Clinical Anatomy NB Flashcards
What are the benefits if anterior and posterior frontanelles?
They are used assess growth
Important for skull and brain growth as well as moulding during normal vaginal birth
When does the bregma close?
18 months
When does the lambda close?
At 6 months
What is the highest point of the transverse sinus?
Asterion
What is the anatomical position pterion?
Meeting point of parietal, frontal, squamous part of temporal and greater wing of sphenoid bone & lies 4 cm above middle of the zygomatic arch and 3 1/2 cm behind the frontozygomatic suture
What is an epicranial aponeurosis?
flat tendon of occipitofrontalis muscle
Where can gapping and profuse bleeding occur?
Epicranial aponeurosis injury
What is the dangerous area of the scalp and why?
it is the dangerous area of scalp because infection can pass into the cranial cavity via the emissary veins present in it.
Haemorrhage here is large and seperates the scalp from the skull bones
What is the radiological apperance of bone marrow hyperplasia?
seen as hair on end appearance; trabeculae are oriented perpendicular to the inner table
What does pituitary adenoma cause?
Causes bitemporal hemianopia
What does anemia do to the diploic layer?
thickens is it due to bone marrow hyperplasia
What is the most common origin of the subdural hemotoma?
venous origin
What causes subdural hemotoma and what can be some pathological causes?
Caused by a tear in bridgig veins in the subdural space
Can happen due to brain shrinkage in neurodegenerative diseases especially Alzheimer’s disease
What does head trauma to the ethmoid bone lead to?
Will affect the cribriform plate leading to rhinorrhea due to the leak of CSF from the anterior cranial fossa into the nasal cavity
What do patients feel when they hae head trauma to the ethmoid bone?
Feel warm water dripping from their nose
What does head trauma to petrous part of temporal bone lead to?
Will lead to otorrhea due to leak of CSF from middle cranial fossa into the middle ear then externanal auditory meatus
What do patients feel when they get head trauma to the petrous part?
Patient feels warm water dripping from ear
What causes thrombs to the cavernous sinus?
Infection from the dangerous area of th e face via direct or indirect pathways
What are the direct/indirect pathways of spread of infection from the dangerous area of the face?
Direct: Facial to superficial opthalamic to cavernous
Indirect: Deep facial to ptyrgoid to emissary to cavernous
What is the function of the emissary veins?
Equalizes intercranial and extra cranial pressure
What are the contents found inside the cavernous sinus?
ICA and abducent nerve (6th cranial nerve)
Wha are the contents embedded in the lateral wall of the cavernous sinus content?
3rd occulomotor nerve
4th trochlear nerv
OPthalamc and maxllary nerves (2 divisions of the 5th nerve)
What are the symptoms of cavernous sinus thrombosis ?
Fever and internal squint due to paralysis of abducent nerve
The eye becomes congested (black eye) and oedematous due to obstruction of its venous drainage and later on the eye is bulging to the outside (proptosis)
How can pelvic tumors directly metastis to the brain?
Through the basilar venous plexus as it is directly connected to vertebral venous structure
What is the motor nerve supply of the face?
Facial nerve
What is the sensory supply of the face?
From the trigeminal nerve except for a small area of skin covering the angle of the mandible and the parotid gland which is supplied by the great auricular nerve (C2-3)
What does buccinator paralysis lead to?
Auccumulation of food in the vestibule of the mouth and dripping food from the angle of the mouth
How and why should an incision to the face be preformed?
Horizontally to avoid injury to facial nerve branches
What is bell’s palsy ?
Lower motor neuron lesion of trigeminal
What happens in bell’s palsy?
The entire ipsilateral side of the face is affected and patients cannot close their eyes or smile
Dryness of the ey and maybe ulceration
Due to inflammation of the facial nere while the facial canal in the petrous bone
What happens in upper motor neuron lesion of trigeminal nerve ?
Contralateral affection
upper part of the face is spared (forehead sparing) but lower part is affected so patient can close their eyes but not smile
Where is the superficial temporal artery pulse felt?
Against the zygomatic arch
Why does forehead sparring occur?
Due to the corticonuclear fibers supplying the forehead but not the lower half of the face
Which nerve do dentist apply anesthesia to?
Inferior alveolar nerve
where does the parotid duct open?
It is 5cm long
and opens in the vestibule of mouth opposite the upper 2nd molar tooth
What are the structures of the parotid gland?
