Head And Neck Flashcards

Question 1

Q

What are the 4 main muscles in the head?

Answer

A

o Muscles of facial expression
o Muscle of the cheek (buccinators)
o Occipitofrontalis muscle
o Muscles of mastication

Question 2

Q

What are the functions of the muscles in the face?

Answer

A

The muscles of the face are in the subcutaneous tissue and they move the skin and change facial expressions

They surround the orifices (opening) of the mouth, eyes and nose and act as sphincters and dilators to open and close them.

Question 3

Q

Do the muscles of the face pull or push?

Answer

A

Most muscles, attached to bone or fascia produce their effects by pulling the skin.

Question 4

Q

What is the function of the buccinators?

Answer

A

The buccinators keep the cheeks taut (not slack) and aids in chewing.

Question 5

Q

What nerve are the muscles of mastication supplied by?

Answer

A

mandibular division of the trigeminal nerve (branch of CN V).

Question 6

Q

What is CNVII and what does it supply?

Answer

A

Facial nerve
supplies the superficial muscle of the neck and chin (platysma), muscles of facial expression, buccinators, muscles of the ear and the occipitofrontalis muscle.

Question 7

Q

What is the course of the facial nerve?

Answer

A

It exits the cranium and enters the substance of the parotid gland in which it divides into its extra-cranial branches. It exits the facial canal via the stylomastoid foreamen

Question 8

Q

What is the most common cause of facial paralysis?

Answer

A

The most common non-traumatic cause of facial paralysis is inflammation of the facial nerve near its exit from the cranium at the stylomastoid foramen.
The inflammation causes oedema and compression of the nerve (Bell’s palsy) in the intracranial facial canal, resulting in a number of structural and functional disorders.

Question 9

Q

What happens during Bell’s Palsy?

Answer

A

The affected area sags, and facial expression is distorted, making it appear passive or sad.

Question 10

Q

What happens during facial nerve damage?

Answer

A

As the branches of the facial nerve are superficial, they are subject to injury in wounds, cuts and in child-birth. As the nerve and its branches pass through the parotid gland, they are vulnerable to injury during surgery on the gland or in disease of the gland.

Question 11

Q

What is a consequence of parotid gland disease?

Answer

A

Parotid gland disease often causes pain in the auricle of the ear, external acoustic meatus, temporal region and the TMJ.

Question 12

Q

What is the blood supply to the face?

Answer

A

Branches of the external carotid artery.

The facial artery is the major arterial supply to the face.

Question 13

Q

Where do you feel for the facial artery pulse?

Answer

A

The pulse of the facial artery can be palpated as the artery winds around the inferior border of the mandible.

Question 14

Q

Why do you have to compress both arteries during facial artery laceration?

Answer

A

Because the artery has many anastomoses with other arteries of the face, in the event of laceration of the artery on one side of the face, it is necessary to compress both the arteries to stop bleeding.

Question 15

Q

What is the main venous drainage of the face?

Answer

A

facial vein

Question 16

Q

Where does the facial nerve drain into?

Answer

A

Internal jugular vein

Question 17

Q

Where do Superficial temporal vein and maxillary vein drain into?

Answer

A

External jugular vein

Question 18

Q

Where do internal and external jugular vein drain into?

Answer

A

Subclavian vein

Question 19

Q

What are the structures in the neck surrounded by?

Answer

A

Layer of subcutaneous tissue

Question 20

Q

How are structures in the neck compartmentalised?

Answer

A

Layers of deep cervical fascia

Question 21

Q

Define superficial cervical fascia

Answer

A

layer of fatty connective tissue that lies between the dermis of the skin and the investing layer of deep cervical fascia

Question 22

Q

What does the superficial cervical fascia contain?

Answer

A

It contains cutaneous nerves, blood and lymphatic vessels, superficial lymph nodes and variable amounts of fat.
Anterolaterally, it contains the platysma.

Question 23

Q

What is the platysma?

Answer

A

broad, thin sheet of muscle in the subcutaneous tissue of the neck

Question 24

Q

Which pharyngeal arch does the platysma develop from?

Answer

A

2nd Pharyngeal arch

Question 25

Q

What is the nerve supply to the platysma?

Answer

A

Facial nerve

Question 26

Q

Where do you find the platysma?

Answer

A

The platysma covers the anterolateral aspect of the neck. Inferiorly, the fibres diverge, leaving a gap anterior to the larynx and trachea.

Question 27

Q

What is the function of the platysma?

Answer

A

Acting from its superior attachment, the platysma tenses the skin.

Acting from its inferior attachment, the platysma helps depress the mandible and draw the corners of the mouth inferiorly, as in a grimace.

Question 28

Q

What are the 3 layers of the deep cervical fascia?

Answer

A

Investing
Pretracheal
Prevertebral

Question 29

Q

What does the carotid sheath contain?

Answer

A

common carotid arteries, internal jugular veins and vagus nerves

Question 30

Q

What are the functions of deep cervical fascia?

Answer

A

o Support
• Viscera (e.g. thyroid gland)
• Muscles, Vessels and deep Lymph Nodes
o Limit the spread of abscesses that result from infections
o Slipperiness that allows structures in the neck to move and pass over one another without difficulty
• Swallowing
• Turning the head and neck

Question 31

Q

What is the investing layer?

Answer

A

most superficial, the investing layer surrounds the entire neck deep to the skin

Question 32

Q

What does the investing layer contain?

Answer

A

o Sternocleidomastoid
o Trapezius
o Submandibular and Parotid Salivary Glands

Question 33

Q

How does the pretracheal layer run in the neck?

Answer

A

A thin layer, limited to the anterior part of the neck. Inferiorly it extends into the thorax, where it blends with the fibrous pericardium. Laterally it blends with the carotid sheath.

Question 34

Q

What does the pretracheal layer enclose?

Answer

A

o	Muscular layer
       •	Encloses infrahyoid muscles
o	Visceral layer
       •	Thyroid gland
       •	Trachea
       •	Oesophagus

Question 35

Q

How does the prevertebral layer extend in the neck?

Answer

A

The innermost layer of the deep fascia, which forms a sheath for the vertebral column and the muscles associated with it. Extends from the base of the cranium of the 3rd thoracic vertebra and extends laterally as the axillary sheath that surrounds the axillary vessels and the brachial plexus.

Question 36

Q

What is the course of the carotid sheath?

Answer

A

A tubular, fibrous structure that extends from the base of the cranium to the root of the neck.

Question 37

Q

What does the carotid sheath contain?

Answer

A

o The common carotid artery - medially
o Internal jugular vein - laterally
o The vagus nerve (CN X) - inbetween and posterior

Question 38

Q

How does infection spread in the deep cervical layers?

Answer

A

Determine the direction in which abscesses in the neck may spread. If an infection occurs:
o Between the Investing layer and the muscular part of the pretracheal surrounding the infrahyoid muscles, it will not spread beyond the manubrium.
o Between the Investing and visceral Pretracheal layers, it can spread into the thoracic cavity anterior to the pericardium.
o Pus from an abscess lying behind the Prevertebral layer of deep cervical fascia may extend laterally in the neck.
• May perforate the fascial layer and enter the retropharyngeal space.
• This will produce a bulge (retropharyngeal abscess) in the pharynx, resulting in dysphasia (difficulty swallowing) and dysphonia (difficulty speaking)

Question 39

Q

What is retropharyngeal space?

Answer

A

potential space between the Prevertebral layer of fascia and the fascia surrounding the pharynx superficially.

Question 40

Q

What is the importance of retropharyngeal space?

Answer

A

major route of spread of infection from the neck to the thorax.

The space runs to the diaphragm.

Question 41

Q

What are the borders of the anterior triangle of the neck?

Answer

A

o Anterior – Mid line
o Posterior – The anterior border of SCM
o Superior – Inferior border of the mandible
o Apex – Jugular notch in the manubrium
o Roof – Superficial cervical fascia, containing the platysma
o Floor – Pharynx, larynx, thyroid gland

Question 42

Q

What are the subdivisions of the anterior triangle of the neck?

Answer

A

Submandibular triangle
Submental triangle
Carotid triangle
Muscular triangle

Question 43

Q

What does the submandibular triangle contain?

Answer

A

Submandibular gland
Submandibular lymph nodes
Hypoglossal and Mylohyoid nerves
Parts of facial artery and vein

Question 44

Q

What does the submental triangle contain?

Answer

A

Submental lymph nodes

* Small veins which unite to form anterior jugular vein

Question 45

Q

What does the carotid triangle contain?

Answer

A

•	Carotid sheath
      o	Common carotid artery 
      o	Internal jugular vein 
      o	Vagus nerve
      o	Deep Cervical Lymph Nodes
•	Thyroid gland
•	Larynx
•	Pharynx
•	External carotid artery and some of its branches
•	Hypoglossal and Spinal accessory nerves
•	Branches of cervical plexus

Question 46

Q

What does the muscular triangle contain?

Answer

A

Sternothyroid
Sternohyoid
Thryoid
Parathyroid

Question 47

Q

What are the borders of the posterior triangle in the neck?

Answer

A

o Anterior – Posterior border of SCM
o Posterior – Anterior border of Trapezius
o Inferiorly – Middle third of the clavicle, between Trapezius and SCM
o Apex – Where SCM and Trapezius meet on the superior nuchal line of the occipital bone
o Roof – Investing layer of deep cervical fascia
o Floor – Muscles covered by the Prevertebral layer of deep cervical fascia

Question 48

Q

What are the subdivisions of the posterior triangle?

Answer

A

Occipital triangle

Omoclavicular (subclavian) triangle

Question 49

Q

What are the contents of the occipital triangle?

Answer

A

Spinal Accessory Nerve (CN XI)
Trunks of Brachial Plexus
Part of external jugular vein
Posterior branches of cervical plexus
Cervicodorsal trunk
Cervical lymph node

Question 50

Q

What are the contents of the omoclavicular (subclavian) triangle?

Answer

A

3rd part Subclavian Artery
Part of Subclavian Vein
Suprascapular artery
Supraclavicular lymph nodes

Question 51

Q

What are the attachments of the hyoid muscles?

Answer

A

In the anterolateral part of the neck, the hyoid bone provides attachments for the Suprahyoid Muscles superiorly, and the Infrahyoid Muscles inferiorly.

Question 52

Q

What are the functions of the hyoid muscles?

Answer

A

steady or move the hyoid and larynx.

Question 53

Q

Name the suprahyoid muscles

Answer

A

o	Mylohyoid
o	Geniohyoid
o	Stylohyoid
o	Digastric Muscles
•	Two bellies (Anterior and Posterior)
•	Joined by an intermediate tendon
•	Fibrous sling, from Pretracheal layer of Deep Cervical Fascia allows the tendon to slide anteriorly and posteriorly

Question 54

Q

What are the suprahyoid muscles innervated by?

Answer

A

o	Mylohyoid (inferior alveolar nerve)
o	Geniohyoid (Cranial nerve I)
o	Stylohyoid (Facial nerve)
o	Digastric Muscles
•	Anterior - Facial nerve
•       Posterior - Inferior alveolar nerve

Question 55

Q

What are the functions of the suprahyoid muscles?

