Clinical Applications of Anatomy Flashcards
What is an Emergency Airway? When might this be performed?
- procedure in which the CRICOTHYROID LIGAMENT is pierced by a fine 1mm needle when patient cannot breathe
- e.g Anaphylactic shock
What is Goitre? What causes this?
- enlarged thyroid gland
- often caused by Grave’s disease or iodine deficiency
Goitre can occur in a patient with Grave’s disease, what other clinical sign should you look for?
Exopthalmos of the eye (bulging/protrudin)
What occurs in a patient with congestive cardiac failure?
The external jugular vein becomes distended
- Bruit may be heard (audible turbulent blood flow)
What is temporal arteritis? What does it cause?
Also known as Horton’s Disease
- superficial temporal artery becomes inflamed
- leads to decreased oxygen supply causing BLINDNESS and STROKE
what type of haemorrhage may occur if there is a large blow to the pterion?
Extradural haemorrhage of the middle meningeal artery
- blood gathers between dura mater and skull
What nerve innervates the pinna of the ear?
Great auricular nerve
What areas are innervated by the great auricular nerve?
- angle of mandible
- skin over parotid gland
- mastoid process
What causes a drooping eyelid & loss of sweating on the same side? what’s another symptom of this?
Damage to the sympathetic trunk (Horner’s syndrome)
- drooping eyelid
Where does the submandibular duct enter the mouth?
Sublingual caruncles (sublingual papilla) under the tongue
what nerve is at risk during surgery to the submandibular gland/duct?
Lingual nerve
Why does laceration to the lip cause excessive bleeding?
Rupture of inferior labial branch of facial artery where the left & right sides anastomose
What muscle is responsible for protrusion of the mandible?
Lateral pterygoid
Which muscle tendon inserts on the coronoid process?
Temporalis muscle tendon
If there is a stroke on the right hand side of the brain, what muscle groups will be affected?
Muscles on the lower LHS of face & tongue
What nerve innervates the motor supply of the tongue?
Hypoglossal
What muscle protrudes the tongue?
Genioglossus
What is long standing ear ache called?
Chronic otitis media
What nerve is at risk of damage during surgery to the middle ear?
Facial nerve (chorda tympani)
What nerve causes the shoulders to roll?
Accessory nerve
What muscle causes the shoulders to roll?
Trapezius
What muscles does the Accessory nerve supply?
- SCM
- Trapezius
What is the carotid sinus?
Swelling on the internal carotid artery that contains baroreceptors that monitor blood pressure
Which nerve supplies the carotid sinus?
Glossopharyngeal
Where do fish bones tend to get stuck?
Valecula
Which type of haemorrhage would you expect to see bruising on the side of head?
Extradural haemorrhage (epidural haematoma)
What artery is typically ruptured in a extradural haemorrhage?
Middle meningeal artery
Which cranial nerve supplies the larynx?
Vagus nerve
What type of epithelium is found in the larynx?
Stratified squamous
Where do the nodes from the maxillary sinus drain?
Submandibular nodes
What can extraction of a maxillary molar cause?
Oro antral communication with the maxillary sinus (if roots become stuck in the sinus this can lead to a fistula)
What supplies sensory innervation to the posterior 1/3 of the tongue?
Glossopharyngeal
What supplies sensory innervation to the anterior 2/3 of the tongue?
Lingual nerve
What supplies taste to the posterior 1/3 of the tongue?
Glossopharyngeal
What supplies taste to the anterior 2/3 of the tongue?
Chorda tympani (facial nerve)
What nerve is damaged if the patient has a fixed dilated pupil?
Occulomotor nerve
What muscle constricts the pupil?
Constrictor pupillae muscle
What can cause the contents of the orbit to drop into the maxillary sinus?
Blow out fracture
What can be damaged in laceration to the medial eye?
Lacrimal caniculli
What is yellow sclera indicative of?
Jaundice
What condition causes proptosis of the eye?
Grave’s disease (hyperthyroidism)
What innervates the ear?
Vestibulocochlear
What name is given to an infection of the external ear?
Otitis externa
How can bacteria in the face spread to the cavernous sinus?
Via the sphenoid emissary vein
Which haemorrhage results after rupture of cerebral veins?
Subdural
Which haemorrhage results from a berry aneurism of a cerebral artery?
Subarachnoid haemorrhage
Which nerve supplies the stylopharyngeus muscle?
Glossopharyngeal
To which side, affected or unaffected, does the tongue deviate in a palsy of CNXII?
Unaffected
What produces CSF in the ventricles?
Choroid plexus
What does the pineal gland affect?
Sleep patterns
What is at risk of rupture during a pharyngeal recess biopsy?
Internal carotid artery
What is vertebrobasilar ischaemia?
When blood flow to the back of brain reduces or stops (occlusion of vertebral & basilar artery when head turns)
- causes dizziness
What disease is a tumour of plasma cells?
Multiple myeloma
What causes a thickening of the bones of the forehead?
