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Kofi: Pure Clinical Sem 3 > H&N: Nerves > Flashcards

H&N: Nerves Flashcards

1
Q

What is anosmia?

A

Loss of sense of smell. Commonly caused by a loss of smell

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2
Q

Damage to what nerve results in a loss of smell.

A

Olfactory nerve.
Secondary to shearing forces or basilar skull fracture. Intracranial tumours at the base of the frontal lobes can interfere with olfaction

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3
Q

What results in issues in both eyes?

A

-Involvement of optic chiasm or further back results in issues with both eyes as optic nerve fibres cross at the optic chiasm. Pituitary tumours can cause these issues

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4
Q

What can results in vision loss in the eye?

A

-Lesions involving the retina or optic nerve can cause visual disturbance affecting only one eye

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5
Q

What are the effects of impingement of the oculomotor nerve?

A
  • Pathology can cause pupillary dilation and/or double vision
  • Down and out position with severe ptosis
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6
Q

What can cause impingement/damage to the oculomotor nerve?

A
  • Raised intracranial pressure
  • Aneurysms
  • Vascular
  • Cavernous thrombosis
  • Oculomotor nerve runs on the tentorium cerebelli can be squashed unchus due to increased intracranial pressure.
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7
Q

What are the effects of impingement of trochlear nerve?

A

-Diplopia (rare and often subtle)

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8
Q

What can damage/impinge the trochlear nerve?

A
  • Head injury is the most common cause
  • Raised intracranial pressure
  • Congenital palsies
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9
Q

What is a blow out fracture?

A
  • A punch in the orbit which leads to increased pressure in the orbital cavity
  • Floor of the orbit can crack and infraorbital nerve(maxillary branch) is very vulnerable
  • Leads to reduced sensation in the lower eyelid and lower cheek
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10
Q

What is the effect of local anaesthetic injected in the mandibular foracment?

A
  • Loss of sensation in the chin and lip due to the inferior alveolar nerve
  • Loss of sensation at the side of the tongue due to lingual nerve
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11
Q

What does the inferior alveolar nerve becomes as it exits the inferior mandibular canal?

A

Mental nerve

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12
Q

What is trigeminal neuralgia?

A

Shingles of the trigeminal nerve

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13
Q

What do patients with injury to the cranial nerve 6 present with?

A

Dipoplia

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14
Q

What is the common cause of injury to cranial nerve 6?

A
  • Raised intracranial pressure due to bleed or tumour
  • Nerve easily stretched due to emerging anteriorly at point-medullary junction before running under the surface of the pons upwards towards the cavernous sinus
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15
Q

What is the facial nerve closely related to?

A
  • Cranial nerve 8 as both run in posterior cranial fossa and enter the internal acoustic meatus
  • Close relationship to the middle ear as it travels through the petrous part of the temporal
  • Close relationship to the parotid but doesn’t supply
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16
Q

What is affected with injury to the vestibocochlear nerve?

A

-Dysfunction in balance and hearing

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17
Q

What is an acoustic neuroma?

A

Benign tumour involving the vestibocochlear nerve. It impinges the nerve. Schwaan cells mostly.

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18
Q

What is presbyacusis?

A

Old age related hearing loss

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19
Q

Which nerve can be affected by inflammation at the back of the throat?

A

Glossopharyngeal which gives referred pain

20
Q

What does deviation of the uvula indicate?

A

Uequal rise in the soft palate due to weakness so therefore the uvula is drawn towards a direction. This can be due to vagus nerve damage

21
Q

What are the sign of damage to recurrent laryngeal nerve?

A

Hoarseness and dysphonia

22
Q

Where does the accessory nerve run in the neck?

A

Posterior triangle

23
Q

What is the significance of the region that the accessory nerve run in the neck?

A

-Susceptible to damage in the area e.g lymph node, biopsies, surgery and stab wound

24
Q

What are the effect of damage to hypoglossal nerve?

A

Weakness and atrophy of muscles of the tongue

25
Q

What are the effect of the sympathetic innerveation to the head and neck?

A
  • Pulpillary dilation (dilator palpillae)
  • Assits in eyelid retraction
  • Vaso-constrciton of blood vessls
  • Sweating
  • Fight or flight
26
Q

What are the effector tissues affected by the sympathetic nervous system?

A
  • Eye
  • Eye lid (superior tarsal muscle)
  • Blood vessels
  • Sweat glands
27
Q

Where does the sympathetic nervous system emerge from?

A

T1-L2

28
Q

How do the sympathetic fibres get to the head and neck?

A

Hitch hike on blood vessels such as the internal and external carotid then onto the trigeminal nerve

29
Q

Why does partial ptosis occur when the sympathetic fibres are impinged?

