Exam 2: Head and Neck Flashcards
The sternocleidomastoid when contracted unilateral will result in……
contralateral rotation and ipsilateral side bending
The sternocleidomastoid when contracted bilaterally will result in……
flexion of the neck and (paradoxically) extension if the head already extended
______ is frequently encountered when the airflow in the nose in impeded, predisposition to congestion
Deviated nasal septum
_______ develop off the nasal cavity. They enlarge within the bones of the skull but remain connected to the nasal cavity
Air sinuses
The lining of the nasopharynx, auditory tube and the middle ear are all innervated by the ______.
CN IX: Glossopharyngeal
Define Mastoiditis. What can occur if left untreated?
a middle ear infection that has spread to the mastoid process.
Meningitis and infection of CNS
What connects the right and left lobe of the thyroid gland?
Isthmus
How many total parathyroid glands are there?
4 total, posterior side of the thyroid have 2 each.
During any thyroid procedure what must you pay special attention to and why?
All 4 parathyroid glands because their product: Parathyroid hormone: cannot be synthetically replaced.
Parathyroid hormone is responsible for?
Increasing serum calcium levels
______ is located posterior to the Pons
Cerebellum
The wrinkles on the brain forms…..
Distinct sulci (grooves) and gyri (bumps) on the surface
What is the difference between a contusion and a concussion?
Concussion is a contusion plus loss of consciousness
Cold or heat pain signals travel faster? Why?
Cold, nerves that carry cold signals have myelin versus heat ones do not
Anterior circulation of the brain is?
Internal carotid artery
The olfactory bulb extends off the _____, which connects it to the ______.
Olfactory tract
Cerebral cortex
The olfactory bulb sends olfactory nerves through the______ of the ethmoid bone to reach the ______.
Cribiform plate
superior nasal cavity
The retina of the eye is a direct extension of the ______ and as such, is actually part of the ________.
Diencephalon
central nervous system
The _____ extends away from the brain and induces formation of the lens from epidermal tissue
optic cup
The _____ sends axons through left and right _______.
retina
optic nerves
_____ travel through the optic canal. These converge and swap axons at the ______.
Right and Left optic nerve
Optic chiasm
Where do the Left and Right optic nerves axons synapse? In what part of the brain?
lateral genicuate nuclei
Thalamus
Where is visual information processed?
Occipital lobe
What part of the eye is the retina?
The back layer of the eye
When light enters the eye, what happens?
Give an example.
It becomes a reversed image by the retina
Lower parts of the visual field project on the superior retina and vice versa
Describe how the brain perceives the Right and Left sides of the visual field.
The temporal side of the visual field projects to the nasal aspect of the retina and vice versa
What happens to the nasal and temporal input on a patient’s left side.
Left temporal stays on the left side of the brain
Left nasal crosses to the RIGHT to join the right side optic radiation.
What happens to the nasal and temporal input on a patient’s right side.
Right temporal stays on the right side of the brain
Right nasal crosses to the LEFT to join the left side optic radiation.
How will a lesion of the optic nerve present?
Visual deficits in ONE eye
How do impingements/lesions of optic radiation present?
Visual deficits affecting one visual field. Will be in BOTH eyes
Homonymous hemianopia
How do lesions in the optic chiasm present?
Loss of bilateral temporal visual field
Bitemporal hemianopia
Define bitemporal hemianopia
Loss of bilateral temporal visual field
Define homonymous hemianopia
Visual deficits affecting one visual field. Will be in BOTH eyes
After the lateral geniculate nuclei, the axons project (Ipsi or contra) laterally on their way to the occipital lobes. They will also separate once again into ____ and ____ optic radiations.
Ipsilaterally
Superior and Inferior
_____ see black and white and motion
Rods
______ color and fine detail
Cones
What are located in the fovea?
Cones
What does the lens do as you get closer and closer to it?
Rounds up- Round lens = seeing close
Flat lens = seeing far away
What area of the world does your superior retina see?
The ground
The superior tract of the optic radiation goes through what lobe?
Parietal lobe
The inferior tract of the optic radiation goes through what lobe?
temporal lobe
For quadrantanopia, how do you determine where the problem is coming from?
The exact opposite (Superior/Inferior and Right/Left)
What does the inferior oblique eye muscle do?
elevate the eye
What does the superior oblique eye muscle do?
Depress the eye
What nerve innervates the superior oblique?
CN IV: Trochlear
What nerve innervates the lateral rectus?
CN VI: Abducens
How do you test the superior oblique muscle?
Have the patient look medial then inferiorly
How do you test the superior rectus muscle?
Ask the patient to look laterally and then superiorly
How do you test the Inferior rectus muscle?
