Head and Neck ( 20% ) Flashcards

Question

The blood brain barrier * Only allows amino acids, fats and sugar to be transported. * Lacks fenestrations and zonulae occudentes * Has enveloping astrocyte foot processes instead of basal laminae * Are innervated by sympathetic fibres only * Is missing from parts of the hypothalamus

Answer 1

**Is missing from parts of the hypothalamus** * Allows amino acids, fats and sugar to be transported, *as well as* *Water, CO2, O2, lipid-soluble steroids not bound to plasma proteins* Will need to find answers to the below * Lacks fenestrations and zonulae occudentes * Has enveloping astrocyte foot processes instead of basal laminae * Are innervated by sympathetic fibres only

Answer 2

**In the arachnoid mater** * Veins cause subdural haemorrhages - slow-growing.* * Arteries cause epidural haemorrhages - fast growing, high pressure.*

Answer 3

**do not follow arteries** * lie *in the Subarachnoid space (subdural is normally just a potential space).* * Venous sinuses lie in partitions within the dura * great cerebral vein drains into *Straight sinus (merging with inferior sagittal sinus)* * *Superior veins -\> superior sagittal sinus* * *Inferior and superficial veins -\> straight, transverse, and superior petrosal sinuses*

Answer 4

**Sigmoid sinus grooves the mastoid part of the petrous bone** * Superior sagittal sinus *drains the superior cerebral veins* * The transverse sinus runs between the layers of the *Tentorium cerebelli* * The cavernous sinus has the III, IV and 2 divisions of V in its *Lateral wall* * Sigmoid sinus drains the occipital sinus. No such thing as occipital sinus

Answer 5

**ICA gives off ophthalmic a** * Posterior cerebral is a branch of the *Basilar artery* * *Middle* cerebral is the largest branch of the ICA. * Middle cerebral supplies *both* motor *and* sensory cortex. * Anterior communicating unites the *2 ACAs*

Answer 6

**ACA is contralat leg, micturition and defaecation** *I will have to take Nicks word for this* * *Vision is ipsilateral ophthalmic artery (off ICA) to the eye, or the contralateral visual field homonymosly in the occipital cortex (PCA)* * *MCA supplies motor and sensory cortex (contralateral arm and leg)* * *Need to confirm speech and auditory areas - likely ACA.*

Answer 7

**The posterior spinal artery is usually a branch of the posterior cerebellar or vertebral aa.** Usually PICA

Answer 8

**ACA supplies motor and sensory control of urination and defecation** * ACA + MCA ar terminal branches of ICA; *PCA is a branch of basilar* * *MCA* is most common site of embolization.

Answer 9

**An artery that has entered the surface of the brain is always an end artery** * Supply originates from the *ICA* and vertebral system. * Congenital aneurysms are most frequently found in the *Ant communicating most common, then Post comm, then MCA, then ICA* * The posterior cerebral artery arises from the *Basilar artery* * The middle cerebral artery is the *largest* branch of the ICA *(others are ACA, ophthalmic and post comm)*

Answer 10

The middle cerebral a

Answer 11

**Gives off the ophthalmic artery** * Enters the skull through the *Carotid canal.* Passes on top of F lacerum * Divides into the anterior and middle *cerebral* arteries * Is accompanied within the skull by *post-ganglionic* sympathetic nerve fibres. * Usually begins about the level of *C3/4*

Answer 12

***Does not* Give off branches to the anterior spinal artery.** *Vertebrals do*

Answer 13

**The ICA gives off the ophthalmic arteries before dividing into anterior and middle cerebral arteries** * The basilar artery divides into right and left posterior *cerebral* arteries. * Gives off superior and anterior inferior cerebellar arteries. * Vertebrals give off post inferior cerebellar arteries * The middle cerebral arteries branch off and supply *both motor and sensory cortex.* * The anterior communicating artery unites the *two ACAs* * It encircles the inferior brains stem at the C2-3 level. * Does not circle the brainstem

Answer 14

**Receives important contributions from radicular arteries** * Is from a single anterior and *2x posterior* artery. * Anteriorly is from the **anterior spinal artery derived from the *vertebral arteries* * Lies in the *probably pia* space.

