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head and neck Flashcards

1
Q

foramen rotundum

A

V2 maxillary division of trigeminal

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2
Q

foramen ovale

A

V3 mandibular division of trigeminal

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3
Q

carotid canal

A

internal carotid artery

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4
Q

foramen spinosum

A

middle meningeal artery

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5
Q

jugular foramen

A

glossopharyngeal n
vagus n
accessory n
internal jugular vein

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6
Q

cribiform plate

A

olfactory nerves

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7
Q

optic canal

A

optic nerve
ophthalmic artery

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8
Q

superior orbital fissure

A

V1 ophthalmic of trigeminal
oculomotor n
trochlear n
abducent n
superior ophthalmic vein

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9
Q

internal acoustic meatus

A

facial n
vestibulocochlear n

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10
Q

hypoglossal canal

A

hypoglossal n

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11
Q

base of skull fractures / fracture through petrous portion of temporal bone
affects which nerves?

A

presents w cranial nerve palsy
commonly affects facial or vestibulocochlear nerves

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12
Q

layers of SCALP

A

skin
connective tissue
aponeurosis (of occipitofrontalis)
loose connective tissue
periosteum

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13
Q

classic epidural presentation

A

Loss of consciousness → lucid → deterioration
Brain shock → bleeding → cerebral herniation

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14
Q

deep to pterion is ?

A

ant division of middle meningeal artery

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15
Q

fracture of pterion leads to?

A

epidural haemorrhage

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16
Q

pterion midpoint bw which bones?

A

frontal
parietal
temporal
sphenoid

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17
Q

meningeal layers

A

bone / skull
dura mater - periosteal
dura mater - meningeal (has invaginations)
subdural space (potential space)
arachnoid mater
subarachnoid space
pia mater (covers brain)

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18
Q

the flax cerebri has ?

A

superior sagittal sinus
inferior sagittal sinus
straight sinus (post)

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19
Q

great cerebral vein bw?

A

straight sinus and inferior sagittal sinus

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20
Q

cavernous sinus contents:

A
  • oculomotor n
  • trochlear n
  • ophthalmic n
  • abducent n
  • maxillary n
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21
Q

in cavernous sinus thrombosis which nerve is affected first?

A

abducens (closest to ICA)

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22
Q

trigeminal nerve innervates which muscles?

A

innervates muscles of mastication + tensor veli palatini, tensor tympani, mylohoid

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23
Q

opthalmic n type of innervation?
exits via?

A

purely sensory
exits via superior orbital fissure

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24
Q

maxillary type of innerv?
exit?

A

purely sens
exits via foramen rotundum into pterygopalatine fossa

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25
Q

mandibular type of inner?
exit?

A

sens and motor innervation
exits via foremen ovale into infratemporal fossa

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26
Q

ophthalmic nerve branches

A

frontal - divides further to give sens to forehead
lacrimal - sens innervation of lacrimal gland
nasociliary - sensation of cornea + sinuses

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27
Q

lacrimal nerve hitchhiker

A

parasym fibers from facial n synapse at pterygopalatine ganglion and travel with zygomatic branch of V2 then with lacrimal branch

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28
Q

nasociliary n hitchhiker

A

sympathetics from superior cervical ganglion get to the dilator pupillae

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29
Q

trigeminal ganglion divided into

A

3 branches
V1 and V2 go through cavernous sinus then leave the skull
has motor and sensory root

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30
Q

maxillary nerve sens innerv

A
  • lower eyelid and its conjunctiva
  • inf post portion of nasal cavity
  • lateral nose
  • cheeks and maxillary sinus
  • upper lip, teeth, gingiva and palate
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31
Q

maxillary n parasym inner

A

FIBERS DO NOT ORIGINATE FROM TRIGEMINAL N
- lacrimal gland ( fibers go from V2 zygomatic branch to V1 nasocilary)
- mucous glands of nasal mucosa (nasopalatine and greater palatine)

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32
Q

mandibular nerve branches

A
  • auricolotemporal
  • buccal
  • inf alveolar
  • lingual
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33
Q

auriculotemporal n innervates?

A

actually convergence of two separate roots
sup root - sens fibers:
- ant auricle, external acoustic meatus, and tympanic membrane
- lateral temple
inf root - parasym fibers from CN IX
- otic ganglion -> parotid

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34
Q

buccal n innervs?

A
  • buccal membranes of the mouth (cheek)
  • 2nd and 3rd molar teeth
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35
Q

inferior alveolar n innervs?

