Exam 1: Part 1 Flashcards
Epitaxis
1) Nosebleed
2) Kiesselbach are = anterior two thirds of nose
3) Trauma = most likely cause
What are the major landmarks of the neck
1) C7 Vertebra
2) Hyoid Bone ~ at C3-4
3) Thyroid and Cricoid Cartilages ~ Cricoid at C6
4) Clavicle and Sternum
5) Mandible
What is the mnemonic for branches of the ECA?
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1) Superior Thyroid a.
2) Ascending pharyngeal a.
3) Lingual a.
4) Facial a.
5) Occipital a.
6) Posterior Auricular a.
7) Maxillary a.
8) Superficial Temporal a.
Post-synaptic fibers of superior ganglia form what?
Internal carotid periarterial plexus
Subclavian A. and Scalene muscles at root of neck relationship
1) Medial to anterior scalene and at apex of lung and cervical pleura
2) Behind anterior scalene
3) Lateral to anterior scalene and anterior to brachial plexus within posterior triangle. comes into contact w/ 1st. rib
Contralateral Homonymous Hemianopsia
Temporal vision loss on contralateral side
Nasal vision loss on the ipsilateral side
CN X injury and Clinical Presentation
1) Brainstem lesion or deep laceration of neck
2) Deviation of uvula to normal side; hoarseness owing to paralysis of vocal fold
What are the borders of the anterior triangle of the neck
1) Midline of the neck
2) Anterior Border of Sternocleidomastoid
3) Inferior border of mandible
Pressure on optic pathway; laceration or intracerebral clot in temporal, parietal, or occipital lobes of brain causes what kind of injury?
Visual Field Defects
Explain how lesions associated with Herpes zoster (shingles) distribute themselves when following terminal branches of V1, V2, and V3.
1) Most common division affected = Ophthalmic Division
- Cornea involved –> painful corneal ulceration and scarring
2) MOA: Eruption of groups of vesicles following course of affected nerve
True or False: Facial Nerve Innervates the Parotid Gland
False; CN IX
Coronal Suture
Articulation between Frontal and both Parietal Bones
CN I Function
Smell and the only type of nervous tissue to regenerate
What does the ansa cervicalis innervate
1) Sternohyoid
2) Sternothyroid
3) Thyrohyoid
4) Omohyoid
What does the CSF surround>
Brain and Spinal Cord
Jugular Foramen (Vernet) Syndrome
1) CN IX, CN X, CN XI
2) Symptoms: Dysphagia (Difficulty in swallowing) and Dysarthria (motor difficulty in speaking)
Describe the course of the Facial a.
Enters submandibular triangle adj. to submandibular gland before passing over mandible border to face
Injury to the base of brain or fracture involving cavernous sinus or obit causes injury to what nerve?
CN VI
Clinical Significance of the Retropharyngeal Space
Easy route for upper respiratory or oral infections to spread
True or False: The Trigeminal nerve carries parasympathetic fibers
FALSE
Describe the course Ascending Pharyngeal
Medial aspect of external carotid near bifurcation of common carotid
What is the first sign of CN III compression
Ipsilateral slowness of the pupillary response to light
What is the parasympathetic function of CN III
1) Innervates Sphicter pupillae muscle of iris to make pupil constrict
2) Contracts ciliary muscles to make the lens of eye more spherical (needed for near vision)
What is the sensory component of the parotid gland?
Auriculotemporal N. Branch of CN V3
Trigeminal Neuralgia
Principal disease affecting sensory root of CN V, produces excruciating pain restricted to maxillary and/or mandibular divisions of the nerve
How does the trigeminal nerve CN V distribute parasympathetic
Post-ganglionic fibers from ciliary, pterygopalatine, otic, and submandibular nuclei piggy back off a branch of the trigeminal
Which cranial nerve is most commonly used in Dental Anesthesia?
CN V; Superior alveolar isn’t readily available so have to inject to surrounding tissue, but the inferior alveolar is.
Clinical presentation of CN VI injury
1) Eye fails to move laterally (medial deviation)
2) Diplopia (double vision)
Function of Muscles of Mastication
1) Masseter and Medial Pterygoid: Elevate and Protrusion of mandible
2) Temporalis: Elevates and Retrusion of Mandible
3) Lateral Pterygoid:
- Protracts and Depresses
- Unilaterally swings jaw toward contralateral side
Fracture of temporal bone (CN VII)
1) As in laceration or contusion in parotid region, but also associated involvement of cochlear nerve and chorda tympani; dry cornea; loss of taste on anterior two thirds of tongue
What is the branch of the facial n. that gives parasympathetic to CN V to innervate lacrimal gland
Greater Petrosal N.
What is the tension of vocal cords regulated by?
intrinsic muscles
Because of their relationship with the cavernous sinus, which CN’s are susceptible to injury via infections, thrombophlebitis?
CN III, CN IV, CN V1, CN VI
List the Infrahyoid Muscles
1) Sternohyoid
2) Omohyoid
3) Sternothyroid
4) Thyrohyoid
5) Cricothyroid
Describe the pathway of the parasympathetic glossopharyngeal n.
