Head and Neck Flashcards
1
Q
What are the borders of the anterior and posterior triangles of the neck?
A
Anterior -
medially imaginary sagittal line, superiorly lower border of mandible, lateroposteriorly medial edge of sternocleidomastoid
Posterior -
superomedially lateral edge of SCM, inferiorly middle 1/3 of clavicle, posteriorly trapezius
2
Q
Where would you insert a central line?
A
Subclavian vein or internal jugular vein in posterior triangle of the neck or femoral vein
3
Q
List the fascial layers of the neck.
A
Deep investing fascia of the neck Subcutaneous fascia Pre-tracheal Pre-vertebral Carotid sheath
4
Q
What 4 triangles can the anterior triangle of the neck be divided into?
A
Carotid, submental, mandibular and muscular
5
Q
What 2 triangles can the posterior triangle of the neck be divided into?
A
Occipital and subclavian
6
Q
What is the function of having multiple fascial planes in the neck?
A
To allow easy independent movement of structures during swallowing and movements of the neck. It also usually contains infections within the compartments formed.
7
Q
What is the retro-pharyngeal space and what is its relevance?
A
The potential space between the pretracheal and prevertebral fascias. It extends down to the diaphragm and thus can become a conduit for infection in the neck to spread to the chest, and potentially cause life-threatening mediastinitis. However this is extremely rare.
8
Q
What are the borders of the carotid triangle and what are its contents?
A
Borders: superiorly - posterioir belly of digastric posteriorly - medial border of SCM inferioirly - superioir belly of omohyoid Contains: bifurcation of the carotid artery internal jugular vein Hypoglossal and Vagus nerves
9
Q
Where would you palpate a carotid pulse?
A
Between SCM and trachea, roughly at level of cricoid cartilage with the patient’s head gently tilted to one side. Do not go above the thyroid cartilage to avoid inadvertently massaging the carotid sinus.
10
Q
How do you measure JVP? Which jugular vein is inspected and why?
A
Position patient reclined at 45’ with head turned away.
Look for pulsation between sternal and clavicular heads of SCM (can check if arterial by palpation)
Measuring the vertical height from sternal angle to the top of the pulse. Add 5cm to obtain the right heart filling pressure in cm of water. A pressure above 9 = elevated.
Can exaggerate pulsations be eliciting hepato-jugular reflux.
Internal jugular vein - more accurate
11
Q
What are the pharyngeal arches?
A
A system of mesenchymal proliferations in the neck region of the embryo
12
Q
Where can branchial cysts be located and how do they develop?
A
Anywhere along the anterior border of the SCM. They develop if the cervical sinus (2nd branchial cleft) is not obliterated during development.
13
Q
Briefly describe diGeorge syndrome.
A
Failure of development in the 3rd & 4th Ph pouches: CATCH 22
Cardiac defects
Abnormal facial appearence
Thymic hypoplasia
Cleft palate
Hypocalcaemia (due to absence of parathryoid glands)
Due to Deletion on chromosome 22
14
Q
What is Treacher Collins syndrome?
A
Causes hypoplasia of mandible and facial bones
It is an example of a first arch syndrome (failure of colonisation of the 1st Ph arch with neural crest cells)
Inhertited autosomal dominant
15
Q
What are the branches of the arch of the aorta?
A
Brachiocephalic trunk
Left common carotid
Left subclavian
16
Q
What is the clinical relevance of the bifurcation of the aorta (3 things)?
A
Location of carotid body
Location of carotid sinus
Common site of atheroma formation
17
Q
As they travel in the neck, where are the vertebral arteries located?
A
Within the transverse foramina in C6-1
18
Q
Which 2 sets of arteries supply the brain?
A
Internal carotid arteries and the vertebral arteries
19
Q
In which layer of the scalp is its blood supply located, and so why do scalp injuries tend to bleed profusely?
A
Dense connective tissue layer, because this limits contriction plus wounds are often help open by the epicranial aponeurosis
20
Q
What are the dural venous sinuses and where are they located?
A
Endothelium lined spaces between the periosteal and meningeal layers of dura
Located posteriorly in the cranial cavity:
superficial sagittal sinus superfically
inferior sagittal sinus deep
21
Q
What are the layers of the scalp and so what is an extra-dural haemorrhage?
A
Skin Connective tissue (dense) Aponeurosis Loose connective tissue Periosteum An extra-dural haemorrhage is where a collection of blood forms between the skull and the periosteum
22
Q
What is the risk of a strong blow to the temple and why?
A
Location of the pterion which is a relatively weak area of the skull where 4 bones join over which the middle meningeal artery passes. If this artery ruptures it can cause an extradural haemorrhage which can cause increased intracranial pressure.
23
Q
How might a scalp infection become dangerous?
A
The veins that drain the scalp connect to the diploic veins of the skull through various valveless emissionary veins which them drain into the dural venous sinuses. Thus infections can spread from the scalp to the cranial cavity and affect the meninges.
24
Q
What is the “danger triangle” of the face and why is it called so?
A
Bounded by bridge of nose and corners of mouth
Infections here may result in thrombophlebitis of the facial vein after which the infected clot can travel into the intracranial venous system and potentially cause cavernous sinus thrombosis. Infections can also spread to the dural venous sinuses and affect the meninges.
25
What is the cavernous sinus and where is it located?
A plexus of extremely thin walled veins located on the upper surface of the sphenoid
26
Which cranial nerves may be affected by cavernous sinus thrombosis?
Typically abducens
But also Occulomotor CNIII ,Trochlear CN IV, and ophthalmic and maxillary branches of the Trigeminal CNV2 and 3
Mnemonic for contents of cavernous sinus = OTOM CAT
Where C is for internal carotid artery
27
What is the function of the lymphatic system?
Allows small proteins, damaged cells and other components of tissue fluid that can't be reabsorbed to be drained, thus preventing oedema.
28
Give 6 causes of chronic lymphoedma.
```
Removal of lymph nodes
Chronic enlargement of lymph nodes
Certain infections
Damage to lymphatics due to radiotherapy etc
Lack of limb movement
Congenital - Milroy syndrome
```
29
How would you examine the lymph nodes of the head and neck?
Palpate under chin for sub mental, under angle of jaw for submandibular, in front of ear for preauricular, behind ear for post auricular, at back of head for occipital, down neck for anterior and posterior cervical chains and in supraclavicular fossa for those nodes (L for Virchows node)
30
What is Waldeyer’s ring?
A ring of nodules of MALT surrounding superior pharynx
31
What features of typical cervical vertebrae differentiate them from thoracic and lumbar vertebrae?
