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Head and neck Flashcards

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1
Q

Blood vessels that supply scalp and their sources

A

-Supraorbital
-Supratrochlear

From internal carotid

Superficial temporal
posterior auricular
occipital

from external carotid

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2
Q

Nerves that supply scalp

A

-Supraorbital
-Supratrochlear

From V1

Zygomaticotemporal (V2)
Auriculotemporal (V3)
Lesser occipital (cervical plexus
Greater occipital (C2)

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3
Q

Signs and symptoms of GCA

A

Constitutiona
-Fever
-Malaise
-Night sweats

Cranial
-Headache
-Jaw claudication
-Scalp tenderness

Eye
-Diplopia
-Blindness
-Anterior ischaemic optic neuropathy
-Amaurosis fugax

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4
Q

HIstological features of GCA

A

-Fibrinoid necrosis
-Granulomatous inflammation
-Destruction of internal elastic lamina
-Giant cells
-Skip lesions

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5
Q

What nerve would be at risk in temporal artery biopsy

A

Temporal branch of facial nerve

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6
Q

What treatment options for trigeminal neuralgia?

A

Medication:
-1) carbamazipne
-Baclofen, pregabalin, gabapentin

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7
Q

What are the main sutures of the cranial vault and what bones do they separate:

A

Saggital: parietal bones
Metopic: frontal bones
Lamdoid: occipital and parietal
Coronal: frontal and parietal

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8
Q

Name complications associated with craniosynostosis

A

-Abnormal hearing–> speech and language developmental delay
-Dental abnormality
-Hydrocephalus

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9
Q

What bones make up pterion

A

Frontal, Greater wing of sphenoid, parietal, temporal

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10
Q

What is the clinical significance of pterion

A

Anterior division

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11
Q

Main parts of sphenoid bone/sella turcica

A

Sella turcica
Dorsum sellae
Tuberculum sellae
Prechiasmatic sulcus
Limbus
Hypophyseal fossa
anterior clinoid process
posterior clinoid process

Greater wing
lesser wing
body

Foramens
-Optic canal
-Superior orbital fissure
-Foramen rotundum
-Foramen ovale
-Foramen spinosum

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12
Q

Anterior cranial fossa boundaries

A

Anterior/lateral: frontal bone
Posteromedial: limbus
Posterolateral: greater wing of sphenoid

Floor
-Ethmoid bone
-Frontal bone
-Anterior aspects of body.lesser wing of sphenoid

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13
Q

MIddle cranial fossa boundaries

A

Anteromedially: limbus
Anterolaterally: lesser wing of sphenoid
Posteromedial: dorsum sellae
Posterolateral: Petrous part of temporal bone

Floor:
-Body and greater wing of spenoid, squamous and petrous parts of temporal bone

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14
Q

Name the bony boundaries of the posterior cranial fossa

A

Anteromedial: dorsum sellae
Anterolateral: petrous part of temporal bone
Posterior: occipital bone

Floor
–> Mastoid part of temporal bone, squamous, condylar and basilar parts of occipital bone

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15
Q

Name three structures which are related to the clivus

A

-Basilar artery
-Abducens nerve
-Pons

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16
Q

What is the clinical significance of the course of the abducens nerve?

A

Long tortuous course
Pons–> runs up clivus–> travels in dorellos canal–> enters cavernous sinus –> enters orbit via superior orbital fissure

False localising signs: Palsy can be caused by cavernous sinus thrombosis, raised ICP, fracture C1.

In raised ICP, pons is pushed down and the nerve is stretched at its origin between pons and medulla

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17
Q

What is key finding in abducens nerve palsy?

A

-Pt’s eye is adducted (unnopposed action of medial rectus)
-Diplopia
-Unable to abduct eye

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18
Q

Embryological origin of anterior and posterior pituitary glands

A

Anterior–> oral ectoderm (rathke’s pouch)

Posterior –> neural ectoderm

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19
Q

Blood supply to anterior and posterior pituitary

A

Blood supply connects to hypothalamus via hypothalamohypophyseal portal system.