Ask the patient to look laterally and then inferiorly
How do you test the inferior oblique muscle?
Ask the patient to look medially and then superiorly
What CN lesions presents with double vision when looking down?
CN IV: Trochlear
What cranial nerve lesion presents with persistently adducted pupil?
CN VI: Abducens
What is the consensual reflex?
When both pupils reaction to the stimulus of one
If only one reacts, indicates a problem
If you shine a light in the eye and neither pupil reacts, what is the likely cause?
Problems with CN II: Optic
What is the most common aneurysm to cause CN III compression?
posterior communicating artery
Loss of parasympathetic innervation of an eye is an early sign of increased intracranial pressure due to what?
pressure from the oculomotor nerve pushed against the dura mater
What is unique about the internal carotid artery?
does a U turn/have a U turn shape present
When the zonule fibers in the eye relax, what happens?
The lens becomes rounder aka can see up close
When the zonule fibers in the eye contract, what happens?
The lens becomes flatter/ more like an oval. aka can see farther away
What are the three regions of the trigeminal nerve?
Ophthalmic - V1
Maxilla - V2
Mandibular - V3
Where does the ophthalmic nerve exit?
Superior orbital fissure
The ophthalmic nerve splits into what branches?
Frontal
Lacrimal
Nasocilary
What branches come off of the Frontal nerve?
Supraorbital nerve
Supratrochlear nerve
What branches come off the nasocilary nerve?
-Posterior and anterior ethmoidal nerves
-Long and short ciliary nerves
Where does the maxillary nerve exit?
Foramen rotundum
What two nerves are responsible for sensation to the forehead?
Give the nerve route from the CN
Supraorbital and supratrochlear
CN: V Trigeminal -> Ophthalmic -> Frontal-> Supraorbital and supratrochlear
What two nerves are responsible for sensation to the eye?
Long and short ciliary nerves
The greater palatine nerve is sensory to….
hard palate
The lesser palatine nerve is sensory to….
Soft palate
What nerves are sensory to the teeth?
Posterior and superior alveolar
Where does the mandibular nerve exit?
foramen ovale
What nerve gives sensation to the lower teeth? What is special about it?
Inferior alveolar
Stays in the mandibule until it pops out as the mental nerve
The ____ nerve provides sensation to the chin
Mental
What nerve provides sensation to the tongue?
Lingual
What nerve supplies sensation to the inner cheek?
Buccal
What is a common cause of trigeminal neuralgia? What can trigger it?
blood vessel pushing against the nerve
light touch or cold air
What branch of the trigeminal nerve is responsible for muscles of mastication?
Mandibular nerve- V3
What are the 4 muscles of mastication?
- Masseter
- Temporalis
- Lateral pterygoid
- Medial pterygoid
If there is a problem with the _____ nerve affecting bite strength, when the mouth is actively open, what side will the jaw deviate towards?
Mandibular nerve
deviate TOWARDS the problem side
Tensor veli palatini function?
Tenses soft palate
Tensor tympani, function?
Keeps the middle ear from shacking violently
What are the four rando muscles that are also supplied by the mandibular nerve?
-Tensor veli palatini
-Tensor tympani
- Anterior belly of diagastric
- Mylohyoid
Lateral pterygoid, function?
open the jaw
Hypoglossus muscle innervation?
CN XII: Hypoglossal
Stylohyoid muscle innervation?
CN VII, facial
Posterior Belly of digastric muscle innervation?
CN VII: Facial
General rule of thumb, facial SENSATION is what nerve?
MOTOR of the face is?
CN V: Trigeminal
CN VII: Facial
Where does the facial nerve enter? Where does it exit?
Internal acoustic meatus of the temporal bone
Stylomastoid foramen
Name the functions of CN VII
-MOTOR to the face
-Sensory to some of the ear
-Taste to anterior tongue
-Innervation to lacrimal, submandibular and sublingual glands
What are the six branches of the Facial nerve
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
- Posterior auricular
Where does the facial nerve (and all of its branches) exit?
Stylomastoid foramen
Bell’s palsy is damage to what cranial nerve?
CN VII: Facial
What is indicated if you have a patient that screams Bell’s palsy but they can generate wrinkles on BOTH side
indicates CENTRALLY LOCATED lesion within the cortex or brainstem
What tiny muscle in the middle ear does the facial nerve innervate? What does de-innervation cause?
Stapedius
Hyperacusis: sounds are abnormally and painfully loud
What two parasympathetic nerves come off the facial nerve? and what nerves do they give rise to?
Greater petrosal -> lacrimal nerve
Chorda tympani -> Submandibular and sublingual glands
How is taste sensation conveyed?
travels backwards on the chorda tympani nerve
Where does CN VIII enter?