Bifid spinous process
Transverse foramina
Triangular vertebral foramen
32
Which cervical vertebra is most easily palpable?
C7
33
How do atlas and axis fit together and what movements do they allow?
Odontoid peg of axis inserts between anterior arch and transverse ligament of atlas
Allows rotation of head in vertical plane (nodding yes - atlas) and in transverse plane (shaking no - axis)
34
What cervical spine fracture is likely to occur due to a fall head first from a height?
(Name and Describe)
Burst or Jefferson fracture
| 2 breaks in anterior arch of atlas and 2 in posterior arch
35
What is a Hangman’s fracture and how might it occur? (A likely cause)
Paired fracture in axis vertebra, located on both sides just posteriorly of the transverse processes
Occurs due to hyperextension of the head of the neck eg falling onto chin or in a RTA
36
Describe the structure and function of the cranial sutures in the neonate.
Coronal suture across skull anteriorly, lamboid suture posteriorly, joined by sagittal suture. Unlike adults also have metoptic suture within frontal bone and these sutures are wide containing thick connective tissue matrix.
Allows the bones to push together and temporarily interlock during birth to protect brain during childbirth.
37
What are bregma and lamda?
Membranous island gaps between the cranial sutures
38
What features of the skull facilitate its protective function? (Remember layers)
Consists of flat bones which are dense and thus strong
| Has 2 layers of compact bone (outer and inner - middle is spongy)
39
The foramina of the skull allow passage of neurovasculature and lymphatics in and out of the the skull. What is a disadvantage of the skull having foramina?
Makes the cranium floor weak thus it is likely to fracture in high energy impacts to the head
40
Where is the ethmoid bone located and what is a likely consequence of a fracture?
Midline of anterior cranial fossa
| Anosmia (loss of sense of smell)
41
Where is the mastoid part of the temporal bone and what does it contain?
Behind pina
| Mastoid air cells
42
How can otitis media lead to meningitis?
Otitis media can lead to infection in the mastoid air cells of the temporal bone (mastoiditis) which can then spread to the middle cranial fossa where it can spread to the meninges.
43
What are the possible consequences of a fractured temporal bone?
Vertigo and other balance problems
Sensorineural, conductive or mixed hearing loss
Facial paralysis
CSF fistula
44
Describe the parts of the embryo at week 4 of gestation that will later become the face.
Frontonasal prominence
| Paired maxillary prominences and paired mandibular prominences both from 1st Ph arch
45
From which embryological tissue does the facial skeleton originate?
Neural crest (of the 1st pharyngeal arch)
46
Describe how cleft lip and cleft palate may develop.
Embryological failure of fusion of medial nasal prominence and maxillary prominence combined with failure of palatine shelves to fuse in the midline.
47
What might low set ears indicate? Explain how they might develop.
A chromosomal abnormality
The auricles of the ears develop from proliferation within the 1st and 2nd pharyngeal arches, initially developing as auricular hillocks in the neck which then ascend as the mandible grows. Any cause of failure of the ascent would cause low set ears.
48
What are the features of foetal alcohol syndrome and how common is it?
Smooth philtrum, low nasal bridge, epicanthal folds, small eye openings, underdeveloped jaw, flat mid face
Can cause neurodevelopmental delay
Fairly common - 1/100 births
49
Name the cranial nerves.
Oh oh oh to touch a female's vagina gives Verne a hallucination:
Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Vagus, Accessory, Hypoglossal
50
Which cranial nerves aren't technically nerves and why?
Olfactory and Optic
| They are brain tracts
51
Where are the jugular foramen and which nerves pass through it?
Paired - one on each side, lateral to occipital condyles on base of the skull
Glossopharyngeal IX, Vagus X and Accesorry XI
52
Which foramina do the 3 branches of the trigeminal nerve pass through?
Ophthalmic branch - sup orbital foramen
Maxillary branch - foramen rotundum
Mandibular branch - foramen ovale
(Some Random (h)'Ole)
53
How would you test the cranial nerves?
Olfactory - orange or coffee smell
Optic - Visual fields and acuity. Pupillary response - direct light reflex, consensual, accommodation. Fundoscopy
Occulomotor, Trochlear and Abducens - inspect resting gaze, "follow my finger" ask about double vision, look for nystagmus
Trigeminal - light touch in ophthalmic, maxillary and mandibular regions. Palpate temporalis and masseter, move jaw side to side
Facial nerve - raise eyebrows, screw up eyes, smile and show teeth, blow out cheeks
Vestibulocochlear- simple test of hearing, Rinne's, Weber's
Glossopharyngeal & Vagus - cough, soft palate movement ("ah"), gag reflex if necessary
Accessory - shrug shoulders, turn head side to side
Hypoglossal - wasting or fasiculations? tongue movement, protrude tongue
54
List some causes of anosmia
Trauma to cribriform plate
Meningitis
Upper respiratory tract infection
55
Describe the pupillary light reflex
The afferent limb (within the Optic nerve) relays stimulus from the retina to Edinger Westphal nucleus from which the efferent limb (within the Occulomotor nerve) relays the stimulus to cause direct (Ie in stimulated eye) and consensual (ie in ipsilateral eye) pupillary constriction.
56
A lesion in which cranial nerve would cause ptosis with a “down and out” pupil? Why is this often associated with a pupil dilation on the affected side?
What are the main causes of this?
Occulomotor
Parasympathetic fibres controlling sphincter papillae and cilary muscles hitchhike on the nerve
Increased intracranial pressure, aneurysm of posterior cerebral artery, cavernous sinus infection, trauma
57
In which cranial nerve does a “false localising sign” imply a lesion in and why?
Abducens
| It is the first nerve affected by raised intracranial pressure
58
Which nerve is responsible for the corneal reflex?
Trigeminal nerve
59
In which structure does the facial nerve divide into its branches?
Parotid gland
60
What are the branches of the facial nerve?
Two Zulus Buggered Mmy Cat:
| Temporal, Zygomatic, Buccal, Marginal mandibular, Cervical
61
What are the functions of the facial nerve?
Supplies muscles of facial expression, stapedius, posterior belly of diagastric muscle and stylohyoid muscle
Special sensory to anterior 2/3 of tongue (taste)
Supplies lacrimal and salivary glands (plus many other glands of head and neck)
62
What is a vestibular schwannoma and what symptoms can it cause?
Benign tumour of the Schwann cells covering the Vestibulocochlear nerve
Causes hearing and balance problems and if large can cause headaches with blurred vision, one sided facial numbness/pain due to compression of facial nerve and one sided limb and coordination problems
63
Which nerves are responsible for the gag reflex?