Anterior: Superior hypophyseal (ICA)

POsterior: Inferior hypophyseal artery (ICA)

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20
Q

What hormones are secreted by anterior and posterior pituitary?

A

Anterior: TSH, ACTH, FSH, LH, Prolactin, GH

Posterior: Oxytocin, ADH (no releasing hormones from hypothalamus)

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21
Q

Name some tumours of the pituitary gland and their clinical deficits.How can you classify them?

A

Classify as:
–> micro vs macroadenoma (<1cm vs >1cm)
–> secreting vs non secreting

Compression from above: craniopharyngioma (bitemporal inferior quadrantinopia, progressing to bitemporal hemianopia)

Compression from below:
-Pituitary adenoma (superior bitemporal quadrantinopia)

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22
Q

What does the pineal gland secrete?

A

Melatonin

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23
Q

Name some tumours of the brain

A

Glioma (glial tissue) vs non glioma (connective tissue)

Glioma
–> glioblastoma multiforme (most aggressive)
–> Oligodedroglioma
–> astrocytoma

Non glioma
–> meningioma
–> acoustic neuroma
–> craniopharyngioma

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24
Q

What areteries form the circle of willis?

A

-Terminal branches of the vertebral arteries and internal carotid arteries

Circle of willis is formed by:
–> Anterior cerebral arteries
–> internal carotid arteries
–> Posterior cerebral arteries

Connecting vessels:
–> anterior communicating artery
–> posterior communicating artery

