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Kofi: Pure Clinical Sem 3 > Blood supply and Beginning of the Skull > Flashcards

Blood supply and Beginning of the Skull 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 buccopharyngeal 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

Only Motor Sign if impinged in Stylomastoid foramen

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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

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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 which provides main sensory innervation to scalp and face
  • Cervical nerve
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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

- Sensation 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 oculi 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 (CN3)

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24
Q

What is the examination for for occipitofrontalis muscle?

A

Raise the eyebrow against resistance

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25
Q

What is the examination for the orbicularis oris?

A

Purse lips and try to pull it up

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26
Q

What is the examination for the buccinator?

A

Blow out cheeks and resist expulsion of air

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27
Q

What is the action of the Buccinator?

A
  • Keeps food from spilling into the cheek to prevent it pooling between the cheeks
  • Flattens cheek and holds the cheek close to the teeth when chewing.
28
Q

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

A
  • Medial pterygoid
  • Masseter
  • Temporalis
  • Lateral pterygoid
29
Q

What is the examination for the temporalis?

A

Palpation during jaw clench

30
Q

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

A
  • Skin
  • Dense Connective tissue
  • Epicranial aponeurosis
  • Loose areolar connective tissue
  • Periosteum
31
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.

32
Q

Which suture can be found between the parietal bones?

A

Sagittal Suture

33
Q

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

A

Coronal Suture

34
Q

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

A

Lambdoid suture

35
Q

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

A
  • Anterior Cranial Fossae
  • Middle Cranial Fossae
  • Posterior Cranial Fossae
36
Q

What is the trilaminar arrangement of the calvaria?

A 
Outer Table (compact bone)
Diploeic Cavity (spongy bone)
Inner table (compact bone)
37
Q

When does growth at sutures stop?

A

Puberty

38
Q

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

A

To prevent slippage and movement

39
Q

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

A

True

40
Q

Where does a cephalohaematoma occur?

A

Occurs between the periosteum and outer table of bone

41
Q

Can bleeding in a cephalohaematoma pass the suture lines?

A

It cannot cross the suture lines

42
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
43
Q

When do the fontanelles fuse?

A 
Posterior = 1 month to 3 months
Anterior = 18 months to 2 years
44
Q

What is early fusion of fontanelles and sutures called?

A

Craniosyntosis

45
Q

What is the shape of the fontanelles?

A

Slightly convex shape in a healthy baby

46
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

47
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

48
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

49
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
  • CSF otorrhea
  • CSF rhonorrhea
50
Q

What is the risk with the pterion?

A

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

51
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

52
Q

What are the layers of the dura?

A 
Periosteal = endosteum lining the inner bones of skull 
Meningeal = Layers adjacent to arachnoi
53
Q

What is the purpose of the dural folds?

A

Helps to stabilise the brain and act as Rigid dividers

54
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)

  • Subfalcine herniation
  • Uncal herniation
  • Tonsillar herniation
55
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

56
Q

What are dural venous sinuses?

A

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

57
Q

Where does venous blood from the brain drain to?

A

Venous sinuses via the cerebral veins

58
Q

Where is the confluence of sinuses found?

A

Deep to the protuberance of the occipital bone

Meeting of the superior Sagittal, straight sinus and the transverse sinus

59
Q

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

A

Bridging veins

60
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

61
Q

What is a common cause of subdural haemorrhage?

A

Venous bleed through the bridging veins.

62
Q

What is subdural haemorrhage?

A

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

63
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

64
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
65
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

66
Q

What are the parts of the temporal bone?

A
  • Squamous part
  • Petromastoid part
  • Tympanic plate
  • Styloid process
67
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

Kofi: Pure Clinical Sem 3 (44 decks)

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