Glossopharyngeal- sensory
| Vagus - motor
64
What is the sensory innervation to the carotid sinus?
Glossopharyngeal nerve!
65
What does the spinal accessory nerve do?
Motor supply to sternocleidomastoid and trapezius muscles
66
If there is damage to the innervation of the tongue, to which side will it deviate?
Towards the side of the lesion
67
Describe the sensory innervation of the face
Supplied by Trigeminal nerve:
Ophthalmic branch - central forehead and centre of nose
Maxillary branch - temples, cheeks and sides of nose, upper lip
Mandibular branch - jaw line from ear to ear, chin, bottom lip
68
What triad of symptoms does Horner’s syndrome encompass?
Partial Ptsois - partial drooping eyelid
Miosis - excessively contracted pupil
Anhydrosis - no sweating on that side
69
Describe the aetiology and pathology of Horner’s syndrome
Unilateral stretching or damage of sympathetic fibres especially sup. cervical due to trauma to sympathetic trunk or ganglia in the neck, spinal nerve lesions, pancoast tumour (apical lung tumour)
Ptsois is partial as only superior tarsal muscle is paralysed
70
What are the 4 parasympathetic ganglia in the head and neck and what do these supply?
Cilary - sphincter papillae and cilary muscles
Pterygopalatine - lacrimal gland, glands of nose, palate and nasopharynx
Submandibular - submandibular, sublingual and other glands of oral cavity
Otic - parotid gland and glands of oropharynx and posterior 1/3 of tongue
71
Which bones contribute to the orbit?
Frontal, Zygomatic, Maxilla, Ethmoid, Sphenoid and Lacrimal
72
In which bone is the superior orbital fissure located?
Sphenoid
73
Which nerves pass through the superior orbital fissure?
Occulomotor nerve (frontal, superior and inferior branches)
Trochlear nerve
Nasocilary branch of Ophthalmic nerve
Abducens nerve
74
Where is the optic canal located and what travels within it?
Within the sphenoid bone
| The optic nerve and ophthalmic artery
75
Which nerve supplies most of the muscles supplying the eye?
(Remember LR6 SO4 R3)
| CN III - Occulomotor
76
What is the innervation of the lateral rectus muscle?
(Remember LR6 SO4 R3)
| CN VI - Abducens
77
Which muscle of the eye does the Trochlear nerve supply?
(Remember LR6 SO4 R3 and Trochlear nerve is CNIV)
| Superior oblique
78
Which muscle is supplied by fibres from the superior cervical ganglion?
Superior tarsal muscle in the eyelid
79
Which muscles allow you to open and close your eyes?
Levatator palpaebrae superioris - retracts and elevates eyelid
Orbicularis oculi - shuts eyes
80
From which branch of the Internal Carotid Artery does the central retinal artery originate from?
The ophthalmic artery
81
What would be the result of central retinal artery occlusion and why?
Instant and total blindness as it is an end artery
82
What clinical sign can be seen on fundoscopy in central retinal artery occlusion?
Central cherry red spot
83
Why is there a risk of infection in the eye tracking back into the cranial cavity?
Central retinal vein that drains the eye drains into superior ophthalmic vein which then drains into the cavernous sinus which is found within the cranial cavity.
84
Why does your nose run when you cry?
Tears run down nasolacrimal duct into the nasal cavity
85
Where is the lacrimal gland located?
Under the lateral side of the eyebrow, above the eyelid
86
What are the differences between a stye and a Meibomian cyst?
A stye forms due to an infection some of the cilary glands, is usually painful and requires antibiotics. While a meibomian cyst is due to blocked tarsal glands (located further up the eyelid), is usually painless and can be treated with a hot compress.
87
Which areas of the eye would you expect to be inflamed in conjunctivitis?
The surface if the eyeball and the inner surface of the eyelid (bulbar and palpebral conjunctiva respectively)
88
What is the function of the eyelid?
Protect eye from injury, excessive light and dryness
89
Which layer of the eyeball is responsible for the “red eye reflex”?
The choriod - vascular layer between sclera and retina that supplies retina
90
What is the difference between the posterior chamber and the posterior segment of the eye?
Posterior chamber is the posterior part of the anterior segment at the front of the eye behind the ciliary muscle
While the posterior segment is that behind the posterior chamber and contains vitreous humour
91
What is the other name for the posterior segment?
The vitreous chamber
92
Where is the anterior chamber located?
At the front of the eyeball between cornea and ciliary muscles
93
How can photophobia be a sign of meningitis?
Optic nerve is a brain tract thus has meningeal covering and so can be affected by meningitis
94
What are the 3 main layers of the eyeball?
Outer fibrous layer
Middle vascular layer
Inner layer
95
What are the symptoms of retinal detachment?
Flashes of light, "floaters", blurred or distorted vision -> blindness
96
Where is the aqueous humour? What produces it?
Within the anterior segment of the eye
| Produced by ciliary body
97
What pathological changes in the eye result in the symptoms of cataracts?
Increasing hardening, flattening and opacity of the lens of the eye leads to vision becoming increasingly blurred and dazzled
98
What are the risk factors for cataracts?
Age
Smoking
Diabetes
Sunlight
99
What is papilloedema?
An optic disc swelling that occurs due to raised intracranial pressure
100
What are the signs of papilloedma?
Elevated margins and congested vessels
101
What causes papilloedema?
Causes of raised intracranial pressure such as a brain tumour, some medications, rarely extreme dehydration
102
What is the clinical term for double vision?
Diplopia
103
What is surgical / subcutaneous emphysema?
Collection of air in subcutaneous tissue
104
What is proptosis?
Abnormal protrusion of eyeball - "starey eyes"
105
What signs are associated with an Occulomotor nerve (CNIII) palsy?
Ptosis, "down and out" eye (pupil positioned inferiorly and laterally) and dilated pupil
106
Why can palsy of CNVI cause binocular horizontal diplopia?
CNVI is the Abducens nerve which innervates the lateral rectus muscle allowing abduction of the eyeball such as occurs when looking sideways. This will mean that when looking sideways, eyes are misaligned and images detected will not be superimposable and so 2 separate images will be perceived by the visual cortex causing double vision.
107
Palsy of which cranial nerve can present with a head tilt, and why?
Trochlear nerve (CNIV) - innervates superior oblique muscle of the eye which allows intortion of the eye - tilting of the head is an attempt to overcome these problems with eye rotation caused by palsy of the nerve
108
What are the 3 key questions in a case of orbital fracture?
(Think what is sight threatening)
Is optic nerve compromised?