Answer

A

Supporting the hyoid in providing a base from which the tongue functions. They also elevate the hyoid and larynx in relation to swallowing and tone production.

Question 56

Q

What are the innervations to the infrahyoid muscles?

Answer

A

C1 - C3 innervation

Question 57

Q

What are the infrahyoid muscles?

Answer

A

o Superficial Plane
• Sternohyoid
• Omohyoid
• Has two bellies (Superior and Inferior)
• Joined by an intermediate tendon
• Fascial sling for the tendon connects to the clavicle
o Deep Plane
• Sternothyroid
• Thyrohyoid

Question 58

Q

What are the functions of the Infrahyoid muscles?

Answer

A

Anchor the hyoid, sternum, clavicle and scapula, and depress the hyoid and larynx during swallowing and speaking.
They also work with the Suprahyoid muscles to steady the hyoid, providing a firm base for the tongue.

Question 59

Q

What is the blood supply to the head and neck?

Answer

A

Common Carotid Arteries and Vertebral Arteries.

Question 60

Q

What is the blood drainage from the head and neck?

Answer

A

Internal Jugular Vein, with the External Jugular Vein and Anterior Jugular Vein

Question 61

Q

How does the carotid sheath form?

Answer

A

Fusion of:
o The Prevertebral layer of cervical fascia
• Posteriorly
o The Pretracheal layer of cervical fascia
• Anteromedially
o The Superficial layer of cervical fascia
• Anterolaterally

Question 62

Q

Where does the sympathetic trunk lie in relation to the carotid sheath?

Answer

A

Medially and posterior

Question 63

Q

Where does the Right common carotid artery originate from?

Answer

A

bifurcation of the Brachiocephalic Trunk behind the right sternoclavicular joint.

Question 64

Q

Where does the Left common carotid artery originate from?

Answer

A

Arch of the Aorta.
Consequently, the left common carotid artery is slightly longer as it courses for about 2cm in the superior mediastinum before entering the neck.

Answer 65

A

midway between the angle of the mandible and the mastoid process of the temporal bone. A reliable anatomical landmark for this is the upper border of the thyroid cartilages.

Answer 66

A

Carotid sinus?

Answer 67

A

Baroreceptors, which detect changes in blood pressure.

Answer 68

A

used to Alleviate Supra-Ventricular Tachycardia through gentle rubbing. This is known as a Carotid Massage.

Answer 69

A

Peripheral Chemoreceptors, which detect arterial O2 concentrations

Answer 70

A

common site for atheroma formation. This causes narrowing (stenosis) of the artery.
Rupture of the clot can cause an embolus to travel to the brain. This will cause a Transient Ischaemic Attack (TIA) or Stroke.

Answer 71

A

Lack branches in the neck

Answer 72

A

Through the carotid canal

Answer 73

A

8 branches

Stop Superior Thyroid
Alcohol Ascending Pharyngeal
Late Lingual
Friday Facial
Or Occipital
Puke Posterior Auricular
More Maxillary
Saturday Superficial Temporal

Answer 74

A

Maxillary and Superficial Temporal Arteries within the substance of the Parotid Gland. It is accompanied here by the Facial Nerve (CN VII) and the Retromandibular Vein.

Answer 75

A

Subclavian artery

Answer 76

A

ascend through the Transverse Foramen in Cervical Vertebrae 6 → 1

Answer 77

A

Supply brain along with internal carotid arteries

Answer 78

A

Vagus and Hypoglossal nerves

Answer 79

A

o	Superiorly
•	Posterior Belly of the Digastric
o	Laterally
•	Sternocleidomastoid
o	Medially
•	Superior belly of Omohyoid

Answer 80

A

o	Skin
o	Connective tissue (dense)
o	Aponeurosis
o	Loose connective tissue
       •	Contains blood vessels
o	Periosteum

Answer 81

A

Supratrochlear and suborbital arteries

Which are branches of opthalmic arteries which arise from internal carotid arteries

Answer 82

A

Numerous anastomoses and the walls of the arteries being closely attached to connective tissue, limiting their constriction.

Answer 83

A

Opposing pull of occipitofrontalis

Answer 84

A

Different blood supply

Answer 85

A

Middle Meningeal artery

Answer 86

A

Superficial veins accompany arteries
o Superficial Temporal Veins
o Occipital Veins
o Posterior Auricular Veins

Some deep parts of the scalp in the temporal region have veins that drain into the Pterygoid Venous Plexus.

Answer 87

A

Supraorbital and Supratrochlear Veins unite at the medial angle of the eye to form the Angular Vein, which drains into the Facial Vein.

Answer 88

A

The veins of the scalp connect to the Diploic Veins of the Skull via several valve-less Emissary Veins and therefore connect to the Dural Venous Sinuses.

This relationship means that infection from the scalp can spread to the cranial cavity and affect the meninges.

Answer 89

A

The Anterior and Posterior Branches of the Middle Meningeal Artery supplies the Dura and Skull. It is is a branch of the Maxillary Artery, which in turn is a branch of the External Carotid Artery.

Answer 90

A

bleeding deep to the cranium but superficial to the Dura.

Answer 91

A

gain access into the cranial cavity. When preformed the bone and skin flap are reflected inferiorly to preserve blood supply.

Answer 92

A

Endothelium-lined spaces between the periosteal and meningeal layers of the Dura.

Answer 93

A

o Superior Sagittal Sinus
o Inferior Sagittal Sinus
o Cavernous Sinus
o Sigmoid Sinus
• Continue as the Internal Jugular Veins
• Exit the skull through the jugular foramen
o Transverse Sinus

Answer 94

A

External Carotid Artery, except the Supraorbital and Supratrochlear that are from the Internal Carotid Artery via the Opthalmic Artery.

Answer 95

A

Facial
•External Carotid
•Muscles of facial expression and face

Superior and Inferior Labial
•Facial
•Upper lip, side and septum of nose
Lower lip

Maxillary
•External Carotid
•Deep structures of the face

Lateral Nasal
•Facial
•Skin on ala and dorsum of nose

Angular
•Facial
•Superior cheek and lower eyelid

Transverse Facial
•Superficial Temporal
•Facial muscles and skin of temporal frontal and temporal regions

Supratrochlear
•Opthalmic (Int. Carotid)
•Muscles and skin of forehead and scalp
Superior conjuctiva

Supraorbital
•Opthalmic (Int. Carotid)
•Muscles and skin of forehead and scalp
Superior conjuctiva

Answer 96

A

Facial Vein, which in turn drains into the Internal Jugular Vein.

Cavernous sinus
Supratrochlear vein
Supra-orbital vein
Angular vein
Deep facial vein
Facial vein

Answer 97

A

plexus of extremely thin-walled veins on the upper surface of the spehnoid bone.

Answer 98

A

o	Internal Carotid Artery
o	CN III – Oculomotor
o	CN IV – Trochlear
o	CN VI – Abducent
o	CN V – Trigeminal
       •	CN V 1 – Opthalmic 
       •	CN V 2 – Maxillary

Answer 99

A

At the medial angle of the eye the Facial Vein and the Superior Opthalmic Vein communicate and drain into the Cavernous Sinus

Answer 100

A

Infection can travel from Facial Vein → Dural Venous Sinuses
Thrombophlebitis of Facial Vein – Infected clot can travel to intracranial system

Answer 101

A

superior sagittal sinus
Cavernous sinus
Transverse sinus
sigmoid sinus
facial vein
jugular vein

Answer 102

A

Under sternocleidomastoid

Answer 103

A

Internal jugular vein

Answer 104

A

o Use right IJV
o Effectively like a direct connection to right atrium
o Patient at 450 angle
o Height from sternal angle + 5cm

Answer 105

A

o	Occipital
o	Retroauricular (A.k.a. Mastoid)
o	Parotid
o	Buccal  (A.k.a. Facial)
o	Submandibular
o	Submental
o	Anterior
o	Cervical
o	Superficial Cervical
       •	Along the course of External Jugular Vein
o	Retropharyngeal
o	Laryngeal
o	Tracheal

Answer 106

A

o A.k.a. Deep Cervical Nodes
• Receive all the afferent lymph vessels of the head and neck, either directly or indirectly, via one of the regional groups.
• Closely related to the Carotid Sheath (Internal Jugular Vein)

o Jugulo-Digastric
• A.k.a. Tonsillar node
• Located just below and behind the angle of the mandible
• Lymphatic drainage of tonsil and tongue

o Jugulo-Omohyoid
• A.k.a. Tongue node
• Lymphatic drainage of the tongue, oral cavity, trachea, oesophagus and the thyroid gland

oDeep Cervical Nodes in the Posterior Triangle of the neck
• Lie along the course of the Accessory Nerve.
• Accessory Nerve may have to be removed in malignancy of the neck

o Supraclavicular nodes
• Root of the neck
• Enlarge in late stages of malignancies of the thorax and abdomen
• Virchow’s Node associated with Gastric Carcinoma

Answer 107

A

On the left side the Jugular Lymph Trunk usually joins the Thoracic Duct, which enters the Left Brachiocephalic Vein at the junction between the Subclavian and Internal Jugular Veins.

On the right side the Jugular Lymph Trunk enters the venous system at the junction between the Subclavian and Internal Jugular Veins, but this time via a short Right Lymphatic Duct.

Answer 108

A

Thoracic Duct is the body’s main duct for the return of lymph to venous blood.

Answer 109

A

o Begins in the abdomen at the cisterna chyli (L2)
o 38-45cm long
o Extends vertically in the chest and curves posteriorly to the left Common Carotid Artery and left Internal Jugular Vein
o Empties into the Left Brachiocephalic Vein at the junction between the Subclavian and Internal Jugular Veins
• Left Venous Angle

Answer 110

A

o Drains the upper right side of the body
• Right side of head and neck
• Right upper limb
• Right thorax

Answer 111

A

o Drains into the junction of the Subclavian Vein and Internal Jugular Vein
• Right Venous Angle

Answer 112

A

Lymphadenopathy is the enlargement of lymph nodes

Answer 113

A

o	Infection
•	Feel tender, smooth
•	Glandular Fever
o	Malignancy
•	Feel non-tender, craggy
•	Primary or Metastases
•	Lymphoma, Head and Neck Cancers

Answer 114

A

o Epstein Barr Virus (EBV)

o Viral infiltration produces atypical lymphocytes

Answer 115

A

o Swollen, painful lymph node, sore throat, fatigue, fever

Answer 116

A

block dissection of the cervical nodes. This procedure involves the removal, as a unit (en bloc), of the Internal Jugular Vein, Fascia, Lymph Nodes and the Submandibular Salivary Gland.

Answer 117

A

o Phagocytic cells act as filters for particulate matter and micro-organisms
o Antigen is present to the immune system

Answer 118

A

Fibrous capsule
o	Lymphatic Sinuses
o	Blood vessels
o	Parenchyma 
(Cortex, paracortex, medulla)

Answer 119

A

In the cortex of the lymph nodes, B cells enter lymph nodes via post capillary venules that have High endothelial venules, and pass to follicles.

