Head and Neck Flashcards
1
Q
When does the anterior fontanelle close? Posterior?
A
18-24 months.
Around 9 months.
2
Q
What is craniosynostosis?
A
Premature closing of sutures causing deformities of head inhibiting proper brain development.
3
Q
3 layers of cranial meninges?
A
Dura mater (outer endosteal layer and inner meningeal layer)
Arachnoid mater
Pia Mater
4
Q
What space houses CSF?
A
Subarachnoid space
5
Q
What is an epidural hemorrhage?
A
Accumulation of blood outside dura mater within the bone. Can be caused by a blow to the head/skull fracture. Progresses to herniation or death.
6
Q
What is a subdural hemorrhage?
A
Accumulation of blood between dura and arachnoid mater. Acute is life threatening while chronic is less severe. Greatest risk are children(thinner veins) and elderly(longer bridging veins) with brain atrophy.
7
Q
What is a subarachnoid hemorrhage?
A
Accumulation of blood due to rupture of an aneurysm. Produces blood within the CSF (spinal tap will be bloody).
8
Q
What is the function of CSF?
A
Mechanical and protective support of the brain (weighs 90% less in water than in air). Also serves as an ion sink for brain excitability
9
Q
Flow of CSF?
A
Produces in choroid plexuses with later, 3rd, and 4th ventricles.
Interventricular foramina.
Third ventricle.
Cerebral aqueduct.
Fourth ventricle.
Median or lateral apertures.
Absorbed into venous blood through arachnoid villi.
10
Q
2 arteries that supply the brain?
A
Internal carotid and vertebral arteries.
11
Q
2 superficial intrinsic muscles of the suboccipital region and innervation?
A
Splenius capitis and cervicis both innervated by cervical spinal nerves.
12
Q
2 intermediate intrinsic muscles of the suboccipital region and innervation?
A
Longissimus capitis and cervicis both innervated by cervical spinal nerves.
13
Q
5 deep intrinsic muscles of the suboccipital region and innervation?
A
Semispinalis capitis- cervical spinal nerves.
Rectus capitis posterior minor and major.
Oblique capitis superior and inferior.
4 deep muscles are innervated by suboccipital nerve and dorsal ramus of C1.
14
Q
What forms the suboccipital triangle and what is in it?
A
Rectus capitis posterior major, obliquus capitis inferior and superior.
Contains vertebral artery and suboccipital nerve.
15
Q
What is the yes joint? No joint?
A
Yes- atlanto-occipital
No-atlanto-axial
16
Q
What structures are stretched/torn by whiplash?
A
Anterior longitudinal ligament and anterior neck muscles.
Can lead to intervertebral disc rupture, Hangman’s fracture, and breakage of the Dens
17
Q
5 branches of the facial nerve?
A
Temporal Zygomatic Buccal Mandibular Cervical
18
Q
What is Bell’s Palsy?
A
Idiopathic paralysis of the facial muscles usually unilaterally.
Herpes is thought to be a cause.
Mouth draws to unaffected side, can’t wink, close eye, or wrinkle forehead.
19
Q
Sensory innervation of the face comes from what nerve?
A
Trigeminal nerve and it’s 3 branches- ophthalmic, maxillary, and mandibular
20
Q
Blood supply to the face?
A
All comes from either internal or external carotid arteries.
21
Q
5 layers of the scalp
A
Skin, connective tissue, aponeurosis, loose connective tissue, and periosteum.
22
Q
What causes acromegaly?
A
Increased growth hormone.
23
Q
What causes Cushing’s syndrome?
A
Increased adrenal hormone.
24
Q
Examination of the eye can find what problems?
A
Anemia, high BP, high CSF pressure, diabetes, and hyperthyroidism
25
Where do tears(parasympathetic) produced by the lacrimal gland (ophthalmic of V) accumulate?
Lacrimal caruncle
26
What is the difference between a sty and a chalazion?
Sty- acute inflammation of the eyelid. Tender pain. Smaller, less painful. Internal comes from the meibomian gland and external comes from the sebaceous gland.
