h&n

Question 1

how do you test sensory function of trigeminal nerve?

Answer 1

close eyes -> neurotip -> both sides in 3 divisions of face -> equal feeling?

Question 2

how do you test motor function of trigeminal nerve?

Answer 2

masseter and temporalis muscle = mastication

chewing motion

Question 3

how do you test motor function of facial nerve?

Answer 3

copy facial expression I’m doing, against resistance, check for discomfort

temporal - raise eyebrow
zygomatic - eyes tightly shut
buccal - smile with teeth showing
mandibular - blow cheeks
cervical - grimace

Question 4

how do you test motor function of glossopharyngeal nerve?

Answer 4

elicit gag reflex - gently tough the back of the throat using tongue depressor

Question 5

how do you test motor function of vagus nerve?

Answer 5

open mouth and make ahh sound
look for uvula elevation

deviation from midline away from lesion side

Question 6

how do you test motor function of hypoglossal nerve?

Answer 6

stick tongue out

deviation from midline towards lesion side

Question 7

how do you test motor function of accessory nerve?

Answer 7

sternocleidomastoid muscle

look to one side against resistance
repeat to other side

Question 8

how do you test extrinsic eye muscles?

Answer 8

H test
superior oblique - trochlear nerve (IV)
lateral rectus - abducens nerve (VI)
the 4 rest - oculomotor nerve (III)

cover one eye -> abduct or adduct -> elevate or depress

          superior rectus                    inferior oblique lateral rectus                                                              medial rectus
          inferior rectus                       superior oblique

inferior rectus and superior oblique both depress so have to separate them using their secondary action

Question 9

how do you test ipsilateral and consensual pupillary light reflex?

Answer 9

shine light to one eye - observe ipsilateral pupil constriction
move light away for 3 seconds
shine light to same eye - observe other eye pupil constriction (consensual)

Question 10

how do you test accommodation reflex?

Answer 10

focus image far away

countdown to focus on finger 5-10cm away from eye

Question 11

describe afferent and efferent pathway for accommodation reflex

Answer 11

ganglion cell -> optic nerve -> optic tract -> pretectal nucleus -> Edinger-Westphal nucleus -> parasympathetic oculomotor nerve -> ciliary ganglion -> parasympathetic ciliary nerve (V1) -> sphincter pupillae

Question 12

describe afferent and efferent pathway of corneal reflex

Answer 12

touch sensation -> ophthalmic branch of trigeminal nerve -> facial motor nucleus -> facial nerve -> orbicularis oculi

Question 13

how do you test corneal reflex?

Answer 13

cotton wool onto sclera -> rapid eye closure

Question 14

how many teeth are present in a complete adult teeth set?

Answer 14

32

4 sets of...
    2 incisors
    1 canine
    2 premolar
    3 molar

Question 15

what is the significance of C7?

Answer 15

vertebrae prominence

Question 16

how do you palpate hyoid bone?

Answer 16

place index finger on thyroid cartilage
ask patient to swallow
hyoid bone move up

place index and thumb in pincer position 2cm above thyroid cartilage

Question 17

where is laryngeal prominence situated?

Answer 17

between superior thyroid cartilage and inferior cricoid cartilage

Question 18

where is thyroid situated?

Answer 18

below cricoid cartilage

Question 19

where is the lateral mass of atlas found?

Answer 19

between mastoid process and ramus of mandible

Question 20

where and when are tracheostomy and cricothyroidotomy performed?

Answer 20

cricothyroidotomy: through cricothyroid membrane
in an emergency

tracheostomy: below cricoid cartilage between trachea cartilage rings
for temporary intubation or long term airway access

Question 21

describe the start and end of external acoustic meatus

how is it observed?

Answer 21

opening of ear canal -> tympanic membrane

use otoscope

Question 22

carotid pulse

Answer 22

common carotid artery

anterior border of sternocleidomastoid

Question 23

cervical lymph nodes

Answer 23

circular motion
don’t lift fingers off
palpate from behind the patient

(look at the route for lymph nodes palpation)

Question 24

where is central line inserted?

Answer 24

into internal jugular vein (lateral to common carotid artery)

superior apex of triangle (sternal head of sternocleidomastoid, medial third of clavicle, clavicular head of sternocleidomastoid)

at 30’ angle
needle pointing towards ipsilateral nipple

Question 25

why is right internal jugular vein central line preferred?

Answer 25

wider
more superficial
=> easier, safer

Question 26

describe the anterior and posterior triangles of the neck

Answer 26

anterior: midline of neck, inferior border of mandible, anterior border of sternocleidomastoid
posterior: posterior border of sternocleidomastoid, middle third of clavicle, anterior border of trapezius

Question 27

what structures are within anterior triangle of the neck?

Answer 27

hyoid bone
common carotid artery
internal jugular vein (lateral to CCA)
suprahyoid muscles (sylohyoid, digastric, mylohyoid, geniohyoid)
infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid)

Question 28

what structures are within posterior triangle of the neck?

Answer 28

external jugular vein
subclavian artery
subclavian vein
brachial plexus trunks
phrenic nerve
vagus nerve
spinal accessory nerve

Question 29

what does nasal septum consist of?

Answer 29

vomer bone inferiorly
perpendicular plate of ethmoid bone
septum cartilage

Question 30

how is inferior nasal concha different from middle and superior nasal conchae?

Answer 30

is a bone itself

middle and superior nasal conchae are from ethmoid bone

Question 31

what is the purpose of concha?

Answer 31

increase SA of cavity

warming and humidifying air before reaching lungs

Question 32

what are the paranasal sinuses and where is mastoid air cells found?

Answer 32

maxillary sinus
ethmoid air cells
sphenoid sinus
frontal sinus

in mastoid process - post-auricular

Question 33

where is epidural injection performed?

Answer 33

L3/4 or L4/5
spinal cord ends at L1/2 -> cauda equina

use L4 supracristal line as guidance

sacral foramina for children

Question 34

what is epidural and subarachnoid injections used for?

Answer 34

epidural - x CSF, analgesia

subarachnoid - CSF, anaesthetic

Question 35

structures of typical vertebra

Answer 35

(anatomy flashcard)

Question 36

what are the vertebrae of cervical, upper thorax, lower thorax, limbo-sacrum regions?

Answer 36

C1-7
T1-7
T8-12
L1-S4

Question 37

what are the ranges of motion possible - identify which regions of vertebral column has large range of that motion?

Answer 37

flexion/extension: cervical, limbo-sacrum > lower thorax
lateral flexion: cervical, lower thorax > upper thorax, limbo-sacrum
rotation: cervical, lower thorax > upper thorax

Question 38

give explanation for each region’s range of movement

Answer 38

cervical: atlanto-occipital and atlanto-axial joint allow all movement

upper thorax: limitation due to ribs
no flexion/extension due to long articulations processes

lower thorax: ribs floating so less limitation

limbo-sacrum: vertebral processes optimised for flexion/extension
vertical articulation so no rotation

Question 39

describe the articulation of atlanto-occipital joint and atlanto-axial joint

Answer 39

AOJ: superior articular surface of atlas + occipital condyle
flexion/extension

AAJ: dens (dontoid process) of axis + anterior arch of atlas
lateral rotation