Unstimulated B cells pass out rapidly to return to circulation with lymph.

If activated by antigenic stimulation, B cells proliferate and stay in lymph nodes

Answer 120

A

Follicle centre cells

Answer 121

A

Pale staining central area of secondary follicle

Answer 122

A

Stimulated B cells proliferate and undergo somatic hypermutation and are selected for high affinity antibodies to the antigen displaced by follicular dendritic cells. They then take up the antigen, process and present it to T cells.
T cells then further promote the development of B cells by releasing of cytokines (IL-4). B cells then become centrocytes and then centroblasts.

Answer 123

A

Follicle centre cells either have cleaved nuclei (Centrocytes) or more open/several nuclei (centroblasts).

Answer 124

A

The centroblasts leave the follicle and pass to the paracortex and medullary sinuses, where they become immunoblasts.

Immunoblasts give rise to plasma cells or memory B cells.

Answer 125

A

The paracortex contains lymphocytes, accessory cells and supporting cells.
The Paracortex is the predominant site for T-Lymphocytes in the lymph node.

Answer 126

A

The medulla is rich in macrophages and comprises:
o Large blood vessels
o Medullary cords
• Rich in plasma cells
• Produced Ab’s pass out of the node via the efferent lymphatic
o Medullary sinuses

Answer 127

A

Ethmoid 
Frontal
Inferior conchae
Lacrimal
Mandible
Maxilla
Nasal
Parietal
Sphenoid
Temporal
Vomer
Zygomatic

Answer 128

A

Inferior nasal concha (2)
Lacrimal bones (2)
Mandible
Maxilla (2)
Nasal bones (2)
Palatine bones (2)
Vomer
Zygomatic bones (2)

Answer 129

A

Parietal
Temporal
Sphenoid
Frontal

Answer 130

A

Cranial Bones:

Calvaria
•	Frontal
•	Parietal (2)
•	Occipital
•	Ethmoid

Cranial Base
• Sphenoid
• Temporal (2)

Answer 131

A

The bones of the calvaria consist of 2 layers of compact bone separated by a layer of bone marrow, the Diploe.

Answer 132

A

1st cervical vertebra
Facial skeleton
Mandible

Answer 133

A

Coronal
Sagittal
Lamboidal

Answer 134

A

o Squamous Temporal Bone and Parietal Bone over the temples and sphenoid air sinus
o Foramen Magnum and the inner parts of the Sphenoid Wing at the skull base
o Anterior Cranial Fossa
• Cribriform plate of the Ethmoid Bone, roof of the orbits
o Middle Cranial Fossa
• The weakest, with thin bones and multiple foramina
o Posterior Cranial Fossa
• Areas between the mastoid and dural sinuses

Answer 135

A

Bleeding from the wound, ear, nose or around eyes, bruising, draining of CSF from ears or nose, swelling, confusion, convulsions, difficulties with balance, drowsiness, headache, loss of consciousness, nausea, vomiting, visual disturbance, stuff neck and slurred speech.

Answer 136

A

Depressed Fracture
A severe, localised blow may result in a local indentation, in which a fragment of bone may compress or injure the underlying brain.

Linear Calvarial Fractures
Trauma to the Calvaria often results in radiating linear fractures, the fracture lines radiating away from the point of impact in two or more directions.

Comminuted Fractures
The bone is broken into several pieces.

Contrecoup (Counterblow) fracture
No fracture occurs at the point of impact, but one occurs on the opposite side of the cranium.

Simple Fracture
A break in the bone without damage to the skin

Compound Fracture
Involves a break in, or loss of, skin and splintering of the bone accompanied by brain injury and bleeding.

Basal Skull Fracture
Presents with Battle’s Sign

Answer 137

A

Bone fragments from fractures may rupture the Middle Meningeal Artery, leading to an Extradural Haemorrhage

Answer 138

A

Bone inflammation due to infection

Answer 139

A

The Emissary Veins (see above) connect the superficial veins of the scalp with the Diploic Veins of the skull bones and with the Intracranial Venous Sinuses, providing a route for infection. Infection of the scalp may spread to the skull bones via these veins,

Answer 140

A

Foramen Magnum
Foramen ovale
Foramen spinosum
Foramen Lacerum
Carotid Canal
Jugular Foramen

Answer 141

A

Frontal
Zygomatic
Orbits
Nasal Region
Maxillae
Mandible

Answer 142

A

Nasal bones
Zygomatic bones
Lacrimal bones
Ethmoid bone
Spehnoid bone

Answer 143

A

Frontal bone
Sphenoid bone
Temporal bones
Maxillae

Answer 144

A

Temporomandibular joint

Answer 145

A

massive facial trauma. A hard blow to the lower jaw often results in a fracture of the neck of the mandible and may be associated with TMJ dislocation.

Answer 146

A

Skin bruising around the orbit causes tissue fluid and blood to accumulate in the surrounding connective tissue.

Answer 147

A

A trauma or blow to the Supraciliary Arches may cause laceration of the skin and cause profuse bleeding.

Answer 148

A

Redness of the skin covering the Zygomatic bones is associated with Mitral Stenosis.

Answer 149

A

Axis - Cervical vertebra 2

Answer 150

A

dislocated in neck injuries with relatively less force than is required to fracture them.

Slight dislocations may not damage the spinal cord because of the large vertebral canal, but severe dislocation can cause serious injuries.

Answer 151

A

o May occur due to a fall on the head
o Displacement of fractured dens may injure the spinal cord
• Quadriplegia - paralysis leading to total loss of limb and torso movement
o Displacement of fracture dens may injure the medulla of the brainstem
• Death

Answer 152

A

o Head on collisions (car)
o Rupture of lower intervertebral discs (C5/C6 and C6/C7) resulting in compression of spinal roots C6 and C7
o Pain is felt in the neck, shoulder, arm and hand

Answer 153

A

o Whiplash injury (rear-end car collision)
o Tearing of anterior and posterior longitudinal ligaments, fracture of cervical spinous processes, disc rupture, neck muscle injury, blood vessel injury

Answer 154

A

o Joints of the vertebral arches (zygopophyseal joints) are close to intervertebral foramina through which spinal nerves emerge
o When these joints are affected by Osteoarthritis (osteophyte formation), related spinal nerves are compressed, causing pain along dermatomes and muscle spasms along myotomes

Answer 155

A

o Compression of the cervical spine against the shoulder
o May involve spinal cord damage
• Partial or complete paralysis
• Death
o Most common at C2, C6 and C7
o The most fatal injuries occur in the upper part of the spine (C1 or C2)

Answer 156

A

o Head first fall from height

o Diving head first into a pool

Answer 157

A

o Hyperextension of the head on the neck

Answer 158

A

irregularly shaped space on the lateral aspect of the skull.

Answer 159

A

o Inferior part of the Temporalis muscle
o Inferior parts of the Medial and Lateral Pterygoid muscles

o Maxillary Artery
• Larger terminal branch of External Carotid Artery
o Middle Meningeal Artery
• Branch of the Maxillary Artery
o Superficial Temporal Artery
• Smaller terminal branch of External Carotid Artery

o Maxillary Vein
o Middle Meningeal Vein(s)
o Pterygoid Venous Plexus

o	Mandibular Nerve 
•	3rd Branch of the Trigeminal (CN V3)
o	Branches of the Mandibular Nerve
•	Auriculotemporal Nerve
•	Inferior Alveolar Nerve
•	Lingual Nerve
•	Buccal Nerve
•	Chorda Tympani (Branch of Facial Nerve)
o	Otic Ganglion

Answer 160

A

o	Foramen Ovale
•	Mandibular division of Trigeminal Nerve (CN V3)
o	Foramen Spinosum
•	Middle Meningeal Artery
o	Alveolar Canal
o	Inferior Orbital Fissure
o	Pterygomaxillary Fissure

Answer 161

A

o	Anaesthetic is injected near the Mandibular Nerve, where it enters the Infratemporal fossa
•	Near to Foramen Ovale
o	Nerves affected:
•	Inferior Alveolar
•	Lingual
•	Buccal
•	Auriculotemporal

Answer 162

A

o Dental procedures
o Anaesthetic is injected around the Mandibular Foramen
• Passage for the inferior alveolar nerve and vessels
• Medial side of the mandible
o All mandibular teeth are anesthetised on the medial side
o Skin and mucous membranes of the lower lip, the labial alveolar mucosa, gingivae and skin of the skin are also anesthetised
• Mental Branch of the Inferior Alveolar Nerve

Answer 163

A

modified hinge type synovial joint between the Mandible and the Cranium.

Answer 164

A

Superiorly
o	Mandibular Fossa
•	Posterior and concave
o	Articular Tubercle
•	Anterior and convex

Inferiorly
o Head of the mandible

Answer 165

A

It is always the mandible that displaces in order for movements to occur. Movements occur by displacements in either the Superior Joint Cavity (gliding) or Inferior Joint Cavity (hinge).

Answer 166

A

Flexion (Elevation)
o Closing the mouth
o Occurs in the inferior compartment
o Temporalis, Masseter, Medial Pterygoid

Extension (Depression)
o	Opening the mouth
o	Occurs in the inferior compartment
o	Prime mover is gravity
•	Lateral Pterygoid, Suprahyoid, Infrahyoid
•	Active against resistance

Gliding (Translation)
o	Protrusion and Retrusion of the jaw
•	Protrusion – Lateral Pterygoid, Medial Pterygoid, Masseter
•	Retrusion – Temporalis, Masseter 
o	Occurs in the superior compartment

Rotation (Pivoting)
o Occurs in the inferior compartment

Answer 167

A

Condyles are pulled forwards
o	Protrusion / Gliding
•	Superior compartment
o	Lateral Pterygoid
Chin moves down and back 
o	Hinge movement
•	Inferior compartment
o	Usually by gravity
o	Suprahyoid and Infrahoid can depress the mandible against resistance

Answer 168

A

Retraction of the mandible
o	Retrusion / Gliding
•	Superior compartment
o	Posterior fibres of temporalis muscle
Elevation of the mandible
o	Hinge movement
•	Inferior compartment
o	Remainder of temporalis 
o	Masseter 
o	Medial Pterygoid

Answer 169

A

by extra-capsular ligaments.

Answer 170

A

Superiorly
o Circumference of the mandibular fossa and articular tubercle
Inferiorly
o Neck of the condyle of the mandible

Answer 171

A

Lateral
o	1, strong ligament
o	Temporomandibular ligament
•	Strongest ligament of the TMJ
•	Deep fibres blend with joint capcule
Medial
o	2, accessory ligaments
o	Sphenomandibular ligament
o	Stylomandibular ligament

Answer 172

A

The TMJ is most stable when the jaw is closed.
o Mandibular condyle is in contact with the mandibular fossa
o Teeth are in occlussal contact
• Perfect occlusion further stabilises the TMJ

Answer 173

A

The TMJ is least stable when the jaw is open.