Facial nerve
Retromandibular vein
External carotid artery
DEep parotid lymph nodes
Auriculotemporal nerve
What is the parasympathetic supply of th eparotid gland?
The glossopharyngeal nerve
Where do preganglion fibers arise from and what are their pathways?
Arise from inferior salivary nucleus in the medulla and pass in tympanic branch of glossopharyngeal nerve which enters the middle ear cavity to form the tympanic plexus
Where do the postganglionic fibers end up?
They join the auriculotenporal nerve which carries them to the parotid gland
What does the tympanic plexus give rise to?
The lesser superficial petrosal nerve which passes through foramen ovale to relay to the otic ganglion
Where is the endotracheal tube inserted?
Rima glottidis
(Potential space between the vocal ligaments contained within these intrinsic ligaments and membrane)
What are is the nerve supply of muscle of mastication?
From mandibular nerve
What is the most common form of tempomandibular joint dislocation ?
Anteriorly and reduction: downward, backward, upward
What is the nerve supply of tempomandibular joint?
Auriculo-temporal nerve
what are the branches of spheno-palatine ganglion?
1.Orbital branches: supply periosteum of orbit and lacrimal gland
2. Nasal branches
3. Palatine branches
4.Pharyngeal branches: supply nasopharynx and ausitory eustachian tube
What is frey’s syndrome (gustatory sweating)?
Redness and sweating on cheek with adjacent ear while eating, thinking or seeing food with salvation.
What causes frey’s syndrome?
A lesion in the auriculotemporal nerve.
How can you test for frey’s syndorme?
Lemon wedge
What is the pathway of the greater superficial petrosal nerve?
Superior salivary nucleus in the pons then joins deep petrosal nerve to form nerve of pterygoid canal (vidian nerve) and relay in spheno-palatine ganglion.
The postganlionic fibers (through lacrimal nerve) supply lacrimal gland and mucosal glands of nose and palate.
What is the motor supply of the tongue?
All muscles of the toongue are supplied by hypoglossal nerve except palatoglossus muscle which is supplied by pharyngeal plexus (cranial root of accessory)
What is the sensory supply of the tongue?
Anterior 2/3 are supplied: lingual nerve (general) and chorda tympan (taste) and posterior 1/3 is supplied by: glossopharyngeal nerve (general and taste sensation)
What is the motor nerve suply of the soft palate?
All muscles of soft palate are suppliedby pharyngeal plexus (cranial root of accessory nerve through pharyngeal branch of vagus) except tensor palati supplied by mandibular nerve (via the nerve to medial pterygoid)
What is the sensory supply of the soft palate?
Lesser palatine nerve and glossopharyngeal nerve
What innervates the lacrimal gland?
Innervated by greater superficial petrosal nerve (facial nerve)
What causes the unilateral paralysis of tongue?
Due to complete section of the hypoglossal nerve on one side if left for a long time atrophy of tongue muscles occur.
How do you test for unilateral paralysis of tongue?
Ask the patient to protrude their tongue and it will deviate towards the affected side.
What happens when genioglossus muscles get paralyzed?
Retraction of the tongue obstructs the airway leading to suffocation.
How do you avoid genioglossus paralyses to cause airway obstruction during anesthesia?
Inserting an oropharyngeal tube
What does inury of oculomotor nerve produces?
1.Ptosis (drooping of the upper eyelid)
2.lateral squint
3.Disaltation of pupil
4.Loss of accomodation
What cause ptosis?
paralysis of the levator palpebrae superioris
What causes lateral squint?
Due to paralysis of medial rectus and unopposed action od the lateral rectus
What causes lateral squint?
Due to paralysis of medial rectus and unopposed action od the lateral rectus
What causes dilatation of pupil?
paralysis of sphincter pupillae
What causes loss of accomodation?
Paralysis of ciliary muscle
What does injury of abducent nerve lead to?
Leads to medial squint due to paralysis of lateral rectus and diplopia
What causes horner’s syndrome and what are its symptoms?
Injury to sympathetic trunk
SYmptoms : ptosis, miosis, anhydrosis
What can be seen ina fundus examination?
The whole view of back of retina
Optic disc, macula lutea and retinal vessels can be seen
What cause glaucoma?
Results from blockage of aqueous humour drainage
What causes papilledema?
increase in intracranial pressure & is reflected on the optic nerve and causes edema of the optic disc.