A
  • Loss of supply to the surperior tarsal muscle

- Occulomotor nerve supplies the rest of the eyelid so only partial ptosi

30
Q

What is the path taken by the parasympathetic autonomic fibres?

A
  • Arise from brainstem
  • Hitch hike onto one of 4 cranial nerves
  • Pass to the ganglia
  • Hitch hike on cranial nerve 5
  • Target tissue
31
Q

What are the target tissue of the parasympathetic innervation ?

A
  • Both muscle in iris for constriction and ciliary muscle
  • Lacrimal glands
  • Mucosal glands
  • Salivary glands
32
Q

What is the action of the parasympathetic innervation when a light is shone in the left eye?

A

Direct Constriction of the left pupil

Consensual constriction of the right eye

33
Q

What is the effect of decreased parasympathetic innervation from the facial nerve?

A
  • Reduced effect on sublingual and submandibular glands
  • Reduced effect on the lacrimal gland
  • Reduced effect on nasal and oral mucosal glands
  • Can cause dry eyes and mouth if interrupted
34
Q

What gland is parasympathetically innervated by the glossopharyngeal nerve?

A

Parotid gland

35
Q

What is parasympathetically innervated by the vagus nerve?

A
  • Glands in the laryngopharynx
  • Larynx
  • Glands and smooth muscle of the oesophagus and trachea
  • Heart
  • Smooth muscle and land with respiratory and GI tract
36
Q

What can pathology involving apex of the lung and internal carotid artery cause?

A

Autonomic dysfunction in the eye and face

-Sympathetic nerves travel on the Internal Carotid Artery

37
Q

What are the signs of a pancoast tumour?

A

Horner’s syndrome

  • Partial ptosis
  • Miosis
  • Anhydrosis
38
Q

Outline the pupillary light reflex?(start from the left eye)

A
  • Sensory afferent from left retina
  • Some branches leave CNII to enter midbrain
  • Connection with edinger westphal nuclei
  • Parasympathetic fibres from EDW leave the brainstem
  • Hitch hike on the oculomotor nerve
  • Passes via ciliary ganglion
  • Reach the sphincter papillae
  • Direct light reflex and consensual light relex
39
Q

What are the two main branches of the facial nerve arising inside the petrous bone?

A
  • Greater petrosal nerve
  • Chorda tympani nerve

(nerve to stapedius as well)

40
Q

What is the parasympathetic route to the submandibular and sublingual glands?

A
  • Facial nerve emerges from brainstem
  • Hitchhikes the pre-ganglionic parasympathetics (CN VII) into petrous bone
  • Continues along facial nerve
  • Joins chorda tympani nerve
  • Crosses the middle ear cavity
  • Exits base of the skull
  • Submandibular ganglion
  • Leaves via Post ganglionic (CN V) to the submandibular and sublingual salivary glands
41
Q

What is the parasympathetic route to the lacrimal, nasal and mucosal glands?

A
  • Facial nerve emerges from brainstem
  • Hitchhikes the pre-ganglionic parasympathetics (CN VII) into petrous bone
  • At geniculate ganglion, greater petrosal nerve leaves to pterygopalatine fossa
  • Interacts with the pterygopalatine ganglion
  • Hitch hikes the trigeminal nerve to Lacrimal gland and nasal and oral mucosal glands
42
Q

What is the path of the parasympathetic to the parotid gland?

A
  • Pre-ganglionic parasympathetics arise from the brainstem with Cranial nerve 9 and into the jugular foramen
  • Leaves via the Tympanic nerve
  • Joins tympanic plexus
  • Leaves the tympanic plexus via the lesser petrosal nerve through the foramen ovale
  • Interacts with the otic ganglion
  • Post ganglionic parasympathetics then with hike on branch of mandibular branch of trigeminal nerve
  • Parotid gland
43
Q

What is the route of parasympathetic innervation of the vagus nerve?

A
  • Medulla of the Brainstem
  • Parasympathetic fibres hitch hikes on CN X and its branches
  • Meets ganglion at or in target tissue
44
Q

How do the pre ganglionic sympathetic fibres synapse with the post ganglionic sympathetic fibres?

A
  • Pre ganglionic fibres ascend from the thorax and synapse with one of the upper cervical ganglia of the chain in the superior and middle cervical ganglia.
  • Post ganglionic fibres reach their target tissues in the head and neck by hitch hiking onto blood vessels
45
Q

How can the eye be placed at risk with a facial nerve injury?

A
  • Can’t close eye to protect from dust and foreign objects

- Can’t lacrimate the eye

46
Q

Which nerve supplies the carotid sinus?

A

-Afferent nerve is the ‘Glossopharyngeal nerve’

Kofi: Pure Clinical Sem 3 (44 decks)

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