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25
What are the most common sites for berry aneurysms?
-Anterior communicating artery 40% -Middle cerebral artery 34% -PCOM 20% -Basilar tip 8%
26
What is the aetiology of a subarachnoid haemorrhage?
Aneurysmal disease: --> asociated with ADPKD, atherosclerosis, connective tissue disorders, HTN Non aneurysmal -->Ttrauma --> AV malformation --> Coagulopathy
27
Key signs and symptoms in patient with subarachnoid haemorrhage
-Sudden onset 'thunderclap' headache in occipital region -Meningism: photophobia, stiff neck, pain on neck flexion, +ve kernig's sign) Raised ICP: --> nausea and vomiting --> reduced consciousness --> collapse --> seizures
28
Which structures lie within the cavernous sinus?
Centre: --> ICA --> Abducens nerve Lateral wall: --> 3, 4, V1, V2
29
What are the attachments of the falx cerebri and tentorium cerebelli?
Falx cerebri: --> anterior: crista galli --> posterior: tentorium cerebrelli Tentorium cerebelli -SPhenoid bone anteriorly -Petrous temporal bone laterally -Squamous part of occipital bone posteriorly
30
Name the paired dural venous sinuses?
-Transverse sinus -sigmoid sinus -Superior petrosal sinus -Inferior petrosal sinus -Cavernous sinus
31
Unpaired dural venous sinuses
-Superior sagittal -Inferior sagittal -Straight -Occipital -Intercavernous
32
Where do the dural venous sinuses drain into?
Superior sagittal sinus --> confluence. Runs from crista galli anteriorly to internal occipital protruberance (confluence) Inferior saggital sinus--> lies in inferior border falx cerebri, joins great cerebral vein to become straight sinus Straight sinus--> formed by confluence of inferior saggital sinus and great cerebral vein, runs inferoposteriorly to confluence Sigmoid: curve medially then exit through jugular foramin to become internal jugular veins Occipital: runs from epidural plexus to confluence Cavernous sinus --> drain opthalmic/sphenoparietal/middle cerebral veins into superior and inferior petrosal sinus Superior petrosal sinuses: cavernous sinus --> junction of transverse and sigmoid sinuses Inferior petrosal sinus--> cavernous sinus to IJV
33
What bones make up the orbit?
Many friendly zebras enjoy lazy summer picnic Maxillary Frontal Zygomatic Ethmoid Lacrimal Sphenoid Palatine
34
What are the structures passing through optic canal?
Optic nerve Ophthalmic artery Meninges, CSF
35
What does the ophthalmic artery supply?
-Supplies the structures of the orbit
36
What are the structures exiting via the superior orbital fissure?
3, 4, V1, 6, superior and inferior ophthalmic veins, sympathetic fibres
37
Which nerves are responsible for the corneal reflex?
-Afferent: long ciliary -Efferent: 7
38
Name the branches of the maxillary division of the trigeminal nerve
Infaorbital Zygomatic Superior labial Superior alveolar Palatine Pharyngeal
39
What are the branches of the mandibular branch of the trigeminal nerve?
Medial pterygoid Tensor tympani Tensor veli palatini Anterior division --> Nerve to lateral pterygoid --> Deep temporal --> Masseteric --> Buccal Posterior division --> Inferior alveolar (also motor to mylohyoid and anterior belly of digastric) --> Auriculotemporal --> Lingual
40
What type of joint is the mandible?
-Biarthrodial hinge joint (synovial)
41
What are the articulating surfaces of the temporo-mandibular joint?
-Head of mandible -Mandibular fossa of the temporal bone -Articular tubercle (from squamous part of the temporal bone)
42
What are the movements at the tmj?
Protrusion: --> lateral pterygoid assisted by medial pterygoid Retraction --> posterior fibres of temporalis, deep part of masseter, geniohyoid and digastric Elevation --> temporalis, masseter, medial pterygoid Depression --> gravity --> digastric, geniohyoid, mylohyoid Opening: protrusion and depression DGLM -Digastric -Lateral pterygoid -Geniohyoid -Mylohyoid
43
Function of temporalis
Elevation, retraction (posterior fibres)
44
Function of masseter
Elevation, retraction (deep part)
45
Function of pterygoids
Lateral pterygoid: protrusion, opening Medial pterygoid: Elevation, assists with protrusion
46
What are the parts of the mandible and the important foramina?
-Head of mandible -Coronoid process -Mandibular notch -Foramen of the mandible -Submandiblar fossa -Angle of mandible -Sublingual fossa
47
What are the main actions of the pterygoids?
-Lateral pterygoid: protrusion -Medial pterygoid: elevation (also assists with protrusion)
48
What are the attachments of the muscles of mastication?
Masseter: -Origin: Zygomatic arch -Insertion: ramus of the mandible Temporalis: -Origin: temporal fossa of the skull -Insertion: coronoid process of the mandible Medial pterygoid: --> Medial aspect of lateral pterygoid plate of sphenoid bone --> Insertion on ramus of mandible near the angle Lateral pterygoid: --> origin: lateral aspect of lateral pterygoid plate --> Insertion to neck of mandible