Answer 174

A

Yawning or taking a large bite, excessive contraction of the Lateral Pterygoids may cause the heads of the mandible to dislocate anteriorly (pass anterior to the articular tubercles).
In this position the mouth remains depressed and the person is unable to close their mouth.

Dislocation of the TMJ most commonly results from a side-ways blow to the chin when the mouth is open

Answer 175

A

o Grinding teeth when asleep

Answer 176

A

o Muscular pain

Answer 177

A

o Muscular pain

Answer 178

A

emerge through foramina or fissures in the cranium and are covered by tubular sheaths derived from the cranial meninges

Answer 179

A

No.	Nerve
I	Olfactory
II	Optic
III	Oculomotor
IV	Trochlear
V	Trigeminal
VI	Abducent (Abducens)
VII	Facial
VIII	Vestibulocochlear
IX	Glossopharyngeal
X	Vagus
XI	Spinal Accessory
XII	Hypoglossal

Answer 180

A

Some Say Marry Money But My Brother Says Big Boobs Matter Most

Answer 181

A

o Special Sensory fibres
• Distributed to the uppermost part of the nasal cavity
• Smell

Answer 182

A

o Reaches the nose via the cribriform plate of the ethmoid bone
• Fractures of the cribiform plate involving the dura mater may be associated with leakage of CSF from the nose (rhinorrhea).
• Fractures of the cribiform plate may result in Anosmia

Answer 183

A

o Sensory

Innervates the eye

Answer 184

A

o Direct trauma to eye or orbit, fracture of optic canal or pressure on optic pathway may result in nerve lesions
• Loss of pupillary constriction and visual field defects

Answer 185

A

o Motor
• Innervates the Extraocular Muscles
• Innervates the Ciliary Muscles
• Innervates the Sphincter Pupillae

Answer 186

A

o Fractures involving the cavernous sinus or aneurysms may cause lesions
o Dilated pupil, ptosis, eye turns down and out, pupillary reflex on side of lesion is lost

Answer 187

A

o Motor

• Innervates the Superior Oblique of the Eye

Answer 188

A

o Stretching of the nerve during its course around the brainstem or orbit fractures may lead to nerve lesions
• Inability to look down when eye is adducted

Answer 189

A

o Both
o Three divisions

o Opthalmic
• Sensory (Skin, cornea)
• Corneal reflex

o Maxillary
• Sensory
• Skin, mucous membrane of nose, palate and upper dental arcade

o	Mandibular
•	Sensory
o	Skin, lower teeth, cheek and anterior 2/3rd of tongue (general sensation)
•	Motor
o	Innervates the muscles of mastication

Answer 190

A

o Nerve lesions lead to paralysis of muscles and sharp, intense facial pain

Answer 191

A

o Motor

• Innervates the Lateral Rectus

Answer 192

A

o Fractures involving the cavernous sinus or orbit may lead to nerve lesions
• Eye fails to move laterally, diplopia on lateral gaze

Answer 193

A

o Both
o Sensory
• Special sensory (taste) anterior 2/3rds of tongue
• General sensory fibres supply part of the external acoustic meatus and auricle
o Motor
• Muscles of facial expression
• Parasympathetic secretomotor to submandibular and sublingual salivary glands via the chorda tympani
• Parasymathetic secretomotor to glands of nasal mucosa, paranasal sinuses, palate and the lacrimal gland

Answer 194

A

o Lacteration or contusion in Parotid Region
• Paralysis of facial muscles, eye remains open, angle of mouth droops, forehead does not wrinkle
• Bell’s Palsy
o Fracture of Temporal Bone
• Bell’s Palsy
• Involvement of cochlear nerve and chorda tympani; dry cornea; loss of taste in anterior 2/3rds tongue
o Intracranial Haematoma
• Forehead wrinkles because of bilateral innervation of frontalis muscle
• Paralysis of contralateral facial muscles

Answer 195

A

o Sensory
o Special Sensory – Balance and hearing
• Vestibular Branch – Controls balance
• Cochlear Branch – Hearing

Answer 196

A

o Skull fractures, ear infections, tumour of the nerve (acoustic neuroma) may all cause nerve lesions
• Progressive, unilateral hearing loss, tinnitus (ringing in the ear), vertigo (sensation that environment is moving or spinning)
• Acoustic neuroma frequently impairs Facial Nerve (CN VII) too

Answer 197

A

o Both
o Sensory
• General and Special sensory (taste) to posterior 1/3rd of tongue
• General sensory widely distributed to the pharynx, oropharyngeal isthmus, dorsum of palate, the auditory tube and related structures, the mastoid antrum and mastoid air cells
• Sensory to Carotid Body and Sinus
o Motor
• Innervates the Stylopharyngeus
• Parasympathetic secretomotor fibres to Parotid salivary gland

Answer 198

A

o Deep lacerations of the neck may cause nerve lesions

• Loss of taste to posterior 1/3rd of tongue

Answer 199

A

o Both
o Sensory
• eGeneral Sensory lower pharynx and larynx, external auditory meatus and back of auricle
• Special Sensory (taste) to epiglottis
o Motor
• Innervates all muscles of the pharynx, except Stylopharyngeus
• Innervates muscles of airways, larynx, heart and GI tract
• Innervates all of the palate muscles, except tensor veli palatine

Answer 200

A

o Nerve lesions in the neck affecting Recurrent Laryngeal branch of Vagus
• Hoarseness of voice due to paralysis of vocal fold
o Left recurrent laryngeal nerve is lower than the right
o Bronchial or oesophageal carcinoma
o Enlarged mediastinal lymph nodes
o Stretched over an aneurysm of the aortic arch
o Mitral stenosis → Enlarged LA → Pushed up left pulmonary artery, compressing the left recurrent laryngeal nerve against the aortic arch
o Thyroidectomy causing damage to Superior Laryngeal Nerve
• External branch lies close to superior thyroid artery and may be damaged when ligating the blood vessel

Answer 201

A

o Motor
o Cranial Component
• Innervates the Pharynx, Larynx and soft palate
o Spinal Component (contains fibres from C2, C3, C4)
• Innervates the Trapezius and Sternocleidomastoid muscle

Answer 202

A

o Surgery or lacerations to the neck can cause lesions to the nerve
• Paralysis of sternocleidomastoid and superior fibers of trapezius
• Shoulder droop

Answer 203

A

o Motor

• Innervation of all Extrinsic and intrinsic muscles of the tongue, with the exception of Palatoglossus

Answer 204

A

o Neck laceration and basal skull fractures may cause nerve lesions
• Protruded tongue deviates towards the affected side due to the arrangement of the muscles

Answer 205

A

o Anterolateral to the vertebral column
o Lying on the prevertebral fascia and muscles
o Deep to the carotid sheath.

Answer 206

A

Preganglionic fibres arise mainly in the first thoracic neural segment and synapse in one of the three Cervical Sympathetic Ganglia, the Superior, Middle or Inferior.

After synapsing, the postganglionic fibres travel as the Internal and External Carotid Nerves

Answer 207

A

pass with the Internal and External Carotid Arteries and its branches to:
o The Pharyngeal Plexus
o The Upper 4 Cervical Nerves
o Cardiac Branch to the Cardiac Plexus

Answer 208

A

pass with the Inferior Thyroid Artery to:
o The 5th and 6th Cervical Nerves
o Cardiac Branch to the Cardiac Plexus

Answer 209

A

pass with the Vertebral Artery to:
o The 7th and 8th Cervical Nerves
o Cardiac Branch to the Cardiac Plexus

Answer 210

A

The inferior ganglion is a small ganglion, which in 80% of people combines with the 1st Thoracic Ganglion to form the Stellate Ganglion.

Answer 211

A

ciliary ganglion
Pterygopalatine ganglion
Submandibular ganglion
Otic ganglion

Answer 212

A

Oculomotor (CN III)
Facial (CN VII)
Glossopharyngeal (CN IX)
Vagus (CN X)

Answer 213

A

Oculomotor → Ciliary Ganglion
Facial → Pterygopalatine / Submandibular Ganglion
Glossopharyngeal → Otic Ganglion
Vagus nerve does not have a discrete ganglion associated with it

Answer 214

A

o Lies in the Orbital Cavity, lateral to the optic nerve
o Parasympathetic fibres derived from Oculomotor Nerve (CN III)
• Sphincter Papillae
• Ciliary Muscles
o Sympathetic Fibres come from the Superior Cervical Ganglion
• Via the plexus on the Opthalmic Artery (First branch of the Internal Carotid Artery)
• Distributed to the eyeball
o Sensory fibres from the eyeball pass to the nasociliary nerve

Answer 215

A

o Lies in the Pterygopalatine Fossa
o Connected to the Maxillary Nerve (CN V2) by small branches
o Parasympathetic fibres derived from Facial Nerve (CN VII) via the Greater Pterosal Nerve
• Lacrimal glands
• Glands of the nose, palate and nasopharynx
o Sympathetic fibres come from the Superior Cervical Ganglion
• Via the plexus on the Internal Carotid Artery
• Distributed to the nose, palate and nasopharynx
o Sensory fibres from the nose, palate and nasopharynx pass in the branches of the ganglion to the Maxillary Nerve (CN V2)

Answer 216

A

o Suspended from the Lingual Nerve by small branches
o Parasympathetic fibres derived from the Facial Nerve (CN VII) via the Chorda Tympani, then the Lingual Nerve
• Submandibular Gland
• Sublingual Gland
• Other glands on the floor of the oral cavity
o Sympathetic fibres come from the Superior Cervical Ganglion
• Along the Facial Artery
• Pass to the glands in the floor of the oral cavity
o Taste fibres may pass through the ganglion

Answer 217

A

o Parasympathetic fibres derived from the Glossopharyngeal Nerve via the Auriculotemporal Nerve
• Parotid Gland
o Sympathetic fibres come from the Superior Cervical Ganglion
• Along the Middle Meningeal Artery
• Pass into the Parotid Gland
o Motor branches from the Mandibular Nerve (CN V3) pass through the ganglion without synapsing

Answer 218

A

Interruption of a cervical sympathetic trunk results in Horner’s Syndrome. It is manifested by the Absence of Sympathetically Stimulated functions on the Ipsilateral side of the head.

o Miosis
• Constriction of the pupil
• Parasympathetically stimulated Sphincter Papillae of the pupil is unopposed

o Ptosis
• Drooping of superior eyelid
• Paralysis of smooth muscle fibres interdigitated with the aponeurosis of the Levator Palpebrae Superioris that collectively constitute the Superior Tarsal muscle (innervated by Sympathetic fibres)

o Vasodilation
• Redness and increased temperature of the skin
• Loss of sympathetic tone

o Anhydrosis
• Absence of sweating

Answer 219

A

o	Roof
•	Frontal and Sphenoid
o	Floor
•	Maxilla, Zygomatic (and palatine)
o	Medial
•	Ethmoid, Maxilla, Lacrimal
o	Lateral
•	Zyogmatic, Sphenoid