Is there a risk of retrobulbar haemorrhage?
Is there an injury to the globe?
109
Besides the 3 key questions, what other questions should you also consider in the case of orbital fracture?
Are other facial bones involved?
| Is there a risk of foreign bodies in the eye?
110
What are the signs and symptoms of an orbital fracture?
Lid swelling, double vision (diplopia), reduced vision
| Restriction of eye movements, reduced visual field and vision, enophthalmos (sunken eye)
111
What sign may you see on scans in the case of orbital fracture?
Eye protruding out of orbital cavity through broken bone
112
What is the most commonly fractured bone in orbital fractures?
Maxillary
113
What are the clinical signs of ethmoidal (medial orbital) fractures?
Horizontal diplopia, surgical emphysema
114
What are the symptoms of thyroid eye disease?
Ocular irritation, redness, double vision (diplopia)
115
How do you evaluate the severity of thyroid eye disease?
```
Use NOSPECS method:
0 No symtoms or signs
1 Only symptoms, no signs
2 Soft tissue involvement (eg lid oedema)
3 Proptosis
4 Extra-ocular muscle involvement
5 Corneal ulceration
6 Sight loss
```
116
What are the signs and symptoms of orbital cellulitis?
Inflamed eyelids, pain, sticky discharge
| Fever, painful/restricted eye movements, decreased vision and colour vision, RAPD, proptosis if severe
117
Which signs of orbital cellulitis are not associated with other inflammatory diseases?
RAPD, decreased vision and colour vision, proptosis, painful/restricted eye movements (i.e. all but fever)
118
What is an important potential clinical consequence of a capillary haemangioma in a child?
Can affect sight development
119
What is dacryoadenitis?
Lacrimal gland irritation - potential cause of an orbital mass lesion
120
Why is it important to consider Wegener’s in the case of an orbital mass lesion?
Wegener's (necrotising granulomatous vasculitis) has systemic implications
121
List 7 causes of orbital mass lesions
Wegener's (necrotising granulomatous vasculitis)
Dacryoadenitis
Pseudo-tumour (idiopathic orbital inflammatory disease)
Dermoid cyst
Mucocele
Capillary haemangioma
Cavernous haemangioma
122
Describe the innervation of the external ear
Auriculotemporal nerve - superomedial incl crus of helix
Auricular branch of the Vagus nerve - concha
Great auricular nerve - lateral lobe, helix except most medial part and lateral part of antihelix
123
What is the ear-cough reflex and why does it occur?
Triggering of gag/cough reflex by irritation to concha of external ear in the area innervated by the branches of the vagus nerve, irritation is referred along other branches of vagus including efferent branch of cough/gag reflex
124
What glands does the epithelium of the external acoustic canal have?
Ceruminous and sebaceous glands (produce cerumen - earwax)
125
How do the sensory fibres of the Vestibulocochlear nerve reach the inner ear?
Through the internal acoustic meatus within the petrous temporal bone
126
What fluid is contained within the membranous labyrinth of the inner ear?
Endolymph
127
Where is the perilymph located, and what function of the ear does it support?
Located within the bony labyrinth
| Supports hearing
128
What is the difference between the pars flaccida and pars tensa of the tympanic membrane?
Pars tensa has radial and circular fibres, pars flaccida has neither
129
What is the innervation of the tympanic membrane?
External surface: mainly Auriculotemporal nerve (branch of CNV3) and some Auricolotemporal branch of Vagus
Internal surface: Glossopharyngeal nerve
130
What separates the tympanic and cranial cavities?
A thin layer of bone called the tegmen tympani
131
What forms a communication between the middle ear and the nasopharynx?
The Eustachian (pharyngotympanic) tubes
132
Name the auditory ossicles and describe how they are arranged
Malleus - articulates with -> Incus articulates with -> Stapes
133
Name the 2 muscles of the inner ear
Tensor tympani and Stapedius
134
What is the function of the round window of the cochlea?
Allows movement of fluid within the cochlea, which in turn allows hair cells of basilar membrane to move and audition to occur
135
Where is the round window in the inner ear located?
At the basal turn of the cochlea
136
Where does the stapes attach to?
The membrane covering the oval window in the lateral vestibule
137
What number of semi-circular canals are there in the inner ear? Describe their arrangement
3, set at right angles to each other
138
What lies between the semi-circular canals and the cochlea?
The vestibule of the inner ear
139
How would you examine the tympanic membrane?
With an otoscope, gently pulling ear upwards and back to straighten external auditory canal
140
What is associated with congenital deformities of the pina?
Chromosomal syndromes and thus other malformations
141
What is a perichondrial pina haematoma?
A build up of blood between the perichrondium and cartilage of the pina due to trauma causing ripping of the perichrondial vessels
142
What can a perichrondrial pina hematoma lead to and why?
Cauliflower ear as the resulting separation of cartilage from its bloood supply will cause pressure necrosis resulting in scarring if not treated
143
What are the causes of tympanic perforation?
Trauma or secondary to infection (causing pressure necrosis)
144
Explain an important potential clinical consequence of otitis externa in an immunocompromised individual
Can lead to necrotising otitis externa where infection (often pseudomonas aeuginosa) spreads to bone
145
Describe how “glue ear” can develop after an acute ear infection
Thick effusions behind the tympanic membrane
| Can develop after acute otitis media if it causes prolonged tympanic retraction
146
Which species of bacteria are implicated in the aetiology of acute otitis media?
Pneumooccus
Haemophilus
Streptococci
147
What rare complication of otitis media causes swelling behind the ear?
Mastoiditis
148
How can otitis media lead to facial drooping?
If the causative infection causes damage to CNVII (Facial nerve) which runs through the middle ear to then supply the muscles of facial expression
149
What are the classical 4 symptoms of Meniere’s disease?
Vertigo
Tinnitus
Hearing loss
Aural fullness
150
Give 3 examples of locations from where pain may be referred to the ear
Nasopharynx
Teeth
Jaw and Temporomandibular joint
151
What is otalgia?
Ear ache
152
What is the cause of benign positional paraoxysmal vertigo
Otolith displacement
153
Describe the aetiology of cholesteatoma
Negative ear pressure -> retraction pockets -> dead skin cells accumulate and become necrotic, forming a mass known as a cholesteatoma
154
Why is a cholesteatoma called so?
It behaves somewhat like a malignancy in that it causes the erosion of middle ear and bone due to lytic enzymes
155
List 3 clinical consequences of a cholesteatoma
Painless otorrhea - the hallmark symptom
Conductive hearing loss
Meningitis (and other CNS complications)
156
What are the functions of the nose?