Answer 15

**Bridge over the nose** * Upper incisor - Infra-orbital * Labial gum - Infra-orbital * Upper lip - Infra-orbital * Skin of the lower eyelid - Infra-orbital

Answer 16

Unclear answer **Receive blood supply from the branches of the anterior cerebral artery** * Nick says the above, but central retinal artery and all ciliary arteries are branches of ophthalmic artery (off ICA)* * I cannot confirm nor deny the last answer* * Pass to the *LGB* for relay to the visual cortex. * From the *nasal* surface of the retina cross at the chiasma * Pass through the *Optic canal* * Pass to the lateral geniculate body for constriction of the pupil. * Some optic nerve afferents bypass the LGB, instead going to the pretectal nuclei in the sup colliculus, which then stimulate the E-W nucleus -\> pre-G para in III -\> ciliary G (from nasociliary of V1) -\> post-G para in short ciliary nerves

Answer 17

**Passes between superior cerebellar and posterior cerebral a** * *CN VI* supplies LR. * Travels in the *lateral* wall of the cavernous sinus. * Divides into superior and inferior branches *before* exiting from the superior orbital fissure. * Complete division causes *mydriasis* and ptosis (carries parasympathetic fibres). * Miosis + ptosis is a Horner’s (sympathetic loss)

Answer 18

**Branches of VII** * Subarachnoid space surrounds the optic nerve in the optic sheath until it enters the eye (part of the reason you can see raised ICP in the discs) * II (optic) and III (occulomotor) are in the orbit * Inferior rectus obviously in the orbit

Answer 19

**combined SR + IO = vertical up.** *Both elevate, and their adduction-abduction and intorsion-extorsion cancel out* **IR + SO move eye down** *(IR = depression and ADduction; SO depression + ABduction)* * IV paralysis = can’t look down when eye turned *in* * SR moves eye up and *in* * _III_ paralysis = eyes look down and out *due to unopposed SO and LR* * **VI palsy causes addiction (loss of abduction) * Combined IR +SO gives *Downwards gaze (see above)* * SO action in full abduction is minimal. * SO’s main action is depression in adduction. Is also an abductor

Answer 20

**Superior rectus turns the eye up and** ***_in_*** * There are 7 extraocular mm. * According to Moore’s: LPS, 2 obliques, 4 recti * Superior oblique is supplied by IV - SO4LR6 * Medial rectus turns eye in - (MR = adduction) * In VI paralysis the eye cannot look outwards - *true*

Answer 21

**moves eye down and out** * SO = down and out* * IO = up and out* * SR = down and in* * IR = up and in* * MR/LR = adduction/abduction only*

Answer 22

**Trochlear nerve lies outside the cone of muscles.** *Enters through the superior orbital fissue, along with the Frontal Nerve and Lacrimal Nerve (V1)* * Floor consists of the maxilla, *As well as zygomatic and palatine bones* * Superior orbital fissure leads to the *Middle cranial fossa* * Inferior orbital fissure leads to the *Pterygoid plexus* * The superior oblique muscle causes the eye to look *Down and out*

Answer 23

**Sphenoid.** Lesser wing contributes to roof at the apex

Answer 24

**none of the above are correct** * the maxillary a enters posteriorly *superficial* to the spheno mandibular ligament. * the *lateral* pterygoid plate represents part of the medial wall. * the *facial nerve (VII)* gives off the chorda tympani immediately on entering the region. * *Lingual nerve lies between mandible and medial pterygoid*

Answer 25

**The retromandibular vein lies immediately deep to VII** * Duct opens opposite the 2nd *upper* molar tooth * Is supplied by the *ECA (lies deep within the gland)* * The VII lies *within the gland (superficial to ECA and RMV)* * The ECA lies *deep* within the gland.