Chalazion- Lump in the eyelid as a result of chronic blockage of the tarsal glands. Non-tender pain. Larger, more painful
27
Differences between allergic, viral, and bacterial conjuctivitis?
Allergic- itchy eye
Viral(most common)- usually associated with a cold, watery discharge, and itch
Bacterial- Grittiness or irritation and a stringy grey or yellowish discharge that can cause the eye to stick together
28
Muscles that raise and lower the eyelid?
Raise- levator palpebrae superioris, superior tarsal, and frontalis all innervated by oculomotor.
Lower- orbicularis oculi innervated by facial (T and Z branches)
29
What is a blow out fracture?
Orbital fracture that involves the maxillary bone protruding into the orbital contents of the maxillary sinus
30
Which extraocular muscles of the eye are not innervated by the oculomotor nerve?
Superior oblique (trochlear) and lateral rectus (abducens)
31
What is exophtalmos?
Eyes that protrude slightly from Grave's disease due to increased size of extraocular muscles and edema within the orbit
32
What is glaucoma?
Excessive pressure within the eye leading to inadequate blood supply and slow onset blindness.
33
What is presbyopia?
Loss of lens elasticity with age and become farsighted
34
What is cataract?
Loss of transparency of the lens
35
What is papilledema?
Swelling of the optic disc and pooling of blood in the veins on the retina's surface that is caused by excessive CSF pressure
36
What is Horner's syndrome?
Caused by loss of sympathetic innervation of the head (usually unilaterally). Leads to ptosis, miosis(constriction), and anhidrosis.
37
What is sinusitis?
Inflammation of 1 or more of the paranasal sinus usually due to bacteria.
38
What is anosmia?
Loss of smell (shearing of oflactory nerves)
39
What is epistaxis?
Nose bleed. Kiesselback's area is a frequent site(press on upper lip or inciser foramen) (anterior ethmoid, sphenopalatine, greater palatine, and superior labial arteries anastamose here)
40
Pain from frontal and maxillary sinuses?
Tapping on the bone superficial to the sinus will cause pain
41
Referred pain from the ethmoid sinus? Sphenoid sinus?
Lateral to the eyes.
| Top of the head.
42
Muscles of mastication and their innervation
Temporalis, masseter, lateral/medial pterygoid all innervated by the mandibular branch of trigeminal nerve.
Buccinator isn't considered a muscle of mastication (innervated by facial nerve)
43
Temporomandibular joint
The mandible, temporal bone, and fibrocartilaginous articular disc make up a hinge and gliding joint for opening, closing, protrusion, retraction, and lateral rotation of the jaw.
44
What causes a dislocated jaw?
Mouth open too wide, bumped when open, or over-contraction of lateral pterygoid. Leads to the head of the mandible sliding to far anteriorly over the articular tubercle. Must supply downward pressure to move it back posteriorly into place
45
What is chora tympani?
A branch of the facial nerve that joins the lingual nerve to provide sensory for taste to anterior 2/3 of tongue. Lingual nerve provides general sensation.
46
What nerve innervates salivary glands?
Facial nerve (except parotid gland-glossopharyngeal)
47
What extrinsic tongue muscle is not innervated by the hypoglossal nerve?
Palatoglossus innervated by the vagus nerve
48
Nerve supply to the tongue (5 nerves)
Motor- CN 12 except palatoglossus (CN10)
Sensory (anterior 2/3)- lingual nerve off CN V3
Taste (anterior 2/3)- chora tympani off of CN 7
Sensory and taste (posterior 1/3)- CN 9
49
3 regions of the pharynx
Oro, naso, and laryngopharynx
50
3 coverings of the pharynx pathway?
Soft palate, epiglottis, and glottis
51
Pharynx constrictors are innervated by what nerve?
Vagus nerve (superior, middle, inferior constrictors)
52
All muscles of the soft palate, except one, are innervated by what nerve?
Vagus- musculus uvulae, levator palate, palatopharyngeus, and palatoglossus
V3- tensor palati
53
What can cause sleep apnea or snoring?