A

mylohyoid branch -> motor n to mylohyoid and ant digastric
sens fibers to mandibular teeth
emerges from mental foramen and becomes mental n

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36
Q

mental n

A

sensation to lower lip and chin

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37
Q

lingual n

A

gen sens - ant 2/3 tongue
(chorda tympani travels w lingual + autonom fibers from facial that go through submandibular ganglion to submandibular and sublingual glands)

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38
Q

V3 nerve (motor)

A

muscles of mastication - masseter, med + lat pterygoid, temporalis
- tensor tympani
- tensor veli palatine
- suprahyoid muscles:
- ant belly of digastric (pos innerv by facial n)
- mylohyoid m

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39
Q

artery coursing transversely just medial to the neck of the condyle of the mandible is ?

A

maxillary artery

40
Q

all masseter muscles elevate except?

A

lateral pterygoids - protract mandible

41
Q

infratemporal fossa bw?

A

ramus of mandible and wall of pharynx

42
Q

pterygopalatine ganglion in?

A

pterygopalatine fossa

43
Q

tmj dislocation almost always dislocates ?

A

anteriorly

44
Q

middle meningeal is a branch of ?

A

ECA - maxillary

45
Q

lingual and chorda tympani will link up in ?

A

infratemporal fossa somewhere

46
Q

contents of the parotid gland
superficial to deep

A
  • facial n - 5 terminal branch
  • retromandibular vein
  • external carotid artery
  • lymph nodes
47
Q

innervation of the parotid gland

A

pregang: lesser petrosal n branch of glossopharyngeal
ganglion: otic
postgang: auriculotemporal n

48
Q

submandibular and sublingual glands sep by

A

mylohyoid m

49
Q

below submandibular duct is

A

lingual n - prone to injury surgically

50
Q

what artery courses through submandibular ganglion

A

facial a

51
Q

optic canal contents

A

optic n and opthalmic artery

52
Q

superior orbital fissure located bw

A

greater and lesser wing of sphenoid bone

53
Q

inferior orbital fissure contents

A
  • zygomatic branch of maxillary n
  • inf ophthalmic vein
  • SNS nerves
54
Q

orbital rim fracture

A

fracture of the bones forming outer rim of bony orbit

55
Q

blowout fracture

A

rim is intact but the walls of the orbit is fractured
partial herniation of orbital contents occurs due to blunt force trauma
if maxillary sinus involved then can lose sens to malar region

56
Q

trap door

A

What is it: Happens in children due to the elasticity of their bones - rather than just snapping, the bone initially breaks outwards but returns to its original position
Why is it bad: Upon return, the fracture may entrap some soft tissue of the orbit, such as orbital fat or sometimes musculature (eg. inferior rectus)

57
Q

CN IIII / oculomotor autnomics

A
  • supplies PNS to sphincter pupillae (constricts) and cilary muscle (lens becomes more sperical, better for short range vision) via short ciliary n
  • supplies SNS to sup tarsal m
58
Q

CN III palsy presentation

A

down and out gaze
ptosis - inactive levator palpebrae
mydriasis - dilated pupil due to decreased tone of constrictor pupillae muscle

59
Q

CN III palsy causes

A
  • raised ICP
  • post communicating artery aneurysm
  • cavernous sinus infection/ trauma
60
Q

vertical diplopia when walking down stairs due to ?

A

CN IV palsy

61
Q

SO and IO function

A

SO - depression and abduction
IO - elevation and abduction

62
Q

CN IV palsy causes

A
  • microvascular disease (diabetes)
  • raised ICP
  • cavernous sinus thrombosis
63
Q

CN VI palsy presents w

A
  • medially deviated eye
  • diplopia
64
Q

accomodation distant vision

A

When ciliary muscle relaxes → suspensory ligaments taut → lens is pulled thin → distant vision

65
Q

accommodation close vision

A

When ciliary muscle contracts → suspensory ligaments relax → lens becomes thick → close vision

66
Q

vasculature of eye

A

ophthalmic artery - branch of ICA
arises immediately distal to cavernous sinus

venous drainage:
sup and inf ophthalmic veins drain into cavernous sinus

67
Q

Macula - Responsible for what parts of vision?

A

the central, high-resolution, color vision that is possible in good light. Contains the central fovea

68
Q

Central fovea

A
  • tiny pit located in the macula of the retina that provides the clearest vision of all as light falls directly on the cones..
69
Q

Optic disc -

A

where the optic nerve exits. This area has no rods or cones, so creates a blind spot.

70
Q

Papilloedema

A
  • swelling/blurring of the optic disc due to raised ICP
  • Subarachnoid space extends into the optic nerve sheath
  • So raised ICP → increased pressure transmitted into optic nerve sheath → pappiloedema
71
Q

lacrimal gland blood supply

A

Arterial supply → ophthalmic artery → lacrimal artery
Venous: → superior ophthalmic vein → cavernous sinus

72
Q

Corneal reflex
sens and motor comes from?