Answer 220

A

o Usually at bony sutures

o Medial and Inferior walls are thin
• Medial wall Fractures – Can involve Ethmoidal and Sphenoidal Sinus
• Inferior wall Fractures – Can involve Maxillary Sinus

o	‘Blow Out’ Fracture
•	A fracture that displaces the orbital walls and contents
•	Muscle entrapment
•	Diplopia (double vision)
•	Infection

o Enopthalmos
• Depression of eye
• Opposite of exophthalmos (bulging of the eye)
• Infraorbital bleeding may push the eyeball back out (Pulsatile)

Answer 221

A

• Optic Nerve

Answer 222

A

Lateral → Medial
Lacrimal Nerve
Frontal Nerve
Trochlear Nerve (CN IV)
Superior branch of Oculomotor Nerve (CN III)
Nasociliary Nerve
Inferior Branch of the Oculomotor Nerve (CN III)
Abducens Nerve (CN VI)
Opthalmic Veins
Sympathetic Nerves

• Large French Teenagers Sit Numb In Anticipation Of Sweets

Answer 223

A

o Exits the orbit via the Optic Canal

Answer 224

A

4 Recti
o	Superior
•	Look up
•	Muscle loops through the Trochlear
o	Inferior
•	Look down
o	Medial
•	Look medial (Adduct Pupil)
o	Lateral
•	Look lateral (Abduct Pupil)

2 Obliques
o	Superior
•	Look down
o	Inferior
•	Look up

Levator Palpebrae Superioris
• Lifts upper Eyelid

Answer 225

A

LR6SO4R3
o	Lateral Rectus
•	Cranial Nerve 6 
•	Abducens
o	Superior Oblique
•	Cranial Nerve 4
•	Trochlear
o	All the Rest
•	Cranial Nerve 3
•	Oculomotor

Answer 226

A

o Loss of innervation to the Lateral Rectus
• Unable to move eye laterally (abduct pupil)
• Pupil is fully adducted due to unopposed pull of medial rectus
o Caused by fractures involving orbit or cavernous sinus

Answer 227

A

o Loss of innervation to the Superior Oblique
• Unable to look eye down when eye is adducted
o Caused by orbital fractures or stretching of the nerve during its course around the brainstem

Answer 228

A

o Loss of innervation to ‘All the Rest’
• Superior eyelid droops
o Ptosis (drooping of eyelid)
o Loss of innervation to Levator Palpebrae Superioris
o Unopposed activity of Orbicularis Oculi (Facial nerve)
• Pupil is fully dilated and non reactive
o Loss of innervation to Sphincter Pupillae
o Unopposed action of Dilator Pupillae
• Eye has moved ‘Down and Out’
• Unopposed action of Lateral Rectus and Superior Oblique
o Caused by fractures involving the cavernous sinus or aneurysms

Answer 229

A

Opthalmic Artery
o Branch of the Internal Carotid Artery

Central Artery of the Retina
o Branch of the Opthalmic Artery
o End arteries
o Obstruction (e.g. by embolus) results in instant and total blindness

Answer 230

A

Superior and Inferior Opthalmic Veins
o Exit via the Superior Orbital Fissure and drain into the Cavernous Sinus

Central Vein of the Retina
o Drains into the Cavernous Sinus, either directly or via Opthalmic Veins
o Occlusion results in slow, painless loss of vision
o Infections may also spread by this route from the eye to the brain

Answer 231

A

The eyelids protect the cornea and the eyeball from injury and keep the cornea moist by covering it with lacrimal fluid. Conjuctiva line the inner surface of the eyelids. The eye blinks when the cornea becomes dry and the eyelids carry a film of fluid over the cornea. Dust and other foreign material is also swept across to the medial angle of the eye and removed.

The eyelids are strengthened by Tarsal Plates, dense bands of connective tissue that contain Tarsal Glands, which produce secretions that lubricate the edges of the eyelids and prevents them from sticking together when they close.

Answer 232

A

o Secretes Lacrimal Fluid (Tears)
• Watery physiological saline
• Contains the bacteriocidal lysozyme enzyme
• Moistens and lubricates the surfaces of the conjuctiva and cornea
• Provides some nutrients and dissolved oxygen to the cornea
o Lies in a fossa on the superolateral part of the orbit

Answer 233

A

Conducts lacrimal fluid from the gland to the conjuctival sac

Answer 234

A

o Commence at the medial angle of the eye where lacrimal fluid is drained from the lacrimal lake → lacrimal sac

Answer 235

A

o Conveys lacrimal fluid to the inferior nasal meatus

• Inferior to the inferior nasal concha

Answer 236

A

o Levator Palpebrae Superioris
• Innervated by Oculomotor Nerve (CN III)
o Assisted by Superior Tarsal Muscles
• Sympathetic innervation

Answer 237

A

o Orbicularis oculi

• Innervated by Facial Nerve (CN VII)

Answer 238

A

If the eyelids are prevented from closing properly the protective effect of blinking is lost. The cornea becomes dry and is left unprotected from dust and other particulate material. Irritation of the eyeball results in excessive tear formation

Answer 239

A

1.	Outer Protective layer
o	Sclera
•	Fibrous and provides attachment for the Extraocular muscles
•	White, relatively avascular
o	Cornea
•	Transparent, avascular
•	Nourishment from lacrimal glands and vascular beds
•	Sensitive – CN V1

2.	Middle Vascular layer
o	Choroid
•	Red of eye, continues anteriorly as the Ciliary Body
o	Ciliary Body
•	Anterior muscle thickening
•	Attaches and focuses the lens
•	Ciliary process secretes aqueous humor into the Anterior Chamber
o	Iris
•	Thin diaphragm, aperture is pupil
•	PSNS contracts the Sphincter Pupillae
•	SNS contracts the Dilator Pupillae
o	Rich network of blood vessels

3.	Inner Retina layer
o	Optic part
•	Photosensitive
•	Neural and Pigmented layer
o	Non-visual part
•	Anterior

Answer 240

A

o	Fundus
•	Posterior of eye
•	Seen with a fundoscope / opthalmoscope
o	Macula (a.k.a. macula lutea)
•	Fovea centralis
o	Optic Disc
•	Blind spot
•	Convergence of sensory fibres

Answer 241

A

Cornea
Aqueous Humor
Lens
Vitreous Humor

Answer 242

A

o	The cornea is the primary refractive medium
o	Myopia
•	Short or near-sight
•	Image focussed in front of retina
o	Hyeropia or Hypermetropia
•	Long or far-sight
•	Imaged focussed behind the retina 
o	Presbyopia
•	Far sight due to age-related changes of lens

Answer 243

A

o Produced by the Ciliary process
o Drains into scleral venous sinus via trabecular meshwork
o Responsible for intraocular pressure
• Glaucoma is caused by raised intraocular pressure (outflow of aqueous humor is blocked)

Answer 244

A

o Near vision
• Accomodation
• Parasympathetic activity in CN III → Sphincter like contraction of Ciliary muscle → Lens more globe like/fatter
o Far vision
• No parasympathetic activity to Ciliary muscles → Lens stretched → Flatter
• Becomes thicker with age
• Cataracts – Clouding of the lens

Answer 245

A

o Holds retina in place
o Retina
• Rods – Low light, black and white
• Cones – Bright light, colour vision

Answer 246

A

o Afferent fibres
• Opthalmic Branch of the Trigeminal Nerve (CN V1)
o Efferent Fibres
• Temporal and Zygomatic Branches of the Facial Nerve (CN VII)
• Contraction of the Orbicularis Oculi, causing the eye to blink
o Dirt and other extraneous particles cause corneal abrasions that result in sudden pain and excessive tears
o Injury to the nerve removes this reflex, rendering the cornea vulnerable to foreign particles as they will not be felt
o Loss of reflex may lead to Corneal Ulceration

Answer 247

A

People with scarred or opaque corneas may receive corneal transplants from donors (usually deceased). Corneal implants of non-reactive plastic material are also used.

Answer 248

A

Mydriasis is dilation of the pupil, sometimes referred to as a ‘Blown pupil’.
o Under-activity of PSNS → Lack of innervation to Sphincter Pupillae
o Over-activity of SNS → Increased innervation to Dilator Pupillae
Raised intracranial pressure is a possible cause of mydriasis.

Answer 249

A

Outflow of aqueous humor through the scleral venous sinus into the blood circulation must occur at the same rate at which it is produced. If the outflow is decreased significantly because the pathway is blocked, pressure builds up in the anterior and posterior chambers of the eye. This is known as Glaucoma.

Blindness can result from compression of the inner layer of the eyeball (retina) and the Central Artery of the Retina.

Answer 250

A

As people age, their lenses become harder and more flattened. These changes gradually reduce the focusing power of the lenses,

Answer 251

A

Some people also experience a loss of transparency (cloudiness) of the lens from areas of opaqueness (Cataracts). Cataract extraction combined with an intra-ocular lens implant has become a common operation.

Answer 252

A

The Intraretinal Space separates the layers of the retina in the developing embryo. During the early foetal period, the layers fuse, obliterating this space. However, although the Pigment Cell Layer becomes firmly fixed to the choroid, its attachment to the Neural Layer is not firm.

Consequently, a blow to the eye may cause detachment of the retina, perhaps days or even weeks after trauma to the eye.

Persons with retinal detachment may complain of flashes of light or specks floating in front of the eye.

Answer 253

A

Coloboma is the absence of a section of the iris. It may result from a birth defect, penetrating or non-penetrating injuries to the eyeball or a surgical iridectomy.

Answer 254

A

Haemorrhage within the anterior chamber of the eyeball (Hyphema or Hyphemia) usually results from blunt force trauma to the eyeball.

Initially, the anterior chamber is tinged red, but blood soon accumulates. The initial haemorrhage usually stops in a few days and recovery is good.

Answer 255

A

Protrusion of the eye, causing the eyelids to part more than normal so that the whites of the sclera are visible all around the cornea and iris.
o	Bilateral
•	Grave’s Disease (Hyperthyroidism) 
o	Unilateral
•	Aneurysm
•	Haematoma

Answer 256

A

o Optic nerve is surrounded by meninges with CSF in the subarcachnoid space
o Increase in CSF pressure may compress the optic nerve → compress blood vessels supplying retina → blindness
o Vein is occluded before the artery, leading to oedema of the retina (Papillodema)

Answer 257

A

The eye may appear bloodshot. This may result from trauma, infection, allergy or increased pressure in the eye. Severe coughing spells or recurrent vomiting may cause a patient to have a conjuctival haemorrhage.

Answer 258

A

Blocked Tarsal Gland, which lies behind the eyelash within the eyelid.

Answer 259

A

Infection of the Sebaceous Gland at the base of the eyelash.

Answer 260

A

External, Middle and Internal Ear

Answer 261

A

tympanic membrane

Answer 262

A

Middle ear to nasopharynx

Answer 263

A

The Auricle (Pinna)
o Irregularly shaped plate of Elastic Cartilage covered by thick skin
o Several depression and elevations, including the Helix (outer rim) and Tragus (small flap guarding the external acoustic meatus)
o Non-cartilaginous Lobule (lobe) consists of fibrous tissue, fat and blood vessels.