Dropping of tongue, enlarged tonsils or soft palate
54
Uvuluar deviation indicates what?
Lower motor lesion of the vagus nerve
55
Oflactory nerve function and lesion
Smell
| Anosmia (usually from skull fracture, early indicator of Alzheimer's, Parkinson's, or Huntington's)
56
Optic nerve function and lesion
```
Sight
Bitemporal hemianopsia (tunnel vision), homonymous hemianopsia, or eye blindness
```
57
Oculomotor nerve function and lesion
Movement of the eyeball and pupillary constriction/accomodation
Lateral trabismus (eye rotates down and abducted, double vision), ptosis, myadriasis (pupil dilation), and loss of accomodation
58
Trochlear nerve function and lesion
Movement of the eyeball (superior oblique)
Head tilts 5 degrees toward the unaffected side due to eye rotation
59
Trigeminal nerve function and lesion
General sensation of the face, open/close the mouth, and tension of the tympanic membrane.
Tic doloureux (severe pain in regions covered by trigeminal nerve)
60
Abducens nerve function and lesion
Movement of the eyeball (lateral rectus)
Weakness/paralysis of lateral rectus; eye rotates inward and medially (common in diabetes)
61
Facial nerve function and lesion
Facial expression and taste
Bell's palsy
62
Vestibulocochlear function and lesion
Hearing and balance
Acoustic neuroma and Schwann cell tumor
63
Glossopharyngeal nerve function and lesion
Taste(posterior tongue), swallowing(posterior tongue), and salivation(parotid gland)
Test by eliciting a gag reflex
64
Vagus nerve function and lesion
General sensation, visceral sensation, control of heart rate, respiratory, and GI systems
Hoarseness, difficulty swallowing, and deviated uvula
65
Accessory nerve innervated what muscles?
Trapezius and sternocleidomastoid
66
Hypoglossal nerve function and lesion
Movement of tongue
Tongue deviation to same side as lesion when tongue is protruded
67
What does the carotid sheath surround?
Common carotid artery(medial-highest pressure), vagus nerve(posterior), and internal jugular vein(lateral)
68
What muscle separates anterior and posterior triangles?
Sternocleidomastoid
69
What is muscular torticollis?
Tearing of sternocleidomastoid during birth (wryneck). Typically on the right side. Patient will turn away from affected side.
70
Triangles within the anterior triangle?
Muscular, carotid, submental, mandibular
71
What muscles does the ansa cervicalis innervate?
All 4 infrahyoid muscles and geniohyoid
72
What is in the inferior region of the posterior triangle?
Accessory nerve, brachial plexus, phrenic nerve, and subclavian artery and vein (careful zone)
73
Stylomastoid foramen?
Facial nerve
74
Anterior ethmoid foramen?
Anterior ethmoid VAN
75
Hypoglossal canal?
Hypoglossal nerve
76
Foramen rotundum?
Maxillary branch of trigeminal nerve
77
Foramen cecum?
Vein to superior sagittal sinus
78
Optic canal?
Optic nerve and ophthalmic artery
79
Supraorbital foramen?
Supraorbital nerve and artery
80
Foramen magnum?
Medulla oblongata, roots of CN 11, vertebral arteries, anterior/posterior spinal arteries, and spinal vein
81
Superior orbital fissure?
CN 3, 4, V1, 6, and superior ophthalmic vein
82
Internal acoustic meatus?
Cranial nerves 7, 8, and labyrinthe artery
83
Foramen lacerum?
Internal carotid artery and internal carotid sympathetic nerve plexus
84
Hiatus of canal of lesser petrosal nerves?
CN 9 sympathetics
85
Jugular foramen?
CN 9, 10, 11, inferior petrosal sinus, sigmoid sinus, and posterior meningeal arteries
86
Mastoid foramen?
Emissary vein
87
Posterior ethmoid foramen?
Posterior ethmoid VAN
88
Hiatus of canal of greater petrosal nerves?
CN 7 sympathetics
89
Sphenopalatine foramen?
Nasal nerve, nasopalitine nerve, sphenopalatine vessels
90
Foramen ovale?