Humidification and filtering
Olfaction and respiration
Drain and eliminate paranasal sinus and nasolacrymal duct secretions
157
What is the limen nasi?
The border between the vestibule, which is lined by skin, and the nasal cavity proper
158
What are the alae? (singular: ala)
The ridges forming the lateral boundaries of the nostils
159
What bones contribute to the nose?
Frontal, Nasal, Ethmoid, Sphenoid, Vomer, palatine process of Maxilla, horizontal process of Palatine bone
160
*What may happen if the cribriform plate is fractured?
Anosmia (loss of sense of smell)
161
*How can a nasal fracture lead to a saddle nose deformity?
Septal deviation and haematoma -> avascular necrosis
162
What are the choanae?
The two posterior openings/apertures of the nasal cavity into the nasopharynx
163
What type of epithelia lines the nasal cavity?
Respiratory - pseudostratified columnar ciliated epithelium with goblet cells
164
What are conchae and what is their function?
Protrusions on the lateral wall of the nasal cavity that create turbulent airflow, allowing the mixing of air, facilitating the humidifcation and warming of inspired air
165
Which structures drain into the nasal cavity?
The paranasal sinuses
Lacrimal apparatus
Middle ear
166
What is the spheno-ethmoidal recess?
The space between the superior turbinate and the roof (cribriform plate) of the nasal cavity (sphenoid sinuses drain here)
167
What are the superior, middle and inferior meatuses of the nose?
The spaces between the turbinates / conchae
168
*Branches from which 3 arteries of the face anastomose to form the blood supply to the nasal cavity?
The facial artery, the maxillary artery and the ophthalmic artery
169
*Name the arteries supplying the nasal septum
Posterior and Anterior ethmoid arteries
(branches of) Superior labial artery
Greater palatine artery
Sphenopalatine artery
170
*What is Kiesselbach’s (Little’s) area?
An area of rich anastomoses on the anterior nasal septum that is the commonest site of ruptured vessels in epistaxis (nose bleeds)
171
*What is epistaxis?
Nosebleed
172
*Branches originating from which cranial nerves innervate the nose?
CNI - Olfactory
| CNV1and2 - Opthalmic and Maxillary divisions of Trigeminal
173
What nerves supply the external nose?
```
Infraorbital nerve (CNV2)
External nasal nerve (CNV1)
```
174
Name the nerves that supply to nasal mucosa
Nasopalatine nerve
branches of Greater palatine nerve
branches of Nasocilary nerve
175
What is the innervation to the paranasal sinuses?
Branches of Opthalmic (CNV1) and Maxillary (CNV2)
176
Why does chronic sinusitis tend to present after puberty?
Sinuses small, or not present in case of frontal, at birth and enlarge around puberty
177
Name the paranasal sinuses and describe their locations
Frontal - forehead
Ethmoidal - between orbit and nasal cavity
Sphenoid - related to pituitary and middle cranial fossae
Maxillary - cheeks
178
How can tooth ache be linked to sinusitis?
Sensory innervation of maxillary sinus, which is the most commonly inflamed, includes branches of alveolar nerves thus pain can be referred to the teeth (and the skin of cheek and upper jaw)
179
How can you ascertain if tooth ache is linked to sinusitis?
The pain will be worse on leaning forward
180
Describe the drainage of the maxillary sinus
Upwards into posterior middle meatus
181
How could inflammation in the sphenoid sinus potentially affect endocrine function?
It is anatomically related to the pituitary gland
182
How can an infection in the ethmoidal sinus be dangerous to the eye?
Posterior ethmoidal air cells are located near orbit, near to optic canal, and so, if drainage is blocked, infections can break through into orbit and potentially damage the optic nerve causing blindess
183
What are the symptoms of rhinitis?
Increased secretions - runny nose
Swelling - stuffy nose
Headaches
Sneezing
184
Describe the common aetiology of sinusitis
Often viral with secondary bacterial infection - S. pneumoniae, H. influenzae
185
How do rhinitis and sinusitis cause the symptom of headaches?
Sensory innervation is via the Trigeminal nerve which also supplies meninges etc. and so pain can be referred to cause a headache
186
*Resp. What are the main causative organisms of upper respiratory tract infections?
Rhinovirus, Coronavirus, Influenza, Parainfluenza, Respiratory Syncitial Virus
187
Describe the two main types of nose bleeds
Anterior - bleeding from Kiesselbach's plexus
| Posterior - bleeding from sphenopalatine artery
188
What are the main causes of nose bleeds?
Local - infections, trauma, mucosal drying
| Systemic - hypertension, coagulation defects, NSAIDs
189
What is the epidemiology of nose bleeds?
Bimodal distribution - common in young children and older people
190
How would you first manage a nose bleed?
Pinch soft part of nose just below nasal bones and lean forward for 20 mins, apply ice if possible
191
What treatments are indicated if initial (first aid level) management of a nose bleed is unsuccessful?
Cautery -> anterior packing with rapid rhino or merocel -> posterior packing with a female / Foley catheter and then anterior pack as well -> ligation of SPA, maxillary, external carotid arteries
192
Describe and explain the main signs of a “pupil sparing” Occulomotor nerve lesson
Lesion of just the Occulomotor nerve itself,
causing ptosis due to denervation of levator palpaebrae superoris,
and "down and out" position of eye due to unopposed actions of lacteral rectus and superior oblique muscles (only muscles of the eye not supplied by Occulomotor n)
193
Why can a lesion of the Occulomotor nerve cause pupil dilation?
Autonomic parasympathetic fibres from Edinger-Westphal nucleus "hitchhike" on Occulomotor nerve so are often also affected by lesions affecting the Occulomotor nerve due to their proximity. These fibres supply the sphincter pupillae muscle of the eye, denervation of which causes pupil dilation due to unopposed action of dilator pupillae muscle.
194
What is mydriasis?
A "blown" or abnormally dilated pupil
195
What are the branches of the Occulomotor nerve and what do they supply?
Superior branch supplies sup. rectus and levator palpabrae superioiris
Inferior branch supplies inf. rectus, inf. oblique and medial rectus
196
Name the 3 nerve roots of the Trigeminal nerve
Opthalmic, Maxillary and Mandibular
197
Which nerve is responsible for the corneal reflex?
Nasociliary branch of Opthalmic branch of Trigeminal nerve
198
What types of nerve fibres does the Trigeminal nerve carry?
Sensory, motor and sympathetic
199
What types of nerve fibres does the Facial nerve (CNVII) carry?
Sensory, special sensory, motor and autonomic
200
What part of the tongue does CNVII innervate?