Answer 26

**geniculate ganglion.** Facial nerve as it turns within the temporal bone. Taste to anterior 2/3 tongue

Answer 27

**IX** IX does sensation and taste to posterior 1/3rd VII (chorda tympani) does anterior 2/3rds taste V (lingual branch of V3) does anterior sensation IX does all motor

Answer 28

**Each side may drain lymph to nodes on the contralateral side of the neck** * All tongue muscles *except palatoglossus* are innervated by XII. * ??? It elevates the epiglottis through attachment of the lateral glossoepiglottic folds

Answer 29

**Lymphatic drainage goes to ipsilateral and contralateral sides of the neck** * It is moved only by the intrinsic and extrinsic muscle. * Unclear why this is false. Lots of other muscles move the mouth * Intrinsic alter shape of tongue, extrinsic alter its position * All supplied by IX except palatoglossus * It is supplied *lingual artery (branch of ECA)*. *Branches - deep - supplies body; dorsal - supplies root* * There is free communication between *deep lingual arteries* *only* *at the apex* * The lingual nerve supplies sensation to the *anterior* tongue, *IX posterior 1/3*

Answer 30

**Is covered by columnar epithelium in its posterior 1/3** * Has *collaterals only at the apex (deep lingual arteries)* * Has lymph drainage to both its ipsilateral *and contralateral* lymph nodes. * Has intrinsic and extrinsic muscles all of which are supplied by the hypoglossal n *except Palatoglossus by X* * Has sensory *and taste* nerve supply to its posterior third from the *hypoglossal nerve (IX)* * ***Lingual nerve (branch V3) supplies sensation to anterior 2/3rds (chorda tympani of VII does taste)*

Answer 31

**Nasolacrimal duct** * Frontal sinus - Hiatus semi-lunaris (middle meatus) * Ethmoid sinus - Anterior with frontal, middle via bulla on the uncinate (also middle), posterior into superior meatus * Maxillary sinus - Hiatus semi-lunaris (middle) * Auditory tube - Posterior to the meati

Answer 32

**Mainly enters the sphenopalatine foramen** * Is *from both* external carotid *and internal carotid* * ECA - sphenopalatine and greater palatine (from maxillary) and superior labial (from facial artery) * ICA - Anterior and posterior ethmoidal (from ophthalmic a.) * Mainly enters through the *Sphenopalatine recess* * *Does* communicate with intracranial vessels. As for (A) * Arrives to Little’s area from ophthalmic artery branches * Appears to be primarily facial and maxillary branches

Answer 33

**Kieselbach’s plexus is formed from branches of the sphenopalatinal, superior labial and greater palatine arteries.** * Lymphatics follow the *?veins* * *Superior* nasal concha is the smallest * Nasolacrimal duct opens behind the *Inferior nasal concha* * Is supplied by the: * Posteroinferior - both branches of maxillary (V2) * Septum is by nasopalatine, * lateral wall by greater palatine * antero-superior by anterior and posterior ethmoidal (nasolacrimal [V1]) * frontal n. supplies the forehead

Answer 34

**d. All of the above**

Answer 35

**d. Mainly enters the sphenopalatine foramen** * a. Is from the external carotid *and internal carotid - Anterior and posterior ethmoidal from ophthalmic arteries (ICA)* * c*. Does* communicate with intracranial vessels. * e. Arrives to Little’s area from ophthalmic artery branches. * Unclear why this is not true, but seems to be primarily maxillary and facial branches

Answer 36

**a. nasopalatine nerve from cranial nerve V2** *Posteroinferior septum* * b. posterior ethmoidal nerve from V1 - *Doesn’t reach into the cavity* * *Anterior ethmoidal nerve supplies anterior septum* * c. greater palatine nerve from V2 - *Branches innervate the lateral wall* * d. lesser palatine nerve from V2 - Not involved

Answer 37

**Maxillary n.** Somatic sensation from the nose (Not sure why ophthalmic also does not count)

Answer 38

**V ganglion** * Otic ganglion - *Somatic afferents from parotid gland via auriculotemporal (V3)* * Ciliary ganglion *- Afferents are somatic from the eye via nasociliary (V1)*