Padget’s disease
What vessel is beneath the pterion?
middle meningeal artery
What bones form the pterion?
- temporal
- frontal
- parietal
- sphenoid
What is the function of arachnoid granulations?
Transmit cerebrospinal fluid into the venous system
Which fold of dura separates the right & left cerebral hemispheres?
Falx cerebri
Which fold of dura mater separates the cerebrum from the cerebelli?
tentorium cerebelli
What does the sub-arachnoid space contain?
Cerebrospinal fluid
Which artery do the vertebral arteries converge to form?
Basilar artery
What is the purpose of the Circle of Willis
Provides collateral blood flow between anterior & posterior circulations of the brain
- equalises pressure
- no sudden surges of blood in the brain
What can cause an optic disturbance through pressure on the optic chiasm?
Tumour of the pituitary gland or swelling of ICA
What condition causes ringing in the ears?
Tinnitus
Which cranial nerves pass through the jugular foramen?
Glossopharyngeal, vagus, accessory
- 9
- 10
- 11
Which nerves pass through the internal acoustic meatus?
Vestibulocochlear & facial
- 7
- 8
Which sinus passes through the jugular foramen?
Sigmoid sinus
What causes cavernous sinus thrombosis?
If an upper third molar forms an abscess this can act as a source of bacteria, this bacteria can pass through the sphenoidal emissary vein into the cavernous sinus (the blood flow is slow here so the bacteria can multiply & cause thrombosis formation)
What passes through the foramen rotundum?
Maxillary artery (of CNV)
What passes through the foramen ovale?
Mandibular nerve (of CNV)
Which lobes are separated by the central sulcus?
Frontal & parietal
What are the four loaves of the cerebral hemisphere?
- frontal
- parietal
- temporal
- occipital
What area of the body does the anterior cerebral artery supply?
Lower limbs
What area of the body does the middle cerebral artery supply?
- head & neck
- trunk
- upper limbs
What area of the body does the posterior cerebral artery supply?
Visual cortex
Which area involves movement in the pre-central gyrus?
Primary motor cortex
How does CSF pass from the lateral ventricle to the third ventricle?
Through the inter-ventricular foramen
What is the hippocampus?
Elongated ridges on floor of lateral ventricle associated with memory, emotion & the ANS
At which vertebra does the vertebral artery enter the foramen transversarium?
C6
Which can ischaemia of the vertebral artery cause visual disturbance?
Vertebral artery supplies posterior parts of the cerebral hemisphere (visual cortex location)
Where is the superior cervical ganglion found?
Near the carotid bifurcation
Where is the middle cervical ganglion found?
Can be found on the loop near the subclavian artery
What pharyngeal arch are the muscles of mastication derived from?
2nd pharyngeal arch
In which ventricle is the choroid plexus found
Lateral ventricle
What connects the third and fourth ventricles?
Cerebral aqueduct
What pierces the buccinator?
Parotid duct
Which muscle of mastication depresses the mandible?
Lateral pterygoid
Which other muscle is supplied by the mylohyoid branch of the inferior alveolar nerve?
Anterior belly of digastric muscle
What is Ludwig’s angina?
Serious bacterial infection of the floor of the mouth, neck & jaw. Typically occurs from tooth abscess
Which extrinsic nerve is not supplied by the hypoglossal nerve, what is it instead supplied by?
Palatoglossus muscle
- Vagus nerve innervation
Which branch of the facial nerve joins to the lingual nerve?
Chorda tympani
What are the three regions of the pharynx?
- oropharynx
- nasopharynx
- laryngopharynx
Which three muscles arise from the styloid process?
- stylohyoid
- styloglossus
- stylopharyngeus
Name the only muscle in the palate not innervated by the pharyngeal plexus?
Tensor veli palatini
What type of cartilage makes up the nasal septum?
Hyaline cartilage
Which bone are the middle & superior concha part of?
Ethmoid bone
Which sinuses open into the hiatus semilunaris?
- frontal sinus
- maxillary sinus
What epithelium lines the nasal cavity?
Stratified columnar epithelium with mucus-secreting goblet cells
Which meatus does the sphenoid air sinus open into?
Superior meatus
what branch of the subclavian artery are the inferior thyroid, transverse cervical and suprascapular arteries from?
thyrocervical trunk
What name is given to an enlargement of the thyroid gland?
Goitre
Why does the thyroid gland move upwards with the larynx on swallowing?
The pharyngeal elevator muscle fibres are attached to the thyroid cartilage, causing simultaneous elevation
What is the principle enzyme produced by the parotid gland?
Amylase
What is the action of the orbicularis oculi muscle?
- close the eyelids gently
- close the eyelids tightly
Which two branches of the facial nerve supply the orbicularis oculi muscle?
- temporal branch
- zygomatic branch
Which muscle of mastication retracts the mandible?
Temporalis
Which muscle of mastication attaches to the zygomatic arch?
masseter
Which cerebral artery supplies the head and neck area of the motor cortex?