Anterior 2/3
201
When can unilateral facial paralysis be forehead sparing and why?
In upper motor neurone lesions in facial nerve CNVII, as frontalis muscle receives bilateral innervation
202
What is Bell’s Palsy?
Idiopathic CNVII palsy, common, symtoms usually temporary
203
How can the facial nerve be damaged?
Parotitis, tumours of parotid gland, parotidectomy
Forceps delivery
Inflammation, usually due to infection
Typhanectomy
Surgical procedures of infratemporal fossa
204
What are the borders of the oral cavity?
Hard palate and soft palate
Teeth
Imaginary line between left and right palatoglossal folds
Mylohyoid muscle (inferiorly)
205
Where exactly are the palatine tonsils located?
Between the anterior and posterior tonsillar pillars of the oropharynx (i.e. the palatoglossal and palatopharyngeal arches)
206
What is the intermaxillary suture and what is its embryological origin?
Central sagittal join in bones of hard palate, leaving a ridge down the majority of the roof of the mouth, formed by fusion of palatal shelves of maxillary process
207
Name the muscles of the soft palate and describe their overall function
```
M. uvulae
M. levator veli palatini
M. tensor veli palatini
M. palato pharyngeus
M. palato glossus
Pull on uvula and coordinate swallowing etc.
```
208
Describe the normal appearance of the gingival mucosa
Paler than adjacent alveolar mucosa
209
Describe the nature and potential consequences of being “tongue tied”
Abnormally large lingual frendulum can cause problems with feeding and speech
210
Where do the sublingual and submandibular salivary glands open into the oral cavity?
At the sublingual and submandibular papillae either side of the lingual frendulum under the tongue
211
Where does the parotid gland open into the oral cavity?
Into buccal mucosa above 2nd molar
212
What might a painful mass located under the tongue be?
Salivary calculi (stone)
213
Describe the naming of the teeth
Upper / lower?
Left / right?
Central incisor, lateral incisor, canine, 1st 2nd pre-molar or 1st 2nd or 3rd molar ?
214
Which nerves innervate the muscles of the tongue?
Hypoglossal nerve - all muscles except..
| Palatoglossus muscle - supplied by Vagus nerve
215
Describe the sensory innervation to the tongue
Small central area posteriorly - Internal laryngeal nerve (CNX)
Rest of posterior 1/3 - Glossopharyngeal nerve for sensory and special sensory
Anterior 2/3 - Lingual nerve (CNV) for sensory, Chorda tympani (CNVII) for special sensory
Overlapping region 2/3 posteriorly has mixed supply of Glossopharyngeal, Lingual and Chorda tympani
216
Name and describe the locations of the extrinsic muscles of the tongue
Genioglossus - arises from the mental symphysis and inserts into the dorsum of the tongue
Styloglossus - arises from the hyoid bone and inserts into the side of the tongue
Hypoglossus - arises from the hyoid bone and inserts into the side of the tongue
Palatoglossus - arises from the palatine aponeurosis and inserts broadly across the tongue
217
Name and describe the actions of the intrinsic muscles of the tongue
Superior and Inferior longitudinal - make tongue short and thick and retract tongue
Vertical and transverse - make tongue long and narrow, protrude tongue
218
Describe the common appearance of the tonsils in tonsillitis
Swollen, with white spots of exudate within crypts
219
What is quinsy and how should it be managed?
Peritonsillar abscess - needs surgical draining
220
What type of cartilage does the temporomandibular joint contain? and *Tob* Describe the features of this cartilage
Fibrocartilage!
| Contains fibroblasts, few chrondrocytes, type 1 & 2 collagen with coarse fibres parallel to direction of stress
221
Describe the structural features and function of the articular disc of the TMJ
Concavo-convex upper surface
Concave lower surface
Thinner centrally and thicker at the edges
-> Facilitates articulation of the poorly aligned temporal and mandibular bone
222
How is the stability of the TMJ increased?
By support from various ligaments - particularly the temporomandibular ligament, sphenomandibular ligament and stylomandibular ligament
223
How is posterior, anterior or inferior displacement of the TMJ limited?
Posterior - posterior glenoid tubercle
Anterior - articular tubercle
Inferior - the accessory ligaments - sphenomandiular and stylomandibular
224
Describe the muscles and movements involved in opening the mouth
Lateral Pterygoids pull condyles forward
| Digastric muscles pull chin down and back
225
Describe the muscles and movements involved in closing the mouth
Posterior fibres of Temporalis retract the mandible
| Rest of Temporalis, Masseter and the Medial Pterygoids elevate the mandible
226
What is bruxism?
Clenching the jaw and grinding of teeth especially during sleep
227
How common is TMJ pain?
Very common - 25% of population (though only a small number of these seek medical help)
228
What symptoms suggest arthritis of the TMJ?
Pain, stiffness, feelings of "joint grinding"
229
What are the boundaries of the infratemporal fossa?
```
Lateral - Ramus of mandible
Medial - Lateral pterygoid plate of sphenoid
Anterior - Posterior surface of maxilla
Posterior - Carotid sheath
Roof - Greater wing on sphenoid
Floor - Medial pterygoid muscle
```
230
Describe the arterial contents of the infratemporal fossa and their clinical relevance
Maxillary artery branching into Middle Meningeal Artery
Superficial temporal artery passes NEXT TO fossa
Injuries to these can lead to considerable bleeding
231
Describe the venous contents of the infratemporal fossa
Pterygoid venous plexus
Maxillary vein
Middle meningeal vein
232
Which nerves pass through the infratemporal fossa?
Mandibular nerve - branches within fossa
Chorda tympani
Otic ganglion
233
What areas does an inferior alveolar nerve block anaesthetise?
Mandibular teeth and lower lip
234
Why may tumours in the infratemporal fossa be advanced at presentation?
Fossa provides potential space into which tumours can grow quite large before becoming symptomatic
235
Where is the pituitary gland located?
Within pituitary fossa of sphenoid bone, near to hypothalamus
236
Describe the embryological origin of the pituitary gland
Anterior - ectoderm from Rathke's pouch
| Posterior - neuroectoderm from infundibulum (outgrowth of forebrain)
237
Which pharyngeal arches does the tongue develop from?
1, 2, 3 and 4
238
How is the nature of the sensory innervation of the tongue explained by its embryological origin?
Anterior 2/3 derived from Ph arches 1 and 3 - supplied by CNV and CNIX - the cranial nerves of the 1st and 3rd arches respectively
Posterior 1/3 derived from Ph arches 3 and 4 - supplied by cranial nerves corresponding to those pharyngeal arches CNIX and CNX
(NB Papillae - special sensory from Facial nerve - nerve of second arch)
239
Where does the primordium of the thyroid gland develop?