49
Where does the stylomandibular ligament attach and what is its significance?
-Origin: styloid process -Insertion: angle of the mandible Function -Prevents excessive opening of the mouth with sphenomandibular liagment
50
Name the extrinsic muscles of the tongue and their function/innervation
Genioglossus--> protrusion Hyoglossus--> depression Styloglossus--> elevation and retraction Palatoglossus--> elevation of the posterior tongue All hypoglossal except palatoglossus (vagus)
51
What are the intrinsic muscles of the tongue and their function?
-Superior and inferior longitudinal -Transverse -Vertical Affect size and shape of tongue e.g. tongue rolling, have role in facilitating speech, eating and swallowing
52
What is the motor supply to the tongue
-All hypoglossal except for palatoglossus (vagus)
53
What is the sensory supply to the tongue
-Anterior 2/3rd: general sensation lingual, taste facial -posterior: taste and general glossopharyngeal
54
Structures attaching to styloid process
Muscles: -Stylohyoid -Styloglossus -stylopharyngeus Ligaments -Stylomandibular ligament -Stylohyoid ligament
55
Name the structures attaching to the mastoid process
-Sternocleidomastoid -Posterior belly of digastric -Splenius capitis -Longissimus capitis
56
What are the actions of superior and inferior oblique muscles?
Superior: depresses, abducts and laterally rotates Inferior: elevates, abducts and laterally rotates
57
What nerves are responsible for the accommodation and light reflex?
Accommodation: --> Afferent 2 --> efferent 3 Light --> afferent 2 --> efferent 3
58
Name three causes of ptosis
-Horners -3rd nerve palsy -Myaesthenia
59
What are the key features of horner's?
-Partial ptosis -Anhydrosis -Miosis -Enophthalmos (retraction of the eyeball) -loss of ciliospinal reflex (pinching of skin on nape of neck does not produce dilatation of the pupil)
60
Key features of oculomotor nerve palsy
-Down and out palsy -Mydriasis -Complete ptosis
61
Trochlear nerve palsy
-Loss of intorsion -Vertical diplopia -Head tilted, difficulty reading book, walking down stairs
62
Name the ganglia associated with the facial nerve
-Pterygopalatine: --> Parasympathetic to nasal and palatine glands via greater petrosal nerve Submandibular --> secretomotor to submandibular and sublingual gland via lingual nerve
63
Name some causes for UMN and LMN facial nerve palsies
UMN: -Brain tumour -Brain infection -Stroke -MS LMN -Infective: otitis media, cholesteatoma, viral infection (HSV-1, CMV, EBV) -Neoplasm (parotid malignancy) -Trauma (temporal bone fracture), iatrogenic (mastoid/parotid surgery)
64
How to distinguish between UMN and LMN facial nerve palsy
-UMN: Forehead spearing due to bilateral innervation of occipitofrontalis muscle from cerebral cortex
65
What does the marginal mandibular branch of facial nerve supply?
-Depressor anguli oris -Depressor labii inferioris -Mentalis
66
Nerve supply to external ear
-Great auricular nerve ( postero-inferior aspect) -Lesser occipital (posterior) -Auriculotemporal: anterior and external auditory meatus -7 and 10: external auditory meatus, deeper aspect of auricle
67
Blood supply to ear
-Posterior auricular -Maxillary -Superficial temporal -Occipital
68
Name three signs and symptoms of patient with acoustic neuroma
-Sensorineural deafness -Tinnitus -Dizzyness and disequlibrium -Facial nerve palsy -Features of raised ICP
69
Management of acoustic neuroma
-<2cm: Active surveillance with annual MRI -2-3cm: stereotactic radiosurgery ->3cm: Microsurgerical excision
70
What condition is associated with bilateral acoustic neuromas?
Neurofibromatosis type 2
71
What are the main features of ramsay hunt syndrome (type 2)
-Ear pain -Facial nerve palsy with ipsilateral vertigo, hyperacusis and tinitus -Vesicles on concha, anterior 2/3rd of tongue, soft palate
72
Which arteries form kiesselbach's plexus
-Superior labial -Ethmoidal arteries -Greater palatine -SPhenopalatine
73
Name the paranasal sinuses
Frontal Ethmoid Nasal cavity Maxillary sinus
74
Into where do the paranasal sinuses drain?
Maxillary --> middle meatus Frontal --> middle meatus Ethmoid --> anterior: middle meatus, posterior: superior meatus
75
Name the structures which lie within the substance of the parotid gland
Superficial to deep: -Facial nerve -Retromandibular vein -Branches of external carotid artery -Greater auricular nerve -Lymphatics
76
Describe the borders of the parotid area
Superior: zygomatic arch Inferior: inferior border of the mandible Anterior: masseter Posteriorly: External ear and sternocleidomastoid
77
Describe the course of the parotid duct
-Arises from anterior surface of the parotid, traversing masseter muscle -Duct then pierces buccinator, moving medially -Opens out into oral cavity near second upper molar
78
Describe the surface anatomy of the stensen's duct