Middle cerebral artery
Which cranial nerve carries preganglionic parasympathetic neurons that pass to the submandibular ganglion?
Facial nerve
Which type of haemorrhage around the brain results in a sudden loss of consciousness and blood in the cerebrospinal fluid?
Subarachnoid haemorrhage
Give two clinical signs that might raise suspicion of thrombosis in the cavernous sinus?
- proptosis of eyes
- visual disturbances
When there is a cerebrovascular accident involving the motor pathway through the brain, the muscles of which two specific regions of the head are likely to be paralysed?
Unable to move any facial muscles below the eyebrow on the opposite side of face & tongue too
Where does the submandibular gland open into the oral cavity?
The sublingual papilla (caruncle)
Which salivary gland is arranged around the free edge of the mylohyoid muscle?
Sublingual gland
What is the role of the buccinator during eating?
Ensures bolus remains between occlusal biting surfaces on molars
What nerve is being tested if the patient is asked to protrude the tongue?
Hypoglossal nerve
The tendon of which muscle forms the palatal aponeurosis?
tensor veli palatini
To which group of lymph nodes does lymph from the maxillary sinus principally drain?
Submandibular nodes
Damage to what nerve would cause numbness in pinna of right ear?
right great auricular nerve
what areas does the great auricular nerve innervate?
- pinna/auricle of ear
- skin over angle of mandible
- skin over parotid
what vessels can cause excessive bleeding when the lip is lacerated?
inferior labial artery where the left and right sides anastomose
what muscle tendon inserts into the coronoid process?
the temporalis tendon inserts into the coronoid process
what TWO recesses may fish bones get stuck in?
- valeculla
- piriform fossa
what epithelium covers the majority of the larynx? what covers the true vocal folds?
- pseudostratified columnar (respiratory) epithelium covers majority of the larynx
- true vocal folds are covered in stratified squamous epithelium
what are some symptoms of a cavernous sinus thrombosis?
- swollen/bulging eyes
- high temperature
- visual problems
what is the cause of sudden sharp facial pain?
trigeminal neuralgia
what does the pineal gland do?
controls melatonin secretion for modulating sleep patterns & circadian rhythms
what might an exaggerated/brisk reflex suggest?
common stroke sign (usually UMN)
what is the Babinski reflex?
The sole of the foot is stimulated with a blunt instrument
- normal reaction = big toe should go down
- positive reaction = big toe goes upwards
** indicative sign of a stroke
what nerve has been damaged if the pupils do not constrict?
Occulomotor nerve (CNIII)
What is glue ear?
Otitis media with effusion
- fluid build up in middle ear
what can occur when doing a biopsy of the pharyngeal recess?
Pharyngeal recess can be a common site for occult tumours
- ICA at risk of being ruptured
What can cause a distended external jugular vein?
- heart disease
- hypertension
what can cause inflammation of the parotid gland?
Mumps
- swelling is restricted due to the dense parotid capsule & pressure is put on the facial & glossopharyngeal nerves
what happens to excess tears when crying/when it is cold?
excess tears travel via the lacrimical canniliculae —> lacrimal sac —> nasolacrimal duct —> inferior nasal meatus
- causes a runny nose
what can occur with a blow out fracture?
The orbit floor may fracture & the contents of the orbit fall into the maxillary sinus
- can cause double vision
what can occur if LA is injected into the medial pterygoid muscle?
Trismus
- reduced opening of the jaw
What is Waldeyer’s ring & what is its function?
A ring of lymphoid tissue in the pharynx:
- pharyngeal tonsils
- palatine tonsils
- lingual tonsils
- tubular tonsils
What are the two muscles in the middle ear & what is their function?
Tensor tympani = supplied by the trigeminal nerve which pulls the malleus to reduce movement & thus sound
Stapedius of triangle = supplied by the facial nerve which contracts and reflexes the stapes which dampens sound & reduces movements
what is hydrocephalus?
Condition characterised by the accumulation of fluid in the brain (usually CSF).
- can be caused by tumour in cerebral aqueduct
what is an example of a sub-arachnoid haemorrhage?
berry aneurysm on circle of willis
where is the pharyngeal recess located?
posterior to auditory tube
damage to which nerve may cause nausea and vertigo?
CNVIII (vestibucochlear)
where can infection of the middle ear spread to? what does this cause?
infection from middle ear can spread to mastoid cells
- can cause blurred vision
How do loud sounds affect the ossicles?
- tensor tympani dampens sound at malleus (innervated by CNV)
- stapedius dampens sound of stapes (CNVII)
what is otitis externa? what does it cause?
‘Swimmers Ear’
- inflammation of external acoustic meatus
- ear pain, pus discharge, temporary hearing loss
what lymph nodes may be enlarged in thyroid disease?
- jugulo-omohyoid
- jugulo-digastric
when making a full set of dentures where should they be extended with accord to the mylohyoid line?
Finish above the line (or will move when mylohyoid contracts)
