E1 Flashcards
Bells palsy is from paralysis of what nerve?
Facial Nerve, CN 7
What is the clinical presentation of Bell’s palsy? (6) Explain why each symptom is caused.
Unilateral drooping of facial muscles (upper and lower face) due to motor loss from facial nerve damage. Drooling/difficulty chewing, due to paralyzed buccinator. Inability to close eye, due to paralysis of orbicularis oculi. Loss of taste to anterior 2/3 of tongue, due to facial sensory innervation. Pain in/behind ear, due to sensory innervation. Hyperacousia, due to paralyzed stapedius muscle.
Bell’s palsy is a ______ motor neuron disorder
Bell’s palsy is a lower motor neuron disorder
An upper motor neuron lesion of CNVII would result in what clinical presentation? What could cause this to occur?
Paralysis of lower facial muscles - Corticol stroke
What innervates the outer ear?
CN V, VII, IX, X
Paralysis of orbicularis oculi can result in what outcome?
Damage to cornea of eye
Typically, skeletal muscle of the middle ear act to dampen sound. What clinical condition is caused by the inability to do this?
Hyperacousia
What is the somatic sensory innervation of the face?
Mainly trigeminal (CN-V) with V1 doing the forehead + bridge of nose (opthalmic), V2 doing maxillary region, and V3 doing Mandibular. The outer ear is also 7, 9, 10.
What is unique about the veins of the face?
They have no valves (or few and variable)
Explain venous drainage of the face
Supraorbital and Supratrochlear vein, Facial Vein anastomse with Ophthalmic vein
Infections can easily spread from the face to the brain. Why? What clinical thing will likely occur if this happens.
The cavernous sinus anastomoses with Facial and Ophthalmic, and since there are no valves, prolonged infection can spread to Cav. sinus.
Diplopia (blurred vision) occurs because the cranial nerves pass through cavernous sinus.
Cleft lip is formed from a failure of what two processes to to fuse?
Where does this occur?
Medial Nasal Process and Maxillary Process.
Occurs at the philtrum of lip
Occulomotor parasympathetics leave the brain stem at the ______ and go to ______ to produce and effect on _____ and ______
Occulomotor parasympathetics leave the brain stem at the MIDBRAIN and go to CILIARY GANGLION to produce and effect on CILIARY MUSCLE and SPHINCTER PUPILLAE
The paraympathetics of the facial nerve leave at the _______ and regulate (5) things
Leave at the medulla. Regulate - Lacrimal Gland, Mucous glands of oral + nasal cavities. Palate. Submandibular gland. Sublingual gland.
The zygomatic arch is composed of…
Zygomatic bone, Zygomatic Process (maxillary bone), Zygomatic process (temporal bone)
Name the 5 layers of the scalp and the clinical significance to the layers
Skin, Connective tissue, epicranial Aponeurosis, Loose areolar tissue, periosteum
Clinical: infection can easily spread through the loose areolar layer, which is deep to the epicranial aponeurosis.
What goes through the anterior and posterior ethmoidal formanina? What are these things branches off?
The ant and post. ethmoidal N, A, and V.
V1 and ophthalmic artery and vein
An obstructed Nasolacrimal duct will cause tears to flow..
What can be done to stop this?
Onto the face.
Surgically open the duct.
Obstruction or infection of the sebaceous gland (subcutaneous layer) of the eyelid is called?
Stye or Horde’olum
Obstruction of the tarsal/Meibomian gland (at the tarsal plate) of the eyelid is called?
Chalazion
What is the flow of tears?
Lacrimal Gland -> medial across eye to lacrimal puncta, Lacrimal canaliculu –> Lacrimal sac –> Nasolacrimal duct –> inferior meatus of nasal cavity
What innervates the lacrimal gland?
Facial nerve (CN-VII), Parasympathetics. Pterygopalatine ganglion
In normal vision at a distance, describe the state of the suspensory ligaments, ciliary muscles, and lens.
Ciliary muscles are relaxed, suspensory ligaments are taut, lens is flat
In near vision, describe the state of the ciliary muscles, suspensory ligaments, and lens.
Ciliary are contracted, Suspensory are relaxed, lens is thick.
What nerve is responsible for control of the ciliary muscles? Where are they located anatomically? What are they a branch and what kind of nerve is it.
What other muscle is innervated by the the short ciliary nerve? Clinical effect?
Short ciliary nerve. Located lateral to the optic nerve. It is parasympathetic control from CN 3.
Constrictor pupillae –> Mydriasis
Constrictor pupil is under what nerve control? From what nerve?
Parasympathetics, CN3
Dilator pupil is under what nerve control?
Sympathetics
What are the actions of the superior rectus?
Raise, adduct, medial rotate
What are the actions of the inferior oblique?
Raise, abduct, laterally rotate
What is a symptom of damage to the abducens nerve?
Medial strabismus.
Draw the eye movement diagram from Zill’s notes and explain it.