Mandibular branch of trigeminal nerve, accessory meningeal artery, and lesser petrosal nerve
91
Foramen spinosum?
Middle meningeal artery and meningeal branch of V3
92
Cribriform plate?
Oflactory nerve bundles and anterior/posterior VAN
93
What is an abnormal enlargement of the thyroid?
Goiter
94
Where does abberant thyroid tissue usually end up?
Above, at, or slightly below the hyoid bone
95
What rings of the trachea does the thyroid gland sit on?
2, 3, and 4
96
Two basic functions of the larynx?
Protection and phonation
97
Relationship of false and true vocal cords?
False vocal cords are cranial, true are caudal.
98
What is a valsalva maneuever?
Closure of the glottis
99
3 unpaired cartilages of the larynx? paired?
Thyroid, cricoid, and epiglottic.
Arytenoid, corniculate, and cuniform
All cartilages are hyaline cartlage except epiglottis (elastic cartilage)
100
Why are male vocal cords long?
During puberty, testosterone acts on the thyroid gland and elongates the thyroid cartilage pulling the vocal cords with them (leads to deeper voice)
101
What muscles insert onto oblique line of thyroid cartlage?
Inferior pharyngeal constrictor, sternothyroid, and thyrohyoid.
102
Another name for false vocal cord?
Vestibular ligament
103
Spaces above and below the glottis?
Vestibule above and infraglottic below.
104
What are the largest and most important laryngeal muscle?
The paired posterior cricoarytenoid muscles. They abduct the vocal cords ( we would be dead without them, open the airway during respiration)
105
Function of the cricothyroid muscle (can be seen from anterior larynx)
Contracts to increase tension of vocal ligament (sing high notes)
106
Where is most common location of laryngeal cancer?
Where the two types of epithelium join together
107
Muscles that stick tongue out by raising hyoid bone?
Mylohyoid, anterior belly of digastric, and geniohyoid
108
What is laryngitis?
Inflammation of the vocal cords due to a viral infection of respiratory epithelium and a seconday bacterial infection.
Edema within the vocal cords as well that prevents vibration and causes loss of voice.
Vocal cords turn from white to red.
109
Recurrent laryngeal nerve innervates all intrinsic muscles of the larynx except what?
Cricothryoid muscle which is innervated by external laryngeal nerve off of the superior laryngeal nerve
110
Where can an emergency airway be created?
Below the vocal cords sitting within the larynx such as the cricothyroid membrane(cricothyroidotomy). Also immediately below the cricoid cartilage (can be risky though). Also a suprasternal/jugular airway.
111
What are the KLM sounds?
Kah- soft palate (vagus nerve)
La- testing tongue function (must touch hard palate)(hypoglossal nerve)
Ma- testing opening of mouth (orbicularis oris innervated by facial nerve-mandibular branch)
Sang- sends most of the air out of the nose rather than the oral cavity
112
What innervates the parotid salivary gland?
Lesser petrosal nerve
113
Functions of the 3 divisions of the ear?
External- collect sound
Middle- recieve vibrations?
Inner- interpret
114
What is bruised ear (wrestlers ear)?
Hematoma between the cartilage and perichondrium. If it is not reduced, the cartilage will die and become reduced in size.
115
What nerves innervate the external ear?
Auriculotemporal, greater auricular, branch of vagus, and lesser occipital.
116
What are the 3 layers of the tympanic membrane?
Stratified squamous epithelium, pars tensa, and mucous epithelium
117
What is the tensor tympani muscle attached to?
Originates along cartilage of auditory tube and attaches to the manubrium of the tympanic membrane (shock absorber
118
2 shock abosrbers of the ear are innervated by what nerves?
Tensor tympani muscle (trigeminal) and stapedius (facial)
119
What is a cholesteatoma?
Accumulation of dead skin starting at pars flaccida due to negative pressure in the inner ear. Can destroy any and all middle ear structures by compression. Lacks proper eustachian tube function and is secondary to middle ear infection
120
Where does new bone formation that fixes the stapes in the oval window happen at?
Annular stapedial ligament.