A

Sensory: to the eye (nasocilliary branch of ophthalmic nerve V1)
Motor: Orbicularis oculi (muscle of facial expression) - Facial nerve branches

73
Q

A patient presents with gradual onset of vision loss. To determine if the defect is due to a brain or nerve problem, what is the MOST important thing to determine on examination?
a. Visual acuity
b. Cranial nerve 3,4 and 6 function
c. Visual fields
d. Blind spot testing

A

C visual fields

74
Q

Anterior to the chiasm = ?
Posterior to the chiasm = ?

A

Anterior to the chiasm = unilateral visual field loss
Posterior to the chiasm = ALWAYS have visual field loss on both eyes (e.g. homonomous hemianopia)
So any problem with the brain that effects vision will cause a visual field defect on both eyes

75
Q

middle ear boundaries

A

Medial - labyrinthine wall)
Separates tympanic cavity from internal ear
Contains oval window, round window, prominence lateral semicircular canal, facial nerve canal
Lateral - membranous wall - tympanic membrane
Roof - tegmen tympani separating cranium from middle ear
Floor - jugular wall
Posterior - mastoid wall
Pyramidal eminence (stapedius m.), aditus leading to mastoid anturm
Anterior - carotid wall
Pharyngotympanic tube to nasopharynx for pressure equalization. Also has tensor tympani muscle

76
Q

Issue with vagus [X] = Uvula will deviate towards which side?

A

normal side (thats where the pull is)

77
Q

issue with hypoglossal n. [XII] = Tongue deviates toward ?

A

abnormal side (lick your wounds)

78
Q

stylopharyngeus is innervated by?

A

glossopharyngeal n

79
Q

pharyngeal muscles all innerv by pharyngeal branch of vagus except

A

Except stylopharyngeus (CNIX)

80
Q

gag reflex involves what nerves

A

Gag reflex = 9 sensory - 10 motor (pharyngeal/palate muscle response)

81
Q

only voice related muscle that abducts?

A

Posterior crico-arytenoid only muscle that abducts!!! → important to know this
All other ones adduct, tense vocal cord

82
Q

when you tense vocal cord pitch goes?

A

higher

83
Q

larynx muscles pneumonic
SCAR

A

SCAR:
Superior laryngeal nerve (external branch)
Cricothyorid muscle
All other muscles
Recurrent laryngeal nerve

84
Q

During a carotid endarterectomy, a surgeon accidentally injures the superior laryngeal nerve. Which of the following is MOST accurate with the defects seen post-operatively
a. The patient will have a hoarse voice
b. The patient will be unable to hit high notes
c. The patient will have a stridor
d. Nothing will happen as the other side can compensate

A

B

85
Q

Pretracheal fascia →

A

pericardium
Pharynx/larynx, oesophagus, trachea
Thyroid
Recurrent laryngeal n.
Strap muscles

86
Q

Carotid sheath

A

Common carotid, IJV, CN X
Pierced by glossopharyngeal n. And ansa cervicalis
Connected by alar fascia

87
Q

Investing layer surrounds?

A

Traps, SCM

88
Q

Retropharyngeal space - potential space

A

Bound by buccopharyngeal fascia anteriorly and alar fascia posterioly
Contains retropharyngeal lymph nodes
Continuous with posterior mediastinum → neck space infections here can spread down causing mediastinitis (not good)

89
Q

Danger space

A

Continuous with posterior mediastinum
- can also spread to prevertebral space from here

90
Q

surgery in posterior neck → injure

A

CN XI, subclavian and cervical plexus

91
Q

Surgery in the anterior triangle → injury

A

cn 9, 10, 12

92
Q

A patient is day 1 post-op total thyroidectomy. They complain of muscle spasms and have some perioral numbness. Which of the following is true?
a This may be the first sign of impending airway obstruction
b This presentation is likely due to parathyroid gland removal
c The patient should immediately have the sutures removed on the ward
d This is a normal side effect of anaesthetic

A

B

93
Q

External laryngeal n. Damage -

A

lower pitch
cricothyroid

94
Q

Recurrent laryngeal n. Damage –

A

hoarse voice if unilateral, airway obstruction if bilateral

95
Q

Post-thyroidectomy haemorrhage

A

Bleeding beneath cervical fascia and strap muscle layer
Pressure obstructs lymphatic drainage → laryngeal oedema → airway emergency
If you are ever the surg intern and a post-thyroidectomy patient, this is such an emergency that should open up the sutures all the way down until you see trachea → at the bedside

96
Q

Parathyroid gland removal →

A

hypocalcaemia

exams (5 decks)

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