In the floor of the pharynx
240
Why do some people have a pyramidal lobe of their thyroid gland?
Remnant of embryological thyroglossal duct which normally regresses
241
What is the embryological origin of the parafollicular cells of the thyroid gland? and What is their function?
Ultimobranchial body of the 4th Ph pouch (migrate into thryoid gland)
They produce calcitonin
242
Where may ectopic thyroid tissue be located?
Anywhere along path of descent of thyroid gland from floor of pharynx to thryoid cartilage
243
What may a midline neck swelling close to the hyoid bone be?
A thyroglossal cyst (50% are close to hyoid bone)
244
What is the vertebral level of the thyroid gland?
C5
245
Why might a thyroidectomy result in a disturbance in calcium and/or phosphorus metabolism?
If the parathyroid glands which are located on the posterioir surface of the thyroid gland and control calcium and phoshorus metabolism are also removed
246
*Met* What are the symptoms of hypocalcaemia?
Parathesia, tetany, paralysis and convulsions (due to hyperexcitablity of neuromuscular junction)
247
What muscles are related to the thyroid cartilage?
Omohyoid, sternohyoid and thyrohyoid muscles
248
Why might an enlarged thyroid gland (goitre) cause the voice to become hoarse?
If it compresses the recurrent laryngeal nerve
249
Describe the blood supply to the thyroid gland
Superior thyroid artery, the first branch of the external carotid, supplies anterosuperior aspect
Inferior thyroid artery, from the thryocervical trunk which is a branch of the subclavian, supplies posterior aspect
250
Describe the venous drainage of the thyroid gland
Superior, middle and inferior thyroid veins form thyroid plexus located on anterior surface if the gland
251
Which lymph nodes receive drainage from the thyroid gland?
Prelaryngeal, pre-tracheal and paratracheal which drain to the deep cervical lymph nodes
252
How is secretion by the thyroid gland controlled? (Met)
TSH secretion which is controlled by Hypothalamus-Pituitary-Thryoid axis
253
Name the parts of the pharynx and their borders
-base of skull-
Nasopharynx - chonane anteriroly, pharyngeal tonsil & C1 posteriorly
- soft palate-
Oropharynx - oral cavity anteriorly, C2&3 posteriorly
-epiglottis-
Laryngopharynx - larynx anteriorly, C3-6 posteriorly
254
What are the contents of the nasopharynx?
```
Nasopharyngeal tonsil (adenoids)
Eustachian tube orifice
```
255
What are the contents of the oropharynx?
Pharyngeal tonsils
| Anterior and posterior tonsillar pillars (palatoglossal and palatopharyngeal arches)
256
Describe the nature of the epithelium of the pharynx
Nasopharynx - respiratory - pseudostratified cilated columnar epithelium with goblet cells
Rest - stratified squamous non-keratinised
257
*What is the lymphatic drainage of the palatine tonsil?
Jugulo-digastric node (at angle of mandible)
258
*Describe Waldeyers ring
Ring of 4 aggregated sets of MALT that act as a barrier to infection: pharyngeal tonsil, tubal tonsils, palatine tonsils, lingual tonsils
259
Describe the musculature of the pharynx
3 circular layers that overlap each other - the superior, middle and inferior constrictors. Inferior has 2 components - thyropharyngeus and cricopharyngeus
3 longitudinal muscles - stylopharyngeus, paltopharyngeus and salpingopharyngeus
260
Describe the process of swallowing
Voluntary oral phase -> rapid non-voluntary pharyngeal phase in which tongue and suprahyoid muscles pull hyoid and larynx up, soft palate elevates to close off nasopahrynx and sup. constrictors contract -> food bolus pushed into hypopharynx by middle and inferior constrictors
261
How is the larynx protected during swallowing?
By overhanging tongue, epiglottis and vocal cords
262
What is the action of the longitudinal muscles of the pharynx?
Shorten and widen pharynx
| Elevate larynx
263
Describe the motor innervation of the pharynx
Vagus
| Glossopharyngeal nerve - stylopharyngeus
264
Which nerves provide sensory innervation to the pharynx?
CNV2 - nasopharynx
CNIX (glossopharyngeal) - oropharynx
CNXII (hypoglossal) - hypopharynx
265
Describe the blood supply of the pharynx
Sup. thyroid artery
Ascending pharyngeal artery
Ascending and descending palatine arteries
branches of Lingual, Facial and Maxillary arteries
266
Describe the venous drainage of the pharynx
Pharyngeal venous plexus from internal jugular vein
267
Why might the adenoid (pharyngeal) tonsils be enlarged?
Infection - viral or bacterial
268
What are the potential consequences of enlargement of the adenoid (pharyngeal) tonsils?
Eustachian tube obstruction -> recurrent or chronic otitis media
Nasal obstruction -> mouth breathing, feeding difficulty, snoring or obstructive sleep apnoea
269
What are the potential complications of an adenoidectomy?
Bleeding
Dislocation of atlanto-occipital joint from infection
Eustachian tube stenosis
270
Describe the epidemiology of nasopharyngeal carcinoma and name the most common type
Extremely rare in UK, more common in Chinese population
| Squamous cell carcinoma most common type
271
What are the indications for tonsillectomy?
Recurrent tonsilitis
Previous peritonsillar abscess
Suspected cancer
Obstructive sleep apnoea
272
Describe how a pharyngeal pouch can form
Posterior herniation of pharyngeal mucosa in Killian's area - between inferior constrictor and cricopharyngeal muscles due to weakness in this area, incoordination of pharyngeal phase of swallowing or cricopharyngeal spasm
273
Describe how a patient with a pharyngeal pouch may present (include epidemiology)
Dysphagia, hallitosis, regurgitation, aspiration, chronic cough, wieght loss
Typically over 70 and male
274
Describe the presentation of acute epiglottitis
Septic / Pyrexial >38'c
Leaning forward in classical tripod position with hands on knees
Drooling
Usually children
275
Describe the aetiology of acute epiglottitis
Bacterial infection - usually H. Influenzae type B, Staphylococci,
B. Haemolytic strep,
Pneumococci
276
How would you manage acute epiglottitis?
```
Don't attempt to examine!
Secure the airway
Broad spectrum antibiotics - ceftriaxone
Steroids
Throat swab and bloods
```
277
Describe the aetiology of laryngotracheobronchitis (croup)
Viral infection - Parainfluenza or influenza
278
Describe the presentation of laryngotracheobronchitis (croup)
Stridor
| Harsh, subglottic "barking" cough
279
How should you manage a patient with laryngotracheobronchitis (croup)?