The External Acoustic Meatus (Canal)
o Cartilaginous tube lateral 1/3rd, bony canal medial 2/3rds
o Lies in the Temporal Bone
o Lined by skin secreting Cerumen (modified sebum), which offers protection. The discarded cells of the skin together with cerumen form Wax

Answer 264

A

o Blood supply is from the Posterior Auricular and Superficial Temporal Arteries, which are both branches of the External Carotid Artery

Answer 265

A

o Sensory innervation Anterior to the External Acoustic Meatus is the Auriculotemporal Nerve, a branch of the Mandibular Nerve (CN V3)
o Sensory innervation for the rest of the auricle is from the Great Auricular Nerve

Answer 266

A

o Sigmoid shaped, therefore Auricle is pulled upwards and backwards during ear examination to achieve a good internal view
o In children, the canal should be straightened by pulling the canal downwards and back

Answer 267

A

o Shallow cone with its apex pointing medially
o ~1cm diameter
o Thin, oval, semi-transparent, pearly grey membrane
• Allows for visualisation of some structures within the middle ear, most notably the malleus
o Blood vessels visible around the periphery
o Partition between external and middle ear

Answer 268

A

o External surface supplied by:
• Auriculotemporal Nerve Branch of CN V3
• Auricular Branch of the Vagus Nerve (CN X)
o Internal surface supplied by the Glossopharyngeal Nerve (CN IX)

Answer 269

A

o Stimulation of the Auricular Branch of the Vagus Nerve (CN X)
• E.g. insertion of cotton bud
o Cough reflex (some event vomit)

Answer 270

A

o	Dull and become red or yellow
o	Blood vessels may be dilated
•	Injection of the drum
o	Dense, white plaques 
•	Tympanosclerosis
o	Bulging of the membrane
•	Pus or fluid in middle ear
o	Retracted membrane
•	Infratympanic cavity pressures reduced
•	Obstruction of Eustachian tube
o	Perforation of the membrane
•	Trauma
•	Infection

Answer 271

A

The Cavity of the Middle Ear, or Tympanic Cavity is the narrow air-filled chamber in the Petrous part of the Temporal Bone.

Answer 272

A

o Tympanic Cavity Proper
• The space directly internal to the tympanic membrane
• Connected Anteromedially with the Nasopharynx by the Pharyngotympanic (Eustachian) Tube
• Connected Posterolaterally with the Mastoid Air Cells through the Mastoid Antrum
o Epitympanic Recess
• Space superior to the membrane

Answer 273

A

o	Auditory Ossicles
•	Malleus
•	Incus
•	Stapes
o	Stapedius and Tensor Tympani muscles
o	Chorda Tympani Nerve (Branch of the Facial Nerve (CN VII))
o	Tympanic Plexus of Nerves

Answer 274

A

The ossicles serve to relay the vibrations encountered by the tympanic membrane to the internal ear, amplifying and concentrating sound energy to the oval window.

Answer 275

A

o Malleus
• Handle is attached to the tympanic membrane
• Body articulates with the body of the Incus
o Incus
• Articulates with the Stapes
o Stapes
• Articulates with the Bony Labyrinth of the inner ear at the Oval Window

Answer 276

A

Tensor Tympani
o Inserts into the handle of the malleus
• Pulls handle medially
• Tenses the tympanic membrane, reducing the amplitude of its oscillations
o Prevents damage to the inner ear when exposed to loud sounds

Stapedius
o Pulls the stages posteriorly and tilts its base in the oval window
• Tightens the anular ligament and reduces the oscillatory range
o Prevents excessive movement of the stapes
o Nerve to Stapedius arises from the Facial Nerve (CN VII)

Answer 277

A

The nerve lies in the Facial Canal, separated from the tympanic cavity by a very thin bony partition.

Because of this proximity, a middle ear infection may cause a lesion of the facial nerve.

Answer 278

A

o Vestibule
• Small bony chamber, containing the Utricle and Saccule, which are sensitive to rotational acceleration and the static pull of gravity
o Semi-circular Ducts and canals
• Communicate with the vestibule
• Contain receptors that respond to Rotational Acceleration in three different planes
o Cochlea
• Shell shaped portion of the bony labyrinth containing the Cochlear Duct
o Cochlear Duct
• Accommodates the spiral Organ of Corti
o Organ of Corti
• Contains the receptors of the auditory apparatus

Answer 279

A

A localised collection of blood forms between the Perichondrium and the Auricular Cartilage, causing distortion of the contours of the auricle.

If the blood is not aspirated, fibrosis develops in the overlying skin, forming a deformed auricle (Cauliflower or Boxer’s ear).

Answer 280

A

o Antihelix deformity
o Pinna malformation
o Pre-auricular pit
o Pre-auricular skin tag

Answer 281

A

o Infection / Inflammation of the external acoustic meatus
o Often develops in swimmers who do not dry their meatus after swimming
o Itching and pain in the external ear
• Pulling the auricle or applying pressure on the tragus increases pain

Answer 282

A

o Infection of the middle ear
o Often secondary to upper respiratory infections
• Via the Pharyngotympanic (Eustachian Tube)
• More common in children as their Eustachian tube is shorter and more horizontal, making it easier for organisms to travel up it and harder for fluid to drain away from the middle ear
o Earache and bulging red tympanic membrane
• Pus or fluid in the middle ear
o Inflammation of the mucous membrane lining the tympanic cavity may cause partial or complete blockage of the Pharyngotympanic (Eustachian) tube.

Answer 283

A

o May result from otitis media, the insertion of foreign bodies, trauma, excessive pressure (e.g. from scuba diving)
o One of several causes of middle ear deafness
o Minor ruptures of the membrane often heal spontaneously
o Large ruptures require surgical repair

Answer 284

A

o Infections of the mastoid antrum and mastoid air cells
o Results from Otitis Media
o Causes inflammation of the mastoid process
• Swelling behind the ear
o Infection may spread superiorly into the middle cranial fossa through the petrosquamous fissure in children
• Osteomyelitis

Answer 285

A

o Easily blocked by swelling of mucus membrane
• Even from mild infections, e.g. a cold as walls of its cartilaginous part are normally already in apposition
o When tube is occluded, residual air in the tympanic cavity is absorbed into mucosal blood vessels
• Lower pressure in the tympanic cavity
• Retraction of the Tympanic Membrane
o Interference with the free movement of the tympanic membrane (its retraction) affects hearing
o Adenoidal hypertrophy can block the opening to the tube in the Nasopharynx
• Children 3-8
• Epstein-Barr Virus (EBV)

Answer 286

A

o E.g. from lesion of the facial nerve
o Loss of protective action against loud noises
o Hyperacusis or Hyperacusia

Answer 287

A

o Discordance between vestibular and visual stimulation

Answer 288

A

Injuries of the peripheral auditory system cause three major symptoms:
1.	Hearing loss
•	Usually conductive
2.	Vertigo
•	(Dizziness)
•	When the injury involves the semicircular ducts
3.	Tinnitus
•	Buzzing or ringing

Answer 289

A

o Results from anything in the external or middle ear that interferes with the conduction of sound or movement of the oval or round windows.
o People with this type of hearing loss often speak with a soft voice
• To them, their own voices sound louder than background sounds
o May be improved surgically or by use of a hearing device

Answer 290

A

o Results from defects in the pathway from cochlea to brain
• Defects of cochlea
• Defects of cochlea nerve
• Defects of brainstem
o Cochlear implants can restore hearing
• External microphone transmitting to an implanted receiver that sends electrical impulses to the cochlea, stimulating the cochlear nerve

Answer 291

A

o Blockage of the cochlear aqueduct
o Recurrent attacks of tinnitus, hearing loss and vertigo
o Accompanied by a sense of pressure in the ear, distortion of sounds and sensitivity to noise

Answer 292

A

o Blockage of the Eustachian tube leads to negative middle ear pressure
o Negative pressure leads to retraction pockets
o Dead skin cells accumulate in the pockets
o Necrotic mass of dead skin
• Colesteatoma
o Erosion of middle ear structures and bone via lytic enzymes

Answer 293

A

o Ear pain
o Infection / inflammation around the ear
o Pain from teeth, pharynx or cervical spine commonly referred to the ear

Answer 294

A

o Itching

o May result from primary disorder of the external ear, or middle ear discharge

Answer 295

A

o Discharge from the ear
o Indicates acute or chronic infection
o Blood / CSF discharge associated with skull fracture

Answer 296

A

The external nose is the visible portion that projects from the face. It has both bony and (predominantly) cartilaginous components and provides the opening into the nasal cavity. The nostrils are bounded laterally by alae and the skin covering the nose extends upwards into the vestibule.

Answer 297

A

The supporting skeleton of the nose is composed of bone and hyaline cartilage. 
o	Bony part of the nose
•	Nasal Bones
•	Maxillae frontal processes
•	Frontal Bone (nasal part and nasal spine)
o	Cartilaginous part of the nose
•	2 Lateral cartilages
•	2 Alar cartilages
•	1 Septal cartilage

Answer 298

A

o	Anterior Portion
•	Cartilaginous
o	Middle Portion
•	Perpendicular plate of the Ethmoid Bone
o	Posterior Portion
•	Vomer

Inferiorly, the hard palate, made up of the palatine and maxillary bones, separates the nasal and oral cavities.

Answer 299

A

Nasal fractures are the most common facial fracture, as the nose is an exposed organ.
o History of force to the face
o Deformity
o Complications include septal haematoma

Answer 300

A

o	Nostrils
o	Chonchae (terbinates)
•	Lateral wall
•	Create 5 passages within the cavity
o	Mucosal lining
•	Except for vestibule (skin)
•	Continuous with areas draining into the cavity

Answer 301

A

The superior, middle and inferior Nasal Conchae (or terbinates) curve inferiormedially, hanging like short curtains from the lateral wall of the nasal cavity.
The conchae are scroll-like structures that offer a vast surface area for heat exchange.

The inferior concha is the longest and broadest and is formed by an independent bone (the Inferior Concha).
The middle and superior conchae are the medial processes of the Ethmoid Bone.

A recess or nasal meatus underlies each of the terbinates, diving the nasal cavity into five passages.
The Sphenoethmoidal Recess, lying superoposterior to the superior conca, receives the opening of the sphenoidal sinus.

Answer 302

A

o Spehnoethmoidal Recess
o Lining epithlium of mucus membrane is modified for the purpose of olfaction
o Axonal processes of the olfactory cell pass through the cribriform plate and penetrate the meninges before entering the olfactory bulb

Answer 303

A

o Cribiform plate
• Olfactory Nerve (CN I) runs here
• Fractures may result in CSF leakage and anosmia
o Sphenopalatine foramen
o Incisive foramen
o Foramen cecum
• Nasal veins to superior saggital sinus in some individuals

Answer 304

A

o Branches of the Opthalmic Artery
• Branch of the Internal Carotid Artery
o Branches of the Maxillary and Facial Arteries
• Branches of the External Carotid Artery

The blood supply to the medial and lateral wall of the nasal cavity is very rich. The anterior part of the nasal septum has an area (Kiesselbach or Little’s area) that is rich in capillaries where all the arteries supplying the septum anastomose. It is this area where profuse bleeding occurs in ‘nose bleeds’.