Answer 39

**Includes the X** * Auricular branch of the vagus - supplies the concha* * *Involves the auriculotemporal nerve and greater auricular nerve, as well as the auricular branch of the vagus*

Answer 40

**dens to foramen magnum** * Supraspinous ligament* **=** tips of adjacent spinous processes * Posterior longitudinal ligament =* adjacent vertebral bodies posteriorly * Longitudinal bands of the Cruciate ligament =* bodies of the axis to foramen magnum

Answer 41

**Has the supra-pleural membrane attached to the anterior tubercle** *Above not mentioned in Moores neck section, but others all are, and are clearly wrong* * Is *Atypical (vertebra prominens)* * Has a *non-bifid* spinous process *which is long* * **C2-6 have a short, bifid processes * *Does not* transmits the vertebral artery through the foramen in the transverse process. * Vertebral artery starts at C6 foramina and heads superiorly, hence why C7 TP foramen is small

Answer 42

**Has a posterior arch grooved by the vertebral a** *Atlas (C1) has no body or spinous process, is the widest cervical vertebra, and has foramina transversaria*

Answer 43

**The carotid tubercle is found on C6 vertebra** * Cervical ribs are due to elongation of the costal elements of C4 vertebra * The vertebral foramina are *larger* than the bodies of the vertebrae - *spinal cord is largest in cervical spine, and neck is mobile so bodies need to be small* * All cervical vertebrae *except C1 and C7* have bifid spinous processes. * The vertebral foramina are *triangular* in cross section *- wider laterally than AP*

Answer 44

**Has a bifid spinous process** * *No* costal facets *as no ribs attach* * Has a *triangular* vertebral foramen. * Bodies are often *oval* shaped * Has an intervertebral canal in the *transverse processes (foramina transversaria for vertebral arteries and veins)*

Answer 45

**Has a bifid spinous process** * Has a *large bifid spinous process* * *Does not* articulate with the occiput - Only the atlas does * Is referred to as the *axis* * Has a dens that occupies the *anterior* 1/3 spinal canal - *comes off the vertebral body and occupies region in C1 where the body should be*

Answer 46

**Provides attachment for the cruciform ligament** * Articulates with the dens at the *anterior arch* * Allows *Flexion/extension* of the head at the atlanto-occipital joints. *Rotation occurs at the atlanto-axial joint* * Has *no vertebral body, just anterior and posterior arches* * Has *no spinous process*

Answer 47

**The upper articular surfaces of the atlas are kidney shaped** * Typical vertebrae are *C3-6* only * Vertebrae have foramen in the *transverse processes* * The specialised joint, the *atlanto-axial* joint allows head rotation * The axis plays a role in weightbearing. * Poorly worded - its must bear at least some weight. Moore’s clearly states the atlas bears the weight of the head but does not mention any specifics about whether C2 bears weight

Answer 48

**submental triangle, mandible.** * The mandibular symphysis provides the apex of the triangle (but not really a border)* * Must be an old question - Moores does not use these names for the triangles*

Answer 49

**The *third* part of the subclavian a.** * XI and occipital artery are in occipital region* * Inferior belly of omohyoid divides the triangle into occipital and omoclavicular triangles*

Answer 50

**The triangle contains cervical plexus.** * *SCM* is the anterior border. * The *middle*l third of the clavicle is its floor/*base of triangle* * The investing layer of deep cervical fascia is the *Roof.* * Floor is the muscles covered in pre-vertebral fascia (scalenes, lev scapuli, splenius capitus) * The triangle contains *roots and trunks* of the brachial plexus

Answer 51

**Is bordered by the middle 1/3 clavicle** * Contains the *inferior* belly of the omohyoid (*divides into two)* * Is bordered by the *posterior* border of the SCM. * Has the *superior* nuchal line at its apex.