-Middle1/3rd of a line between Tragus of the ear to halfway between lateral commissure of the mouth and alar of the nose
79
What are the boundaries of the infratemporal fossa
Medial: lateral pterygoid plate Lateral: mandible ramus and coronoid process Anterior: maxilla Posterior: tympanic plate, mastoid and styloid process of temporal bone
80
Name the muscles in the infratemporal fossa
-Muscles of mastication (masseter is outside the fossa)
81
Name the vessels in the infratemporal fossa
Maxillary artery Pterygoid venous plexus
82
Name nerves in the infratemporal fossa
-Mandibular nerve -Otic ganglion
83
Name the main veins that drain the face
-Facial -Retromandibular
84
How is the retromandibular vein formed?
-Superficial temporal and maxillary veins
85
Where do divisions of retromandibular vein drain?
Posterior division: joins posterior auricular vein to drain into external jugular vein Anterior division: joins facial vein to drain into internal jugular vein
86
Into where does the external jugular vein drain?
Subclavian vein
87
how is the internal jugular vein formed?
Union of inferior petrosal and sigmoid sinuses
88
Describe the course of the accessory nerve
Spinal: C1-C3 (ascends via foramen magnum) Cranial: medulla --> exits via jugular foramen
89
What structures pass through the foramen magnum?
Vessels: --> vertebral arteries --> anterior and posterior spinal arteries --> Spinal veins Nerves --> spinal part of accessory nerve Soft tissue --> end of medulla, beginning of spinal cord --> meninges
90
What are the characteristic features of a typical cervical vertebrae? And which cervical vertebrae are typical?
-Bifid spinous process -foramen transversarium -Plane of facet joint is oblique -Broad body
91
How does C1 differ from typical cervical vertebrae?
-Atlas -Occipital condyles for articulating with skull -Kidney shaped, lacks spinous process or body
92
How does C2 differ from typical cervical vertebra?
Has dens
93
How does C7 differ from typical cervcial vertebra?
-Vertebra prominens-most prominent spinous process -Spinous process not bifid -Transverse foramen transmits vein but not arteries
94
What are the parasympathetic ganglia in the head and neck region?
Otic ganglion: glossopharyngeal, secretomotor to the parotid Submandibular: facial nerve, secretomotor to sublingual/submandibular gland Sphenopalatine/pterygopalatine: secretomotor to palatine/lacrimal/nasal glands. Innervated by 7 via vidian nerve (formed by greater petrosal and deep petrosal nerve) Ciliary: 3 to sphincter pupillae
95
Where does the greater petrosal nerve arise from and what is its function?
-Facial nerve -Secretomotor to nasal, paranasal glands, paranasal sinuses, lacrimal apparatus
96
How is the nerve of the pterygoid canal (vidian nerve) formed and what does it supply/
-Formed by greater and deep petrosal nerve -Innervates pterygopalatine/sphenopalatine ganglion and provides secretomotor to nasal/paranasal glands, paranasal sinuses, lacrimal apparatus
97
Where does the lesser petrosal nerve arise from and what is its function>
-From glossopharyngeal -Carries secretomotor to the parotid gland
98
Where are the nucleuses of the cranial nerves locaTED?
The oculomotor nerve (III) and trochlear nerve (IV) emerge from the midbrain, the trigeminal (V), abducens (VI), facial (VII) and vestibulocochlear (VIII) from the pons, and the glossopharyngeal (IX), vagus (X), accessory (XI) and hypoglossal (XII) emerge from the medulla.
99
What are the functions of the superior and inferior salivatory nucleuses?
The superior salivatory nucleus innervates (via CN VII) the submandibular ganglion, which supplies the submandibular and sublingual glands; the inferior salivatory nucleus innervates (via CN IX) the otic ganglion, which supplies the parotid gland. These parasympathetic fibers stimulate secretion of saliva.
100
What is the solitary nucleus (nucleus of soliatary tract)
series of purely sensory nuclei forming a vertical column of grey matter embedded within the medulla oblongata.
101
What is the nucleus ambiguus
The nucleus ambiguus is the common nucleus of the efferent (motor) fibers for glossopharyngeal (CN IX) and vagus (CN X) nerves
102
From where is CSF produced?
Choroid plexus 80%, ependymal cells 20% in the ventricles
103
How much CSF is produced?
-500ml. 150ml in circulation at any one time
104
How does the CSF from the lateral ventricules reach the subarachnoid space?
105
How is csf reabsorbed?
Arachnoid granulations
106
What are the commonest types of hydrocephalus? How is it managed?
-Communicating--> over production (choroid plexus) -non communicating --> tumour, meningitis Mx -VP shunt
107
What are the key biochemical diffrences between CSF and plasma?
Higher in CSF: -Chloride Lower in CSF: -K, ca, glucose No protein/cholesterol in CSF
108

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