What is the nerve supply of the skin of the external nose?
The nasociliary branch of ophthalmic nerve of trigeminal
What are the openings of paranasal sinuses?
1.Frontal sinus: opens in hiatus semilunatis of middle meatus
2.Maxillary sinus: Opens in hiatus semilunaris
3.Anterior ethmoidal sinus: Opens in hiatus semilunaris
4.Middle ethmoidal sinus: OPens in bulla ethmoidalis
5.Posterior ethmoidal sinus: opes into superior meatus
6.Sphenoidal nerve: Opens into sphenoethmoidal recess
7.Nasolacrimal duct: opens in inferor meatus
What are the symptoms of a sinus headache?
Pain, pressure, fllness in cheeks, brow or forehead
Evidence of discharge from nose
Fatigue
Stuffy nose
Worsening of pain in bending forwards or lying down
Why is the maxillary sinusitis most common in inflammation?
its higher position of opening of maxillary sinus makes drainage of any collection of pus or blood very hard
What is the nerve supply of nasal caity?
Olfactory nerve (special sensory) & Trigeminal nerve (general sensation)
What is the arterial supply of nasal cavity?
1.Anterior and posterior ethmoidal arteries: from ophthalmic artery
2.Sphenopalatine artery: (main artery) from 3rd part of maxillary artery
3.Terminal part of greater palatine rtery : from 3rd part of maxilary
4.Septal branch of the superior labial artery from facial
What happens to the nasolabel and labiomental grooves during cases of infection, inflammation and tumors?
they are obliterated
Where does epistaxis occur?
Little’s area
What is the anatomical position of little’s area?
Lies in anteroinferior part of nasal septum in region of vestibule
What is the supply of external auditory meatus?
Supplied by auriculotemporal (trigeminal) & vagus nerve
What is the supply of tympaic membrane?
Supplied by auriculotemporal nerve & vagus nerve & inner surface supplied by tympanic plexus of nerves (glossopharyngeal nerve)
What causes hyperacusia?
Due to paralysis of stapedius muscle
What causes deafness?
Fixation of stapes or damage to cranial nerve XIII
What is labryinthitis?
INflammation of membranous labyrinth
What is the cause of Menier’s disease?
Excessive endolymph producion leads to vertigo
What is the supply of the middle ear?
Tympanic plexus and chorda tympani
What is the subclavian artery surface anatomy?
Convex line one inch above the clavicle and drawn from sternoclavicular joint to midpoint of clavicle
What is the sensory supply of sternomastoid muscle?
C2 and C3
What is the motor supply of the sternomastoid muscle?
spinal accessory nerve
What does one sided injury to recurrent laryngeal nerve cause?
Monotonous voice
What does injury to both sides of the recurrent laryngeal nerve cause?
Complete injury: aphonia
Incomplete injury:Stridor
At what level is tracheostomy done?
C2 and C3
What does injury to both external laryngeal nerve cause?
Hoarseness of voice
What is cricothyroidotomy?
Cutting into the cricothyriod membrane. Life saving in case of airway obstruction when coughing finger removing or chest compression fails.
What is the impaction of removing a foreign body from piriform fossa?
Can cause injury to internal laryngeal nerve causing anaesthesia to supraglottic part (superior to vocal cords)
What causes absence of gag reflex?
Due to damage in ipslateral glossopharyngeal nerve (afferent) or vagus nerve (efferent)
What indicated vagal nerve damage?
uvular deviation towards the contralateral side to the lesion
When is carcinoma in the post circoid region common and hwat is it characterized by?
Common in females with plummer vision syndrome
Characterized by difficulty swallowing, iron-defiecency anemia, glossitis, cheilosis and esophageal webs
What happens when an injury occurs to the accessory nerve?
Absent function of the sternocleidomastoid muscle and trapezius muscle
(shoulder drop)
What happens when an injury occurs to the accessory nerve?
Absent function of the sternocleidomastoid muscle and trapezius muscle
(shoulder drop)
What does damage to the hypoglossal nerve cause?
Paralysis of the tongue (ussually one side is affected when a person sticks out their tongue it deviates to the side)
What does glossopharyngeal nerve lesion produce?
diffucilty swallowing
impairment of taste and general sensation over the posterior one third of the tongue, palate and pharynx
Absent gag reflex
Dysfunction of parotid gland