Answer 52

**The posterior triangle contains the EJV.** **A part of it** * The *anterior* triangle contains the IJV. * The *posterior* triangle contains the 3rd part of the subclavian a. * Posterior belly of the *omohyoid* crosses the posterior triangle. * The trunks of the brachial plexus lie in the posterior triangle *lateral / superficial to the pre-vertebral fascia (which covers the scalene muscles)*

Answer 53

**The trachea begins at the level of C6.** * The *prevertebral* fascia is prolonged to form the axillary sheath - * *extends from the anterior and middle scalene muscles to surround the brachial plexus and subclavian artery as these structures pass into the axilla* * The posterior belly of the digastric muscle is supplied by *VII* * The IJV lies *lateral* to the CCA. * CCA is medial, IJV lateral, vagus posterior * The thyroid isthmus is adherent to the *2nd and 3rd* tracheal rings.

Answer 54

**Occipital LN.** *Contains superficial cervical lymph nodes*

Answer 55

*Bad/old question - 3 of the options are correct as per Moores.* **Contains the anterior rami of the upper 4 cervical nerves.** *C1-C4 forms the cervical plexus* **Has deep cervical fascia lining its floor***(prevertebral layer)* *AND r**oof (investing layer)* * Contains the 3rd part of the subclavian artery *at the base* * Lies between the posterior border of SCM and the *anterior* border of trapezius and the clavicle *(middle third)* * **Contains the subclavian vein.** * Must be an old question as this is marked wrong, however... * *Moores: 'the subclavian vein...curves through the inferior part of the lateral cervical region. It passes anterior to the anterior scalene and phrenic nerve and unites at the medial border of th muscle with the IJV to form the brachiocephalic vein, posterior to the medial end of the clavicle.'*

Answer 56

**hypoglossal a** ECA branches: ascending pharyngeal, occipital, posterior auricular, superior thyroid, lingual, facial Hypoglossal is off internal carotid

Answer 57

**Ascending pharyngeal** Ascending pharyngeal, occipital, posterior auricular, superior thyroid, lingual, facial *Anaesthetists Often Prefer Sucking Large Faces*

Answer 58

**Ascending pharyngeal** *1 medial, 2 posterior, 3 anterior* * Occipital - Posterior * Posterior auricular - posterior * Superior thyroid - Anterior * Lingual - Anterior * Facial - Anterior

Answer 59

**Has its bifurcation at the level of the lesser horn of the hyoid.** **C3 = hyoid** **Superior thyroid cartilage/birfucastion = C4 level** * Lies *medially* within the carotid sheath. * *External carotid has* the superior thyroid artery as one of its branches. * Arises from the brachiocephalic trunk on the *right* side of the neck. * Has often the carotid sinus as a dilation of its terminal portion. * The sinus is usually a dilatation of the proximal ICA but 'may' involve the CCA. * It is a baroreceptor innervated by IX

Answer 60

**Lymph drains into the jugular lymph trunk** * Superficial cervical nodes lie adjacent to the *EJV* * *Deep nodes with IJV* * *Superficial* cervical nodes receive lymph from the face. * *Upper* deep cervical nodes receive lymph from the tonsil. * *Parotid glands are superficial lymph nodes*

Answer 61

**Lies on the lateral mass of the atlas.** * Is a continuation of the *sigmoid* sinus. * *Deep* cervical nodes lie lateral to the vein. * Thoracic duct crosses behind the *left* IJV at C7 * Drains *Into brachiocephalic trunk then SVC*

Answer 62

**d. Lies lateral to the carotid artery in the lower neck** *CCA is medial, IJV latera, Vagus posterior* * a. *Joins* the subclavian vein on the left *to form brachiocephalic vein* * *EJV drains into subclavian* * b. Lies in the carotid sheath with the carotid artery and the *vagus nerve. Sympathetic trunk is posterior to the sheath, in the prevertebral fascia* * c. Lies lateral to the internal carotid artery at the base of the skull. * Somewhere other than lateral * e. Lies *deep* to the sternocleidomastoid.