121
What is acoustic neuroma (vestibular Schawnnoma)?
Benign schwann cell tumor of cells which myelinate CN 8. Loss of hearing, ringing of ears, dysequillibrium, and headache.
122
What are the gravitation receptors in the ear?
Utricle and saccule.
123
What myotomes predominantly flex the elbow?
C5, 6
124
Radiating pain is from what?
Herniated disk
125
Disk herniation generally affects the spinal nerve above or below the level of the herniation?
Below (c6-7 herniation will affect C7)
126
Know the L4/5 symptomes
Know slide 36 of herniated disk
127
Where do herniated disks most commonly occur?
C6/7 (effects triceps/extension of forearm), L4/5(extensor hallucis longus-dorsiflexion), and L5/S1 (gastroc- plantar flexion of foot)
128
What is spina bifida occulta shown by?
Tuft of hair running along the back. May have dura just underneath the skin, not the posterior arch of the vertebral body.
129
Meningocele vs meningomyocele?
Meningocele is when just the meninges are sticking out. meningomyocele is when the meninges and spinal cord stick out.
130
Most mild spinal cord defect? Most severe?
Spinda bifida
| Rachischisis
131
3 layers of the scalp that come off from scalping?
Skin, connective tissue, and epicranial aponeurosis
132
What happens with a trochlear lesion?
Super oblique muscle does not work. Patient's will tilt head about 5 degrees to unaffected side. If the head is not tilted, they will have double vision.
133
What happens with an abducens lesion?
Lateral rectus is paralyzed. Can't rotate eye medially. Common due to diabetes and intracranial hemorrhage
134
What happens with an oculomotor lesion?
Lateral strabismus. Eye will rotate down and out. Double vision. Ptosis due to paralysis of levator palpebrae superioris. Dilation of pupil (myadriasis). Loss of accomodation of the eye.
135
Optic nerve lesion?
Optic chiasm lesion?
Optic tract lesion?
Same eye blindness.
Bitemporal hemianopsia (tunnel vision). Pituitary tumors cause this.
Homonymous hemianopsia. Right optic tract lesion- lose sight to left visual field of both eyes. Left optic tract lesion- lose sight to right visual field of both eyes.
136
What do muscles of facial expression do? Where do they attach?
Move skin.
Attach to skin from either bone, CT layers, or skin.
137
Function of arachnoid granulations?
Reabsorb CSF. Protrudes into superior sagittal sinus where the CSF is reabsorbed back into venous blood
138
Name all of the dural sinuses
Superior sagittal, inferior sagittal, straight, transverse, occipital, confluence, sigmoid, inferior/superior petrosal, and cavernous(over pituitary gland)
139
Cornea reflex?
Touch sclera, afferent information sent back to CNS via ophthalmic division of trigeminal, close eye by stimulating facial nerve to orbicularis oculi, and open eye back up by stimulating oculomotor nerve to levator palpebrae superioris.
140
Functions of the glands of the eyelid- Tarsal gland (meibomian) and sebaceous glands
Tarsal (meibomian)- wax to keep eyelids apart, oil/lipid secretions keep aqueous humor from drying out too fast, also lipid/oil/wax allows tear to travel over eye
Sebaceous- endocrine glands
141
What 2 foramen does V1 go through? V2? V3?
V1- superior orbital fissure and supraorbital foramen
V2- Foramen rotundum and infraorbital foramen
V3- Foramen ovale and mental foramen
142
An inferior alveolar nerve block affects what due to mental nerve continuation?
Lower medial lip
143
What muscle can cause locked jaw due to over contraction?
Lateral pterygoid (only muscle that opens jaw)
144
Functions of the muscles of mastication?
Temporalis- retract and elevate
Masseter- elevate (crunching)
Medial pterygoid- elevate (grinding)
Layeral pterygoid- protrude and open jaw
145
Function of the frenulum of the tongue?
Keep tongue anchored
146
What fascial plane of the neck houses the trap and sternocleidomastoid?
Investing fascia
147
What fascial plane of the neck houses the trap and sternocleidomastoid?