Answer 305

A

Epistaxis is bleeding from the nose. It is very common and can have a local or systemic cause. Anterior bleeds account for 90% of epistaxis. The Sphenopalatine Artery causes posterior bleeds

Answer 306

A

A rich submucosal venous plexus, deep to the nasal mucosa, drains into the:
o Cavernous Sinus
o Facial Vein
o Pterygoid Plexus

Answer 307

A

o Special Sensory (Smell)
• Olfactory Nerve (CN I)

o General Sensory – Posteroinferior Nasal Mucosa
• Maxillary Division of the Trigeminal Nerve (CN V2)
• Nasopalatine Nerve
o General Sensory – Anterosuperior Nasal Mucosa
• Opthalmic Division of the Trigeminal Nerve (CN V1)
• Anterior and Posterior Ethmoidal Nerves

o General Sensory – External Nose
• External Nasal Nose (CN V1)
• Infraorbital Nerve (CN V2)

Answer 308

A

o	Respiratory Region
•	Pseudostratified columnar ciliated
•	With goblet cells
o	Olfactory Region
•	Olfactory cells with olfactory receptors

Answer 309

A

The paranasal sinuses are air-filled extensions of the respiratory part of the nasal cavity into cranial bones (Frontal, Ethmoid, Sphenoid and Maxilla).
The sinuses are named according to the bones in which they are located.

Answer 310

A

The Right and Left Frontal Sinuses are between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. They are usually detectable in children by 7 years of age (not present at birth).

They each drain through a Frontonasal Duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the Middle Nasal Recess.

Answer 311

A

The Ethmoidal cells (Sinuses) are small invaginations of the mucous membrane of the middle and superior nasal recesses into the Ethmoid bone.
The Ethmoidal cells usually are not visible in plain radiographs before 2 years of age.

The Anterior Ethmoidal Cells drain directly or indirectly into the middle nasal recess through the ethmoidal infundibulum.
The Middle Ethmoidal Cells open directly into the middle nasal recess.
The Posterior Ethmoidal Cells open directly into the superior nasal recess.

Answer 312

A

The Maxillary Sinuses are the largest of the paranasal sinuses. They occupy the bodies of the Maxillae.
They drain by one or more openings, the Maxillary Ostium (ostia), into the middle nasal recess by way of the semilunar hiatus.

Answer 313

A

The Sphenoidal Sinuses are located in the body of the sphenoid and may extend into the wings of the bone.
The body of the sphenoid is fragile, and only thin plates of bone separate the sinuses from several important structures (Optic nerves and chiasm, the pituitary gland, internal carotid arteries). They are small at birth, enlarging after puberty.

They drain directly into the Sphenoethmoidal Recess.

Answer 314

A

o The Anterior Cranial Fossa
• Via the cribriform plate of the ethmoid bone
o The Paranasal Sinuses
• Via their openings into the nasal cavity
o The Lacrimal Apparatus and Conjuctiva
• Via the opening of the Nasolacrimal duct
o The Middle Ear
• Via the Pharyngotympanic (Eustachian) tube

Answer 315

A

Inflammation of the nasal mucosa, leading to swelling and increased volume of secretion. Causes include:
o	Infective (Viral)
•	Adenovirus
•	Rhinovirus
•	Respiratory Syncytial Virus (RSV) 
o	Allergic 
o	Nasal Polyps

Answer 316

A

o	Grow close to the ostiomeatal complex of the Nasopharynx
o	Linked to chronic rhinosinusitis
o	Prevalence of ~2-4%
o	Nasal obstruction
•	Snoring / Obstructive sleep apnoea

Answer 317

A

o	Inflammation of the mucosal lining of the sinuses
o	Acute – 7 to 30 days
o	Sub-acute – 4 to 12 weeks
o	Chronic – >90 days
o	Infection
•	Viral with secondary bacterial infection
•	Streptococcus Pneumoniae
•	Haemophillus Influenzae

Answer 318

A

o May break through the medial wall of the orbit
• Proximity to the optic canal, transmitting the Optic Nerve (CN II) and Opthalmic Artery
• Visual disorders

Answer 319

A

o Most commonly infected
• Ostia are small and located high on the supero-medial walls
o When the mucus membrane of the sinus is congested, the maxillary ostia are often obstructed
o Impossible for sinuses to drain when the head is erect until they are full
o When lying on your side, the upper sinus drains

Answer 320

A

o The three maxillary molar teeth are close to the floor of the maxillary sinus
o During removal a fracture of the root may occur
• Piece of root may be driven superiorly into the maxillary sinus
o Communication made between oral cavity and maxillary sinus
o Infection may occur

Because the superior alveolar nerves (Branches of the Maxillary Nerve (CN V2)) supply both the maxillary teeth and the mucous membrane of the maxillary sinuses, inflammation of the mucosa of the sinus is frequently accompanied by a sensation of toothache in the molar teeth.

Answer 321

A

The nasal septum is usually deviated to one side or the other. This could be the result of a birth injury, but more often the deviation occurs during adolescence and adulthood from trauma (e.g. fist fight).

Sometimes the deviation is so severe that the nasal septum is in contact with the lateral wall of the nasal cavity and often obstructs breathing or exacerbates snoring.

This deviation can be corrected surgically.

Answer 322

A

o	Fifth Cranial Nerve
o	Largest Cranial Nerve
o	Mixed nerve
•	Sensation – Principal General Sensory nerve for the head
•	Motor
o	Transit for some Autonomic Nerves
o	Three main branches
•	Opthalmic (CN V1)
•	Maxillary (CN V2)
•	Mandibular (CN V3)

Answer 323

A

The Trigeminal Nerve arises from the Lateral Aspect of the Pons by a large sensory root and small motor root. The crescent shaped Trigeminal Ganglion sits within a Dural recess, the Trigeminal Cave, which sits laterally to the cavernous sinus.

Answer 324

A

o	Exits skull through the Superior Orbital Fissure
o	Sensory Only
•	Cornea
•	Upper conjuctiva
•	Nasal Cavity (Anterosuperior)
•	Frontal Sinus
•	Ethmoid Sinus
•	External Nose
•	Upper Eyelids
•	Forehead and scalp
o	Tested via the Corneal Reflex
o	Three branches
•	Frontal 
•	Nasocillary
•	Lacrimal
•	Lacrimal Gland
•	Conjuctiva
•	Post Ganglionic Parasympathetic Fibres to Lacrimal Gland

Answer 325

A

o	Exits the skull through the Foramen Rotundum
o	Sensory Only
•	Conjunctiva
•	Nasal Cavity (Posteroinferior)
•	Lateral External Nose
•	Maxillary Sinus
•	Superior palate
•	Inferior eye lid
•	Upper lip
o	14 Terminal Branches
o	Associated with a parasympathetic ganglion
•	Pterygopalatine
•	Innervation of lacrimal, nasal and palate glands

Answer 326

A

o	Exits the skull through the Foramen Ovale
o	Sensory
o	Mucous membranes
o	Lower Lip
o	Chin
o	External Ear (Front of auricle)
o	Anterior two thirds of tongue (General Sensation, not taste!)
o	Motor
•	Masseter
•	Temporalis
•	Medial and Lateral Pterygoids
•	Mylohyoid
•	Digastric
•	Tensor Tympani
•	Tensor Vele Palatini
o	Associated with two parasympathetic ganglia
•	Submandibular Ganglion
•	Submandibular Salivary Gland
•	Sublingual Salivary Gland
•	Otic Ganglion
•	Parotid Salivary Gland

Answer 327

A

o	Exits the skull through the Stylomastoid Foramen
o	Mixed Nerve
o	Motor
•	Muscles of facial expression
•	Digastric (posterior belly)
•	Stylohyoid
•	Stapedius
o	Sensory
•	General Sensory
•	Small area of skin close to external acoustic meatus
•	Special Sensory (Taste)
•	Corda Tympani from the Lingual Nerve 
•	Taste Anterior 2/3rds of the tongue
o	Parasympathetic
•	Pterygopalatine Parasympathetic Ganglion
•	Lacrimal Gland
•	Submandibular Gland
•	Sublingual Gland

Answer 328

A

Motor Cortex
Pons
• Facial Motor Nucleus
Internal Acoustic Meatus
• Within Petrous Temporal Bone
Facial Canal
• Within Temporal Bone
• Gives rise to:
• Greater Petrosal Nerve
• Nerve to the Stapedius
• Chorda Tympani Nerve
Stylomastoid Foramen
• Exits Temporal Bone
• Gives rise to Posterior Auricular Branch
Branches to face and neck
• 5 Branches
• Through Parotid Gland

Answer 329

A

o	Temporal
•	Occipitofrontalis
•	Orbicularis Oculi (Superior)
o	Zygomatic
•	Orbicularis Oculi (Inferior)
o	Buccal
•	Orbicularis Oris
•	Buccinator
•	Zygomaticus
o	Marginal Mandicular
•	Mentalis
o	Cervical
•	Platysma

Answer 330

A

Non-Traumatic Causes
o	Inflammation
o	Infection
•	Viral (Herpes)
•	Parotitis (S. Aureus)
o	Compression
•	Parotid Tumour

Traumatic Causes
o	Fractures
•	Temporal Bone
o	Stabbing
o	Gunshots
o	Childbirth

Iatrogenic
o	Surgery (Parotidectomy)

Answer 331

A

All muscles of facial expression paralysed

Answer 332

A

Frontal Sparing
Occipitofrontalis and Orbicularis Oculi not paralysed
Due to their Bilateral Innervation

Answer 333

A

The Pharynx is the superior, expanded part of the Alimentary System, posterior to the nasal and oral cavities and extending inferiorly past the larynx.

The Pharynx extends from the Cranial Base to the Inferior Border of the Cricoid Cartilage Anteriorly and the Inferior Border of C6 Vertebra Posteriorly.
It is widest (Approximately 5cm) opposite the hyoid and narrowest (approximately 1.5cm) at its inferior end, where it is continuous with the oesophagus.

Answer 334

A

The Pharynx is divided into Three Parts:
o Nasopharynx
• Posterior to the nose and superior to the soft palate
• Respiratory Function as it is the posterior extension of the nasal cavities
• Pseudostratified Ciliated Epithelium with Goblet Cells
• Lymphoid tissue forms a Tonsillar ring around the superior part of the pharynx, which aggregates to form the Adenoids. The adenoids may become swollen during infection in children, blocking the Eustachian tube and leading to otitis media.
o Oropharynx
• Posterior to the mouth
• Extends from the soft plate to the superior border of the epiglottis
• Digestive Function
• Stratified Squamous Epithelium non-Keratinised
o Laryngopharynx
• Posterior to the Larynx
• Ends from the superior border of the epiglottis to the inferior border of the cricoid cartilage, where it becomes continuous with the oesophagus.
• Stratified Squamous Epithelium non-keratinised

Answer 335

A

The wall of the Pharynx consists of an incomplete outer circular muscle layer and an inner longitudinal muscle layer. The muscle layer is covered internally by the Pharyngobasilar Fascia, which is in turn covered by the Mucous Membrane.