Answer 63

**b. Ascending pharyngeal artery** "Some Anaesthetists Like Fun, Others Prefer S&M" Superior Thyroid Ascending Pharyngeal Lingual Facial Occipital Posterior auricular Superficial Temporal Maxillary * Inferior thyroid off thyrocervical trunk (first part subclavian) * Internal thoracic off subclavian

Answer 64

**It runs inferoposteriorly *posterior* to the facial artery.** * It drains to the internal jugular vein * It has no valves. * Relevant because infections can therefore travel backwards into the cavernous sinus. Essentially no veins superior to the root of neck have valves. * It communicates with the cavernous sinus via the ophthalmic vein * It communicates with the pterygoid plexus via the deep facial vein

Answer 65

**Communicates indirectly with the cavernous sinus via the deep facial vein.** *Indirectly because it goes through the pterygoid plexus* * Is both deep and superficial * Unclear why this is not true - drains into facial veins AND through cavernous sinus * Empties *mostly* into the IJV, *however transverse facial vein -\> superficial temporal vein -\> EJV* * Communicates *indirectly* with the cavernous sinus via the supraorbital vein, *because the ophthalmic veins are in between*

Answer 66

**Contains valves within its lumen.** *Inferior bulb of IJV has a bicuspid valve to prevent backflow to head* * Is surrounded by the *thinnest* portion of carotid sheath *to allow for expansion (is thick around the carotids)* * Receives drainage from all the parathyroid glands - * Parathyroid veins drain into thyroid venous plexus. Then superior and middle thyroid veins -\> IJV but inferior thyroid veins -\> brachiocephalic veins * Parathyroids supplied mainly by inf thyroid art but can receive blood from any arterial branch of the neck. * Is crossed *anteriorly* by the accessory nerve. * Is crossed *posteriorly* by the thoracic duct.

Answer 67

**The bulk of the sympathetic n supply is derived from the middle cervical ganglion.** *Superior, middle and inferior* * The ima a enters the lower part of the isthmus in *10% people*. * The inferior border of the gland is at the level of *T1; C5 is the superior border.* * Isthmus is at the level of the 2nd-3rd cricoid rings * Hyoid C3, Thyroid cartilage C4, cricoid C6 * *Inferior thyroid arteries are the largest branches of the thyrocervical trunks (also gives off trans Cx and suprascapular), so will always be present* * There are 4 *asymmetrical* lobes joined by an isthmus - *Superior larger than inferior*

Answer 68

**It is supplied by the *superior and inferior* thyroid arteries.** *Superior (ECA) and inferior (thyrocervical trunk) only* * The ima artery may arise from the arch of the aorta *o**r brachiocephalic trunk* * The isthmus is related to the 2nd, 3rd tracheal cartilage * It is related anterolaterally to the sternohyoid muscle. * Possible typo – sternohyoid is anterolateral to the thyroid. * The external laryngeal nerve is related to the gland

Answer 69

**the recurrent laryngeal nerve is always behind the pretracheal fascia** *Ascend in the tracheooesophageal groove* * its isthmus lies in front of *2nd and 3rd* tracheal rings * the superior thyroid artery is a branch of the *ECA* * it has the parathyroids lying behind its medial lobe - *There is no medial lobe* * parafollicular cells are more abundant than follicular cells

Answer 70

**It is initially voluntary and then involuntary** Stage 1: Mouth, pushing food back into the oropharynx (voluntary Stage 2: Oropharynx, sealing off naso and laryngopharynxes (involuntary) Stage 3: Oesophagus, all 3 muscles contract in peristalsis (involuntary)

Answer 71

**Contraction of the cricothyroid m** This muscle stretches and tenses the vocal ligament

Answer 72

**The aryepiglottic fold contains the cuneiform cartilage** * The inlet being bounded *anteriorly* by the epiglottis * The posterior cricoarytenoid being an *ABductor* of the cords. * The *rima glottidis* being the fissure between the 2 cords. * *rima vestibuli is between vestibular ligaments (false VC)* * The cricoid cartilage being *the only* circumferential *laryngeal cartilage*