Investing fascia
148
Where to perform a carotid body massage?
Massage carotid sinus in carotid triangle.
Surrounded by sternocleidomastoid, posterior belly of digastric, and omohyoid.
By massaging, you increase the pressure within the vessel thus increasing parasympathetic outflow by way of the vagus nerve inducing bradycardia.
149
What runs in front of the anterior scalene muscle? Behind?
in front of the anterior scalene muscle? Behind?
Phrenic nerve and subclavian vein.
Brachial plexus and subclavian artery.
150
Boundaries, nerves, and vessels in the posterior triangle
Sternocleidomastoid, middle 1/3 of clavicle, and trapezius.
Spinal accessory nerve, phrenic nerve, and brachial plexus.
Subclavian artery and vein.
151
Branches of external carotid artery
```
Superior thyroid
Lingual
Facial
(greater)Occipital
Posterior auricular
Maxillary
Superficial temporal
```
152
Where is the superior cervical sympathetic ganglion located?
High up in the neck a little lower than the skull. Almond shaped.
153
3 muscles of the pharynx, innervations, and functions
Stylopharyngeal- CN 9. Lifts pharynx.
Salpingopharyngeal- CN 10. Opens the eustachian tube.
Palatopharyngeal- CN 10. Pulls palate down and pharynx up.
154
Functions of the soft palate
Seal off oro and nasopharynx (prevents air out nose) and seal off oral cavity from oropharynx for circular breathing. Also keeps food and water out of nose and middle ear and allows you to play an instrument/blow your nose
155
2 muscles that open the eustachian tube?
Salpingophayngeus(10) and tensor veli palatini (V3)
156
Muscle that opens (abducts) the vocal cords?
Posterior cricoarytenoid innervated by the recurrent laryngeal nerve
157
High note muscle?
Cricothyroid muscle innervated by external branch of superior laryngeal nerve
158
What ossicle is attached to the tympanic membrane?
Malleus (other ossicles are incus and stapes)
159
Pathway of tears?
Produced by lacrimal gland, drain to lacrimal caruncle, then to lacrimal punctum and lacrimal papilla, then flow down lacrimal canaliculi into lacrimal sac. Drain into the nasolacrimal duct.
160
Origin of splenius capitis and cervicis?
| Insertions?
Ligamentum nuchae, spinous process of C7-T3 (C7-T6 for cervicis).
Capitis insertion- Mastoid process, SCM
Cervicis insertion- Transverse processes of vertebrae
161
Origin of semispinalis capitis and cervicis? Insertions?
Capitis O- Transverse processes of C7-T7, articular process of C4-6.
Capitis I- Occipital bone, inferior to nuchal line
Cervicis O- Transverse processes of T1-T6
Cervicis I- Spinous process of C2-5
162
Origins and insertions of trapezius?
Superior nuchal line, ligamentum nuchae, spines of C7-T12.
Spine of scapula, acromion, and lateral 1/3 of clavicle
163
Spinal cord injuries
o C2-C3 - Rapidly fatal unless immediate intervention
o C4 - Respiratory difficulty & quadriplegic
o C5 - Some shoulder & elbow movement are present
o C6 - Shoulder & elbow movements but limited wrist movement
o C7 - Normal arm movements but limited hand movement
o C8 - Normal arm movements & hand weakness
o T1-T10 - Paraplegic
o T11 - May be able to walk w/ braces
164
Muscles that abduct the eye?
Superior/inferior oblique and lateral rectus
165
Muscles that adduct the eye?
Superior/inferior/medial rectus
166
Muscles that elevate the eye?
Inferior oblique and superior rectus
167
Muscles that depress the eye?
Superior oblique and inferior rectus.
168
Medial rotators of the eye (intorsion)?
Superior oblique and superior rectus
169
Lateral rotators of the eye (extorsion)?
Inferior oblique and inferior rectus
170
Ganglion of the 4 parasympathetic visceral motor nerves of the head?
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Oculomotor- ciliary
Facial- pterygopalatine
Facial- submandibular
Glossopharyngeal- otic
??
```