Jus do it
A patient with CN-4 damage will have trouble with what daily task?
Looking down / walking down stairs
What compensatory mechanism will patients with CN-4 damage do?
Tilt head to opposite side.
Damage to the occulomotor nerve produces what 3 clinical presentations and why?
Lateral strabismus (due to paralyzed medial rectus), Ptosis (paralyzed lev. palpebrae superioris), Mydriasis (pupillary constrictor)
Long ciliary nerves are branches of ___ and travel ___ to the optic nerve.
V1 and medial
Parasympathetics do not go to the…
Body wall ( skin / peripheral blood vessels)
What muscle attached to hair on the skin is only innervated by sympathetics?
Arrector Pilae
What are the 3 symptoms of Horners syndrome? And what causes this condition.
Miosis, Ptosis, Anhydrosis
Damage to the sympathetic pathway
What area of the brain regulates sympathetic control? What does this area send signals to?
Hypothalamus, sends signals to the pre-ganglionic neurons in the spinal cord
Where does sympathetic outflow occur in the spinal cord?
Thoracic and lumbar levels
Describe the flow of sympathetic effect for a smooth muscle of eye.
Hypothalamus sends signal down spine, comes out t1, t2. Ascends up the superior cervical ganglion. Postsynaptic fibers join plexus on internal carotid artery. Muscle contracts.
What is the boundary between the oral cavity and pharynx?
Palatoglossal arch
What is the order of innervation of the branchial arches?
First arch, second arch, third arch, fourth arch, 6th arch.
–5 (V3), 7, 9 , 10, 11.–
Note: the 5th arch doesn’t do anything
The first branchial arch innervates what muscles?
Anterior belly of digastric, mastication muscles, mylohyoid, tensor tympani, tensor palati
The second branchial arch innervates what muscles?
Facial expression, stylohyoid, posterior belly of digastric, stapedius
The third branchial arch innervates what muscle?
Stylopharyngeus
The fourth branchial arch innervates what muscles?
All of pharynx (except stylopharengeous), all of larynx, all of palate (except tensor palati)
The sixth branchial arch innervates what muscles?
Sternocleidomastoid, trapezius
The first branchial pouch forms what?
Auditory tube, tympanic cavity
The second branchial pouch forms what?
Palatine tonsils ( t for two and tonsil)
The third branchial pouch forms what?
Parathyroid glands, thymus gland
The 4th branchial pouch forms what?
Superior parathyroid glands, and C-cells (calcitonin) of thyroid
The most common branchial cleft cyst is the..
Tract to palatine tonsils, the second branchial cleft
In thyroid development a piece of thyroid can remain above the structure. This is called..
A pyramidal lobe
Torticollis is what? What is the clinical presentation?
Contracture of the sternocleidomastoid. Head points in opposite direction.
What is the clinical nerve test for CN-11?
Shrug shoulders
What are the compartments of the neck? (3)
Prevertebral, pretracheal, carotid sheath
What space in the neck has potential for obstructing an airway / spreading infection?
Retropharyngeal space – a Retropharyngeal abcess
Why can’t children localize pain when an ear ache is happening?
It is innervated by the CN 9, which is visceral sensory.
What is an infection of the middle ear called?
Otitis media
Piercing the eardrum can cause what unique clinical presentation? Due to damage of what nerve?
Loss of taste to anterior 2/3 of tongue due to damage to chorda tympani nerve.
What muscle increases pitch of vocal cords? What is the movement of the cords?
Cricothyroid - tenses vocal fold
What muscle decrease pitch of vocal cords? What is movement of the cords?
Thyroarytenoid - relaxes vocal fold
What muscle closes the vocal cords by sliding?
Arytenoideus
What surgery is at risk of damaging the recurrent laryngeal nerve, and what is the clinical result if it is damaged.
What is the recurrent layrngeal nerve a branch off of?
Thyroid surgery. Permanent hoarse voice.
Vagus.
What is the lymph drainage of the larynx?
Above true vocal folds - superior deep cervical nodes
Below true vocal folds - inferior deep cervical nodes
In anaphylactic shock, insert tube through cricothyroid membrane. What is the advantage of this?
Less bleeding than a tracheotomy
What is the “first popcorn”
Valleculae. In the oropharynx.
What is the “second popcorn”
Piriform recess. Lateral to inlet of larynx (laryngopharynx)
The pharynx constrictor muscles are innervated by what nerve?
Vagus
What is a crossed extension reflex?
Excite extensors and inhibit flexors in opposite leg. Step on nail, one leg gets flex response (side of stimulus) and the support leg is extended to hold body.
A tendon type of biceps will do …
Excite synergistic muscles and produce opposite effect on antagonist muscle
Some reflexes change after upper motor neuron lesion, what is one?What is the response?
Babinski. Will extend and fan toes if UMN lesion present.
What is the clasped knife reflex response? What person would have this?
Inhibit synergistic muscles, excite antagonist. A person with an UMN lesion would do this.