If mild - at home with oral antibiotics and steam inhalation
| If mod/severe - inpatient -> IV antibiotics, humidifed O2, dexamethasone, nebulised adrenaline, if worsening intubate
280
What are the symptoms of foreign body airway obstruction?
Choking, coughing, disappearance of toy / after playing with foreign body
281
How serious is a foreign body airway obstruction?
Leading cause of death in 1-3 year olds!
282
What signs may you seen on radiology in a patient with a foreign body airway obstruction?
Opaque foreign body
Segmental or lobar collapse
Localised emphysema (from ball valve effect)
Air trapping
283
Name the parts of the larynx
```
Supraglottis
Glottis
Subglottis
Piriform fossa
Epiglottis
Thyroid cartilage
Cricoid cartilage
Arytenoid cartilages
Vocal cords
```
284
If food is stuck in the larynx where is it likely to be?
The piriform fossa - pear shaped depressed either side of laryngeal inlet
285
What is the epiglottis?
Leaf shaped plate of elastic fibrocartilage that is depressed during swallowing to cover larynx
286
Describe the various cartilages of the larynx
Thyroid cartilage with superior horns that articulate with hyoid bone and inferior horns that articulate with cricoid cartilage. This is a signet ring shape with 2 articular facets on each side.
Arytenoid cartilages are pyramid shaped and are located on top of the cricoid cartilage. They are involved in vocal cord movement.
Also - epiglottis
287
Describe the contents of the glottis
Vocal cords- have 4 layers: stratified squamous epithelium, Reinkes space, vocal ligament and vocalis muscle
288
Name the principle muscles of the vocal cords and state which is responsible for abduction and which is responsible for adduction
Posterior cricoarytenoid - ABduction
| Lateral cricoarytenoid - ADduction
289
Which nerves provide motor innervation to the larynx?
Recurrent Laryngeal nerve - all muscles except..
| Cricothyroid supplied by External Superior Laryngeal nerve
290
Describe the laryngeal blood supply and venous drainage
Superior and inferior laryngeal arteries - branches of sup. and inf. thyroid arteries
Superior and inferior laryngeal veins
291
List 6 causes of recurrent laryngeal nerve palsy, excl. idiopathic, thyroid disease and trauma
```
Laryngeal cancer
Cervical lymphadeopathy
Oesophageal cancer
Apical lung cancer
Aortic aneurysm
Neuropathic - diabetes
```
292
Describe the epidemiology of laryngeal carcinoma
Rare but commonest head and neck cancer in the west
| More common in males
293
List 3 causes of laryngeal carcinoma
Smoking, alcohol and HPV
294
Is hypopharyngeal cancer common?
No
295
What cell type is typically affected in carcinomas of the larynx?
95% of cases are squamous cell carcinoma
296
What is laryngeal crepitus and what is the clinical relevance of it?
Grating feeling when larynx is moved side to side by examiner
Its absence is a sign of laryngeal carcinoma or laryngeal trauma
297
What features in a history may lead you to suspect laryngeal cancer?
```
Foreign body sensation in throat
Dysphagia
Odynohagia (painful swallowing)
Otalgia (ear ache)
Hoarse voice
Coughing
Weight Loss
Smoking history
```
298
What examinations and investigations may you perform in suspected laryngeal cancer?
```
Examine larynx for laryngeal crepitus
Examine cervical lymph nodes
Fibroptic endoscopy
Barium swallow
CT or MRI
Direct pharyngo-laryno-oesophagoscopy and biopsy
```
299
2017 Why does a subdural haematoma tend to progress slower than an extradural one?
Subdural tends to be venous bleed while extradural tends to be arterial
300
2017 Explain the appearance of a sub arachnoid haemorrhage on CT scan.
Opacities extending down into sulci as blood collects between arachnoid and pia mater, the latter if which is closely related to the surface of the brain, (including down into its sulci.)
301
2017 Briefly describe how you can differentiate an extradural-from subdural- haemorrhage on CT
Extra dural - lens shaped / biconcave / lemon shaped
| Epidural - crescent / banana shaped
302
2017 What risk do the falx cerebri and tentorium cerebelli pose in raised intracranial pressure?
Brain can be displaced and compressed against them
303
2017 Through which foramina do each of the cranial nerves exit the skull?
```
CN I - holes of cribriform plate
CNII - optic canal
CNIII, IV and Va - superior orbital fissure
CNVb - foramen rotundum
CNVc - foramen ovale
CNVII and VIII - internal acoustic
CNX and XI - jugular foramen
Cranial roots of CNXI - foramen magnum
CNXII - hypoglossal canal
```
304
2017 Where does the middle meningeal artery enter the cranial cavity?
Through the foramen spinosum in the base of the skull
305
2017 Name the most prolific type of immune cells in the brain
Microglia
306
2017 Describe the parts of the brainstem and (briefly) their functions
Midbrain - eye movements and reflex responses to sound and vision
Pons - sleeping, feeding
medulla - CVS and respiratory control
307
2017 Wheres the central sulcus of the brain?
Between the frontal and parietal lobes, on dorsal surface of brain
308
2017 What are the main functions of the cerbellum?
Co-ordination and motor learning
309
2017 Which lobe of the brain deals with vision?
Occipital
310
2017 What does the corpus callosum of the brain do?
Connects the 2 cerbreal hemispheres
311
2017 What is the uncus and what is its clinical relevance?
Central parts of the temporal lobes which can herniate and compress the midbrain if there is an increased intracranial pressure
312
2017 What is the hypothesised reason behind the strength of the connection between scents and/or sounds and memories?
All processed within the temporal lobe of the brain
313
2017 Why might frontal lobe damage cause impaired impulse control?
Frontal lobe is responsible for higher cognition
314
2017 What is the role of the thalamus?
Sensory relay station projecting to sensory cortex
315
2017 Which nerves pass through the cavernous sinus?
Occulomotor II, Trochelar IV,
Abducens VI,
Opthalmic and Maxillary branches of trigeminal VaVb
316
2017 Explain, with reference to the specific anatomy, how atherosclerosis in the carotid artery could lead to monocular blindness.
Thrombus could embolise and travel up internal carotid and ophthalmic arteries to occlude the central retinal artery.
317
2017 List 6 signs of cerebellar dysfunction
```
D - dysdiadochokinesia and dysmetria
A - Ataxia
N - Nystagmus
I - Intention tremor
S - Slurred speech / scanning dysarthria
H - Hypotonia / heel-shin test positivity
```