Answer 336

A

o Superior Constrictor
o Middle Constrictor
o Inferior Constrictor
• Lower horizontal fibres known as Cricopharyngeus

The outer muscle layer attaches posteriorly at the midline raphe. The muscles overlap each other and are incomplete anteriorly. During swallowing the muscle constrict to propel the bolus of food downwards (involuntarily during the swallowing reflex).

Answer 337

A

o Stylopharyngeus
o Palatopharyngeus
o Salpingopharyngeus
During swallowing these muscles act to shorten and widen the pharynx.

Answer 338

A

Innervation of the Pharynx is by the Pharyngeal Plexus of nerves. This is formed by branches of the Vagus (CN X) and Glossopharyngeal (CN IX) nerves along with sympathetic fibres from the Superior Cervical Ganglion.

Sensory Innervation
o Glossopharyngeal Nerve
o Nasopharynx is via the Opthalmic and Maxillary divisions of the Trigeminal Nerve (CN V1+2)
Motor Innervation
o Vagus Nerve (CN X)
o Exception to this is the Stylopharyngeus Muscle
• Glossopharyngeal Nerve (CN IX)

Answer 339

A

Voluntary Phase
o Tongue moves the bolus back onto the pharynx
Pharyngeal Phase
o Afferent information from pressure receptors in the palate and anterior pharynx reaches the swallowing centre in the brain stem.
o A set of movements is triggered
• Inhibition of breathing
• Raising of the larynx – Suprahyoid and Longitudinal Muscles
• Closure of the glottis
• Opening of the upper oesophageal ‘sphincter’
Oesophageal Phase
o The muscle in the upper third of the oesophagus is voluntary striated muscle under somatic control
o The muscle of the lower two thirds is smooth muscle under control of the parasympathetic nervous system.
o A wave of peristalsis sweeps down the oesophagus, propelling the bolus to the stomach in ~9 seconds.
o Coordinated by extrinsic nerves from the swallowing centre of the brain
o Lower oesophageal ‘sphincter’ opens

Answer 340

A

The blood supply of the Pharynx is via branches of the External Carotid Artery
o	Ascending Pharyngeal Artery
o	Lingual Artery
o	Facial Artery
o	Maxillary Artery

Answer 341

A

Venous drainage of the Pharynx is via the Pharyngeal Venous Plexus → Internal Jugular Vein.

Answer 342

A

The gag reflex tests pharyngeal innervation and musculature. It is conducted by touching the back of the oropharynx, which result in a reflex contraction of the pharyngeal muscles (makes the person gag). 
o	Afferent Pathway
•	Glossopharyngeal Nerve (CN IX)
o	Efferent Pathway
•	Vagus Nerve (CN X)

Answer 343

A

o Sub-epithelial collection of lymphoid tissue
o Junction of roof and poster wall of Nasopharynx
o Maximal size between 3 – 8 years then regress
o Enlarge with viral / bacterial infections
o Recurrent infections may lead to chronically enlarge adenoids

Answer 344

A

o Nasal obstruction
o Mouth breathing, nasal speech
o Feeding difficulty (especially infants)
o Snoring / Obstructive Sleep Apnoea
o Block the opening of the Eustachian Tube

Answer 345

A

o Lie in the Tonsillar fossa between two arches
• Anterior – Palatoglossal Arch
• Boundary between mouth and oropharynx
• Posterior – Palatopharyngeal Arch
• Contains the Palatopharyngeus Muscle that blends with walls of the pharynx
o Lymphoid tissue covered by squamous epithelium
o Enlarge with bacterial or viral infection
o Lymphatic drainage is the Jugulo-Digastric (Tonsillar) node
• Angle of the mandible

Answer 346

A

Potential for bleeding as the palatine tonsils are very vascular
Bleeding often from the large External Palatine Vein
Internal Carotid Artery and Glossopharyngeal Nerve lie just lateral to Tonsillar fossa

Answer 347

A

Peritonsillar Abscess
Infection spread to peritonsillar tissue and abscess formation
Uvula pushed to the other side
Requires abscess drainage

Answer 348

A

Oropharynx
o	Vallecula
•	Mucosal Pouch between the base of the tongue and epiglottis
o	Base of tongue
o	Region of palatine tonsil
Laryngopharynx
o	Piriform Fossa
•	Mucosal Recess between the central part of the larynx and lateral lamina of the thyroid cartilage 
o	Cricopharyngeus

Answer 349

A

The Larynx connects the inferior Oropharynx to the Trachea. It also contains the voice box. The Larynx extends from the Laryngeal Inlet, through which it communicates with the Laryngopharynx to the level of the inferior border of the cricoid cartilage. Here the laryngeal cavity is continuous with the Trachea

Answer 350

A

The Larynx’s most vital function is to guard the air passages, especially during swallowing when it serves as the sphincter/valve of the lower respiratory tract, thus maintaining the airway.

Answer 351

A

Made up of the Hyoid Bone and 9 Cartilages:
o	3 Unpaired Cartilages
•	Epiglottis
•	Thyroid Cartilage
•	Cricoid Cartilage
o	1 important set of Paired Cartilages
•	Arytenoid Cartilage(s)
o	2 other sets of Paired Cartilages
•	Corniculate Cartilage(s)
•	Cuneiform Cartilage(s)

Answer 352

A

o Leaf shaped fibro cartilage

o Attached by ligaments to the back of the hyoid bone and thyroid cartilage

Answer 353

A

o	Laryngeal Prominence (‘Adam’s Apple’)
o	Upper surface used to Mark C4 Level
•	Bifurcation of common carotid artery
•	Level of carotid body
o	2 lamina
o	2 horns
•	Superior Thyroid Horns → Ligament → Hyoid Bone
•	Inferior Thyroid Horn → Synovial Joint with Cricoid

Answer 354

A

o	Signet Ring Shaped
o	2 Articular facets on each side
•	Inferior horn of thyroid cartilage
•	Arytenoid Cartilage
o	Surface marking for C6 Level

Answer 355

A

o	Pyramid shaped
o	Crucial in vocal cord movement
o	Concave base articulating with cricoid
o	Anterior – Vocal process
o	Lateral – Muscular process

Answer 356

A

o A.k.a. Conus Elasticus / Lateral Cricothyroid ligament
o Consists mainly of elastic fibres
o Lower border attached to cricoid cartilage
o Upper, Free Border = Vocal Ligament
• Attached to the deep surface of the angle of the thyroid cartilage
• Vocal process of arytenoid cartilage

Answer 357

A

internal cavity of the larynx is divided into three spaces:
o	Supraglottic space
•	Laryngeal Inlet → 
Vestibular folds (false vocal cords)
o	Glottis
•	Vocal Cords and Rima Glottis (space between vocal cords)
o	Subglottic Space
•	Below vocal cords → 
Lower border of Cricoid Cartilage

Answer 358

A

Extrinsic Muscles, which move the entire larynx
o	Infrahyoid muscles
•	Depress larynx
o	Suprahyoid muscles
•	Elevate larynx

Intrinsic Muscles, which act on the:
o	Vocal folds
•	Open and close glottis
o	Aryepiglottic folds
•	Help to close the laryngeal inlet

Answer 359

A

The Recurrent Laryngeal Nerve supplies the intrinsic muscles. The exception is the Cricothyroid Muscle, which is supplied by the External Laryngeal Nerve.

Answer 360

A

o Stratified Squamous Epithelium
o Vocal Ligament
o Vocalis Muscle

The mucosa is firmly adherent to the vocal ligament, with no submucosa. This lack of a submucosa means that:
o Vocal cords look pearly white on laryngoscopy
o No oedema during infections
o Delayed spread of carcinoma of vocal cords

Answer 361

A

Intrinsic Muscles of the Larynx move the vocal cords
o Abduction – Posterior Cricoarytenoid
• ONLY muscle which opens the true vocal cords
o Adduction – Lateral Cricoarytenoid
o Cricothyroid
• Only intrinsic muscle on the outside
• Increases vocal cord tension
• Only intrinsic muscle not supplied by Recurrent Laryngeal Nerve
• Supplied by External Laryngeal Nerve

Answer 362

A

The Larynx is innervated by Branches of the Vagus Nerve (CN X).

Superior Laryngeal Nerve
o Internal Laryngeal Nerve – Sensory to Larynx above true vocal cord
o External Laryngeal Nerve – Motor to Cricothyroid Muscle

Recurrent Laryngeal Nerve
o Sensory below the true vocal cord
o Motor to all intrinsic laryngeal muscles (except Cricothyroid)

Answer 363

A

The recurrent laryngeal nerve arises from the Vagus Nerve (CN X).
o	Right Recurrent Laryngeal Nerve
•	Descends to T2
•	Curves around the Subclavian Artery
o	Left Recurrent Laryngeal Nerve
•	Descends to T4
•	Curves around the Arch of the Aorta

The nerves then course back up the neck to the larynx, lying between the trachea and oesophagus.

Answer 364

A

Pathology in the neck and chest can cause Recurrent Laryngeal Nerve palsy, leading to intrinsic laryngeal muscle weakness. This presents as hoarseness of voice. Hoarseness for longer than three weeks is a red flag symptom and needs evaluation to exclude malignancy.

Some causes of Hoarseness of Voice:
o Infection
• Laryngitis – Viral, Streptococcal
o Overuse of the voice
o GORD – Gastro Oesophageal Reflux
o Benign nodules on vocal cords (Singers)
o Apical Lung Tumour
• Recurrent Laryngeal Nerve Palsy (Both sides)
o Bronchial Carcinoma
• Left Recurrent Laryngeal Nerve Palsy (right doesn’t go low enough)

Answer 365

A

The Larynx is supplied by the Superior and Inferior Laryngeal Arteries, which are branches of the Superior and Inferior Thyroid Arteries respectively.

External Carotid Artery → Superior Thyroid Artery → Superior Laryngeal Artery

Subclavian Artery → Inferior Thyroid Artery → Inferior Laryngeal Artery

Answer 366

A

The larynx is drained by the Superior and Inferior Laryngeal Veins, which accompany the corresponding arteries.

The Superior Laryngeal Vein joins the Superior Thyroid Vein before draining into the Internal Jugular Vein.

The Inferior Laryngeal Vein joins the Inferior Thyroid Vein, which empties into the Left Brachiocephalic Vein.

Answer 367

A

Upper airway / laryngeal obstruction may be caused by:
o Laryngeal Oedema
• Infection – Acute epiglottitis, croup, anaphylaxis
o Inhalation of foreign body
o Tumours
In an emergency situation an aiway is opening through the Cricothyroid Membrane (Cricothyroidotomy). If less urgent, a Tracheostomy is performed (opening into the trachea).

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Head And Neck Flashcards

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