Answer 73

**is visible in anterior dissection of the neck** *Median CT membrane is cut for a surgical airway. Lateral CT membrane attaches to the vocal cords* * Cricothyroid *Muscle - Stretches/lengthens* the VC *by tilting the thyrooid cartilarge forwards* * is a *?fan-shaped* muscle - *small origin, large insertion* * is supplied by the *e**xternal branch (motor) of superior laryngeal nerve* * *Only laryngeal muscle not supplied by recurrent laryngeal* * diverges from lamina of *thyroid* cartilage * Lamina is the large flat area - the cricoid lamina is posteriorly where the bulk of the cartilage is

Answer 74

**The mucous membrane of the larynx above the level of the vocal fold is supplied by the internal laryngeal nerve** * All muscles of the larynx supplies by the recurrent laryngeal n except *Cricothyroid (external branch superior laryngeal nerve)* * With *complete* lesion of recurrent laryngeal n the vocal fold takes up an abducted position *causing partial airway obstructioon.* * *Cannot find/be bothered what a partial injury does.* * Internal laryngeal nerve *provides sensory to level of the cords.* * External laryngeal supplies cricothyroid * **Recurrent laryngeal supplies all muscles except cricothyroid

Answer 75

**Is found at the level of the C3-6 vertebrae.** **C3 (hyoid) to C6 (cricoid)** * Lies *below* the hyoid bone in the midline of the neck. * Has musculature supplied by the *recurrent/inferior laryngeal* and external laryngeal nn. * Internal is sensation only * Is lined by pseudo-stratified columnar epithelium. * (apparently...) Stratified squamous epithelium on the cords only, otherwise this is true. https://www.ncbi.nlm.nih.gov/pubmed/9197504 * Is supplied by the superior *and inferior* thyroid arteries Supplied by laryngeal branches of inferior and superior thyroid arteries, *which give the sup + inf laryngeal arteries respectively*

Answer 76

**The epiglottis is attached to the arytenoid cartilages.** *Epiglottis attaches directly to thyroid cart only but linked to arytenoids by quadrangular membrane (forms the ary-epiglottic fold)* * Cricoid cartilage is *the only complete cartilaginous ring* * Lateral cricoarytenoid is the *ADductor* of the vocal cords *(with transverse and oblique arytenoids)* * All the muscles are supplied by the recurrent laryngeal n, *except* *Cricothyroid by external branch of superior laryngeal* * Mucous membrane *below the cords* is supplied by the recurrent laryngeal n. * Internal branch of the superior laryngeal supplies sensation above the cords

Answer 77

**Thyroarytenoid muscle alters the tension of the cords** *Contraction = relaxes* * All muscles are supplied by the recurrent laryngeal nerve, *except* *Cricothyroid by external branch of SLN* * Recurrent laryngeal nerve passes *posterior* to the cricothyroid joint. * During swallowing the epiglottis acts as an *active* flap. * During swallowing, contraction of the lateral crico-arytenoids, transverse and oblique arytenoids, and aryepiglottic muscles brings the ary-epiglottic folds together and pulls the arytenoid cartilages toward the epiglottis * All of the larynx is covered by pseudostratified columnar epithelium, *except the* *Vocal cords which have stratified squamous epi*

Answer 78

**Posterior cricoarytenoid** * Lateral cricoarytenoid = ADduction * transverse arytenoid = ADduction of arytenoid cartilages -\> adduct cords + close posterior rima glottidis) * Cricothyroid -\> lengthen/stretch cords * Aryepiglottic = ??? (not mentioned in Moores)

Answer 79

**Extends from *C3 (hyoid) to C6 (cricoid cartilage)*** *Epiglottis rests against hyoid* * Is a respiratory organ whose essential function is *Airway protection* * Consists of _3_ single cartilages: the thyroid and the cricoid, *and the Epiglottis* * Also 3x paired: arytenoids, cuneiforms, and corniculate * Is hauled up beneath the tongue with the epiglottis tilted *posterior* and *downwards* during swallowing. * Is supplied by the *recurrent laryngeal nerve* except for the cricothyroid muscle which is supplied by the *external laryngeal* nerve.