Enter: Internal acoustic meatus
Where is an acoustic neuroma/schwannoma usually found? What nerves are affected?
Near the internal acoustic meatus
Facial and vestibulocochlear
Fluid on the inside of the ear canals is called ?
Endolymph
Fluid on the outside of the canals is called?
Perilymph
Where does CN VIII exit?
It does not, stays within the temporal bone
What nerves innervate the external ear?
V3, VII and upper cervical spinal nerves
What nerves innervate the ear canal?
CN VII and X
What are the 3 ossicles of the middle ear?
Malleus, incus and stapes
What are the crystalline deposits called in the inner ear?
otoliths
What are the three semi-circular loops in the ear called?
Utricle- Horizontal
Saccule- Vertical
Ampulla- Rotational
The jugular foramen is the exit point for what three nerves?
CN IX: Glossopharyngeal
CN X: Vagus
CN XI: Spinal
Name some functions of CN IX. (In order)
- Sensory to pharynx and middle ear
- Motor to stylopharyngeus
- General sensory and taste sensory to posterior tongue
- Innervates the parotid salivary gland
- Innervates baroreceptors and chemoreceptors in the carotid vessels
What does a lesion of CN IX present with?
Dry mouth due to decreased salivation
Where does the CN X exit?
Jugular foramen
Name the functions of CN X
- Motor to palate, pharynx, larynx and esophagus
- Sensory to the larynx, esophagus, external ear canal, dura mater of the posterior cranial fossa
- Innervates the aortic baroreceptors
- Motor and sensory to all the thoracic organs, foregut and midgut
What would a lesion of CN X present with?
Increased heart rate, decreased gut peristalsis and sounds, decreased secretions from digestive glands
What nerves form the pharyngeal plexus? Which one is motor vs sensory?
CN IX (Sensory) and CN X (motor)
How do you test CN IX and X?
Check their gag reflex
If the patient felt the touch at the back of their throat checking their gag reflex, what nerve is intact?
CN IX: Glossopharyngeal
If the patient’s throat twitched as a result of checking their gag reflex, what nerve is intact?
CN X: Vagus
Stylopharyngeus muscle is innervated by ?
CN IX: Glossopharyngeal
All laryngeal muscles are innervated except _____ by what nerve? What is the exception innervated by?
Inferior laryngeal nerve from Recurrent branches of CN X: Vagus
cricothyroid muscle- external branch of superior laryngeal nerve
Uvula deviation leans the strong or weak side?
the STRONG side
When swallowing, what happens?
The suprahyoid muscles elevate the hyoid bone, closing off the laryngeal opening
Do not forget to look at this slide
What nerve innervates the larynx? Motor and sensory?
Both by CN X: Vagus
Motor: Inferior laryngeal nerve from recurrent laryngeal nerve
Sensory: Internal branch of superior laryngeal nerve
What branch is sensory to the larynx?
Sensory: Internal branch of superior laryngeal nerve
What branch is motor to the larynx?
Inferior laryngeal nerve from recurrent laryngeal nerve
What muscle is responsible for deepening or heightening the pitch of our voice?
Cricothyroid muscle
What nerve is motor and sensory to the esophagus?
Recurrent laryngeal nerve
What nerve innervates the cricothyroid muscle?
External branch of the superior laryngeal nerve
What is the only muscle that pulls the airway apart?
Posterior cricoaretynoid muscle
What part of the body makes the noise that we hear?
Vibrations of the true vocal folds
The ______ muscle tilts the thyroid cartilage anteriorly on the cricoid. What does this cause?
Cricothyroid muscle
Raising the voice’s pitch
What would de-innervation of the cricothyroid cause?
monotone voice
***The _____ muscles ABduct the vocal folds. If de-innervation happens unilaterally, what is the result?
Posterior cricoaretynoid muscles
it will cause hoarseness as the loose fold flaps in the breeze
Dr. Ward said to really know this one
____ and _____ muscles loosen the vocal folds when they contract. What are they innervated by?
Vocalis and thyroaretynoid
Inferior laryngeal nerve
______ and _______ muscles ADduct the vocal folds. Which allows (more/less) air to travel through the larynx
Innervated by?
lateral cricoaretynoid and aretynoid
LESS
Inferior laryngeal nerve
The accessory nerve originates from the ______ spinal cord level.
C1-5
Axons from the accessory nerve exit the spinal cord and ascend through the ______ and then through the _______.
Foramen magnum
Jugular foramen
What muscles does CN:XI innervate?
Sternocleidomastoid and trapezius muscle
Where does CN: XII exit the skull?
Hypoglossal canal