid bone and thyroid cartilage?

A

-Thyrohyoid membrane

363
Q

What joins the cricoid cartilage and thyroid cartilage?

A

-Cricothyroid membrane

364
Q

What forms the structural framework of the larynx?

A
  • Epiglottis
  • Thyroid
  • Cricoid
  • Arytenoid cartilages (paired)
365
Q

What connects the epiglottis and arytenoid cartilages?

A

Aryepiglottic folds

366
Q

What are the structural features of the cartilages of the larynx?

A
  • Thryoid is shield like and has a laryngeal prominence.
  • Cricoid cartilage is signet-ring shaped. It is the only complete ring of cartilage in the respiratory tract
  • Arytenoid sits on top of the cricoid cartilage posteriorly one on each side
367
Q

What are the two folds of mucosa lining the interior of the larynx?

A
  • Vestibular fold (false vocal cords)

- True vocal cord containing vocal ligament.

368
Q

What is the space found between the true vocal cords?

A

-Rima glottis

369
Q

Which is the only intrinsic muscle that abducts the vocal cords to allow breathing?

A

-Posterior Cricoarytenoid

370
Q

What are the cervical nerve roots for the cervical plexus?

A

C1-C4

371
Q

What is the ansa cervicialis?

A

Supply the infrahyoid muscles

Nerve roots: C1-C3

Action: Motor

372
Q

What does the ansa cervicalis overlie?

A

Scalene muscle

373
Q

Which nerve roots supply the phrenic nerve?

A

C3-C5

Diaphragm

374
Q

Which areas of the scalp are supplied by the cervical plexus?

A

-Posterior to superior scalp

375
Q

What relationship does the posterior border of the sternocleidomastoid have with the sensory branches of cervical plexus?

A

-Overlie the sensory branches

376
Q

What is Erb’s point?

A
  • Sensory nerves enter the skin at the middle of the posterior border of the sternocleidomastoid
  • Cervical plexus nerve block
  • Anaesthetic is injected at this point as a regional block
377
Q

The thyroid gland is palpable. True/False

A

False. Not usually palpable unless it is enlarged (goitre)

378
Q

Which situations cause a goitre in thyroid gland?

A

Hyperthyroidism - Graves

Hypothyroidism - Hashimoto’s

379
Q

Where are the parathyroid glands and how many are there?

A

4 parathyroid glands

Lie beneath the thyroid

Control calcium levels

380
Q

Which muscle overlie the thyroid gland?

A

-Infrahyoid muscles

Strap like muscles

381
Q

What are the extrinsic longitudinal muscles muscles of the pharynx?

A
  • Stylopharygeus (glossopharyngeal)
  • Palatopharyngeus (vagus)
  • Salpingopharyngeus (vagus)
382
Q

What is the function of the extrinsic longitudinal muscles of the pharynx?

A
  • Elevation of the larynx

- Widen and shorten the pharynx

383
Q

Why does the bleed from the loose connective tissue cause ecchymosis?

A
  • The loose connective tissue is under the aponeurosis.
  • The aponeurosis is attached to the frontalis muscle anteriorly. Frontalis muscle is attached to obicularis oculi and subcutaneous tissue.
  • Blood can track in this layer to the extraoccular muscles
  • Causes ecchymosis

Kofi: Pure clinical conditions 2 (5 decks)

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