Answer 80

**Normal vocal cords are always covered by stratified squamous epithelium** * The external laryngeal nerve supplies the *cricothyroid muscle* * The internal laryngeal nerve supplies *sensation above the vocal cords, including superior surface of the cords* * Blood supply above the vocal cords is by a branch of the *ECA (superior thyroid -\> sup laryngeal)* * *Inferior is off thyrocervical trunk/subclavian* * ????Recurrent laryngeal nerve lies immediately behind the cricoarytenoid joint

Answer 81

**a. Abduct the vocal cords** *Pull the ends of arytenoids posteriorly, which due to the way they are hinged causes abduction.*

Answer 82

**b. Supplies the cricothyroid muscle via an external laryngeal branch** * a. Divides into internal and *external* laryngeal nerves * c. Supplies *only cricothyroid, the recurrent laryngeal (-\> inferior laryngeal nerve) supplies all others* of the larynx * d. Is sensory to larynx *above* the vocal cords *by way of its internal branch*

Answer 83

**Bifurcates behind the manubriosternal angle (T4-5)** * *Begins at bottom of larynx = bottom of cricoid cartilage (C6)* * Passes through the *Superior mediastinum, then divides on entering the posterior* * Is supplied *by recurrent laryngeal and vagus* * Blood supply is: *Upper 2/3 inferior thyroid artery, lower 1/3 bronchial arteries*

Answer 84

**Cricoid cartilage to sternal angle**

Answer 85

**b. Origin at C6 vertebra level** Origin = C6 / cricoid Termination = T4,5 / sternal angle 2nd+3rd rings covered by thyroid isthmus

Answer 86

**Contains the III nuclei** * Is largely in the *posterior* cranial fossa. * *?basilar artery* * Lies between the pons and *cerebrum (midbrain-pons- medulla)*

Answer 87

**Tractus solitarius.** Cardiac and respiratory control centre

Answer 88

**Afferent tendon stretch impulses** * Dorsal column – vibration, proprioception, fine touch. * Anterolateral spinothalamic tract – crude touch, pressure. * Lateral spinothalamic tract – pain, temperature * Spinocerebellar - balance * Lateral + anterior corticospinal tract - LMNs

Answer 89

**Damage to Broca’s area produces motor aphasia** * Broca’s area is on the left side in *50% of* left-handed people. * Broca’s area is *Anterior to the primary motor cortex in the pre-central gyrus (frontal lobe)* * Wernicke’s area controls *Interpretation from primary auditory cortex (parietal lobe)* * Damage to Wernicke’s area produces *receptive* aphasia

Answer 90

**It is the part of the brainstem between the pons and the spinal cord** * Is largely within the *posterior* cranial fossa * Is supplies by the *?basilar artery*

Answer 91

**Nucleus of tractus solitarius.** * Gustatory nucleus for special sensation in diagram* * Nucleus ambiguus.* **-** Motor nucleus for parasympathetic efferents

Answer 92

**The motor areas have no connections with the opposite motor cortex**

Answer 93

**loss of vibration unilaterally** * loss of pain *Contralateral* * paralysis *ipisilaterally* * greater weakness in arms than legs. Pyramidal in arms and legs (UL extensors, LL flexor weakness) * *Not* a Horner’s on the contralateral side *- Sympathetic nerves emerge from thoracic and lumbar levels*

Answer 94

**Prolapsed 5th cervical disc impinging on C6** In the cervical spine, the nerve root emerages *above* the vertebrae (ie C6 emerges between C5 and C6), and the discs are number according to the vertebrae above. So C5 disc will impinge C6 nerve root. C6 disc is one space below and less likely to impinge C6 nerve root, but not impossible.