Travel to otic ganglion and then to parotid gland
Maxillary A. Branches 1
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2) D: deep auricular artery A: anterior tympanic artery M: middle meningeal artery I: inferior alveolar artery A: accessory meningeal artery M: masseteric artery P: pterygoid artery D: deep temporal artery B: buccinator artery S: sphenopalatine artery D: descending palatine artery I: infraorbital artery P: posterior superior alveolar artery M: middle superior alveolar artery P: pharyngeal artery A: anterior superior alveolar artery A: artery of the pterygoid canal
Symptoms of Cavernous sinus thrombosis
1) high fever
2) Periorbital edema and chemosis (conjunctival edema)
3) Cranial nerve palsies (CN VI (lateral gaze) most common)
4) Decreased Visual Acuity
Patient comes in with a loss of smell. Describe testing and Differential.
1) Test each nostril w/ patient blind folded and one nostril blocked
- occurs unilaterally
2) Differential
- Fractured Cribriform Plate –> Anosmia (loss of smell)
- Fracture of Cranial Base –> Anosmia and Cerebrospinal Fluid Rhinorrhea
- Meningioma –> Tumor of the meninges
Laceration or contusion in parotid region (CN VII)
Paralysis of facial muscles
Eye remains open
Angle of mouth droops
Forehead doesn’t wrinkle
Describe the pathway for the parasympathetic Facial N.
Nuclei w/ pons (Superior Salivatory Nucleus) –> Internal Auditory Canal –> Travel to autonomic ganglion before innervating respective glands
Describe the function, innervation, and blood supply to the intrinsic laryngeal muscles
1) Function: Control Tension of and spacing between vocal folds
2) Innervation: Vagus nerve via superior and inferior laryngeal n.
3) Blood supply: Superior Laryngeal A. and Inferior Laryngeal A.
Olfactory Hallucinations
Lesion of Temporal Lobe of Cerebral Hemisphere –> Temporal lobe epilepsy or uncinate fits
Treatment for Hydrocephalus
1) Ventriculoperitoneal shunt
- Drains Abdominal Cavity
2) Ventriculostomy
- Creates a hole in the flow of the third ventricle that drains into subarachnoid space
List the Fontanelles
1) Anterior Fontanelle
2) Sphenoid Fontanelle
3) Mastoid Fontanelle
4) Posterior Fontanelle
Describe the location of the Thyroid Gland
1) Deep to sternothyroid and sternohyoid from levels of C5-T1
2) 2 Lobes: anterolateral to larynx and trachea
3) Isthmus unites lobes over 2nd and 3rd tracheal rings
What are the prevertebral muscles innervated by?
Cervical and/or Brachial Plexus
OI and A of Prevertebral muscles
1) Posterior Scalene ~ Laterally Flex Neck and Elevates Ribs during Deep Inspiration
- O&I: Posterior Tubercles (C5-C7) to 2nd Rib
2) Middle Scalene ~ Laterally flexes neck and elevates rib during deep inspiration
- Posterior Tubercles (C2-C7) to Superior 1st rib
3) Anterior Scalene ~ Laterally flexes and rotates neck; Elevates ribs during deep inspiration
- Anterior C3-6 TP to 1st Rib
Longus Capitis and Coli
Rectus Capitis Lateralis and Anterior
Describe the circulation of CSF
1) Circulates in the ventricles and the subarachnoid space and then resorbed via Dural venous sinuses
2) Arises via Ependymal cells of the of choroid plexus in each ventricle
- Drains into the Subarachnoid space –> Resorbed into Dural Venous Sinuses via arachnoid granulations
- Dural Venous Sinuses have a lower pressure gradient that allows for the flow into the sinuses
What is the most common form of visual field loss and is often observed in patients with strokes?
Contralateral Homonymous Hemianopsia
What are Ventricular Folds
1) Brought together when holding breath while straining
2) Don’t contain vocal ligaments
What’s contained within the carotid sheath?
1) IJV = most lateral
2) Vagus = most posterior
3) Carotid and its bifurcation
Describe the borders of the carotid triangle
1) SCM
2) Superior Belly of Omohyoid
3) Posterior Belly of Digastric
Describe relational anatomy of parotid duct
1) Runs over masseter muscle –> pierces buccinator and opens on surface of oral cavity near upper second molar
Hypoglossal m. action and inervation
1) Depresses tongue and shortens it
2) Innervated via CN XII
What is the GVE modality
Parasympathetic
Describe the location of the parathyroid gland
Posterior aspect of thyroid gland in own capsule
Describe the Greater Petrosal n. and the Pterygopalatine ganglion
1) Greater Petrosal n. + Deep Petrosal n. = nerve to pterygoid canal
2) Fibers go to pterygopalatine ganglion and the parasympathetic synapse here while sympathetic use the ganglion as a round about
3) Post-ganglionic fibers leave via multiple routes
- Pharynx
- Nasal cavity and Palate
- Lacrimal Gland
4) To the lacrimal gland, the parasympathetic hop onto the Zygomaticotemporal branch of the maxillary nerve and from there onto the lacrimal gland via communicating branch
Mnemonic for maxillary artery
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Describe the Phrenic N.
Formed via C3 and C4 of cervical plexus and ventral rami of C5
Describe the Retromandibular V.
1) Superficial temporal v. and maxillary v. together form the retromandibular v.
List the different fascial layers of the neck
1) investing Fascia
2) Pretracheal Fascia
3) Prevertebral Fascia
4) Carotid Sheath
5) Retropharyngeal Space
Medial Wall of Orbit
1) Frontal Process of Maxilla
2) Lacrimal Bone
3) Lateral Mass of Ethmoid