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Semester 4 > Head And Neck Session 4 > Flashcards

Head And Neck Session 4 Flashcards

1
Q

What does a nerve bundle consist of?

A

Afferent nerve and efferent fibres

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2
Q

What are collections of cell bodies in the CNS called?

A

Nuclei

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3
Q

What are cell bodies in the PNS called?

A

Ganglia

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4
Q

Are all of the cranial nerves typical peripheral nerves?

A

No, 2 are atypical (brain tracts)

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5
Q

Which cranial nerves are brain tracts?

A

CNI and II

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6
Q

Name the 12 cranial nerves.

A

I: olfactory, II: optic, III: oculomotor, IV: trochlear, V: trigeminal, VI: abducens, VII: facial, VIII: vestibulocochlear, IX: glossopharyngeal, X: vagus, XI: accessory, XII: hypoglossal

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7
Q

Which cranial nerves arise from the forebrain?

A

CNIII and IV

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8
Q

Which cranial nerves arise from the Pons?

A

CNV, VI, VII and VIII

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9
Q

Which cranial nerves arise from the medulla?

A

CNIX, X, XI and XII

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10
Q

Describe the path of the olfactory nerve.

A

Olfactory mucosa –> olfactory receptor neurones –> cribriform plate –> olfactory bulbs

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11
Q

Where are the olfactory bulbs located?

A

Either side of the crista galli

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12
Q

What is a brain tract?

A

Outpouching of the brain

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13
Q

What can cause damage to the olfactory nerve and how would it be tested?

A

Trauma/meningitis/URTI. Test with strong smelling substance

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14
Q

Describe the path of the optic nerve.

A

Retina –> through optic canal –> cross at optic chiasm –> optic tract –> primary visual cortex in occipital lobe

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15
Q

What is assessed when testing the optic nerve clinically?

A

Visual acuity, colour vision, visual fields, pupillary reflexes, fundoscopy

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16
Q

What can testing the visual fields help to predict when testing the optic nerve?

A

Site of lesion

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17
Q

Describe the path of the oculomotor nerve.

A

Oculomotor and Edinger-Westphal nucleus –> superior orbital fissure –> superior to LPS, inferior to extraocular muscles

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18
Q

How is the oculomotor nerve tested clinically?

A

Ask patient to follow finger as you draw an H

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19
Q

What position is the pupil found in the affected eye in oculomotor palsy?

A

Down and out

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20
Q

What is mydriasis?

A

Blown pupil due to damage to the autonomic component of the oculomotor nerve

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21
Q

Why is ptosis often seen with mydriasis?

A

Often associated damage to the motor component of the oculomotor nerve

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22
Q

Describe the path of the trochlear nerve.

A

Trochlear nucleus –> superior orbital fissure –> dorsal midbrain –> cavernous sinus –> superior oblique muscle

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23
Q

Which nerve has the longest intracranial length?

A

Trochlear

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24
Q

Which important structures are found in the cavernous sinus?

A

Oculomotor nerve, abducens nerve, trigeminal nerve branches V1&2 and the ICA

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25
Q

What does a patient presenting with diplopoia on walking down stairs suggest?

A

Paralysis of the superior oblique muscle due to trochlear nerve damage

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26
Q

What might be seen O/E of a patient with trochlear nerve damage?

A

Subtle head tilt

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27
Q

Describe the path of the trigeminal nerve.

A

Trigeminal sensory nuclei in Pons –> trigeminal ganglion –> superior orbital fissure for ophthalmic branch, foramen rotundum for maxillary branch and foramen ovale for mandibular branch

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28
Q

What is trigeminal neuralgia?

A

Shooting pain in the distribution of the trigeminal nerve on light touch due to hyperactive sensory component

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29
Q

What gives innervation to the teeth?

A

Maxillary branch of trigeminal via superior alveolar nerve and mandibular branch of trigeminal via inferior alveolar nerve

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30
Q

How is the trigeminal nerve tested?

A

Corneal reflex (afferent branch), sensory function to face and clench muscles of mastication

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31
Q

Describe the path of the abducens nerve.

A

Abducens nucleus in Pons –> superior orbital fissure –> lateral rectus muscle of eye

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32
Q

What is ‘false localising sign’ in relation to the abducens nerve?

A

Any increase in ICP implicates the abducens nerve without necessarily indicating the site of pathology

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33
Q

What is seen on examination of a patient with damage to the abducens nerve?

A

Inability to abduct the affected eye

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34
Q

Describe the path of the facial nerve.

A

Motor and visceral nuclei in Pons –> IAM –> facial canal –> stylomastoid foramen –> 5 branches

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35
Q

What are the 5 branches of the facial nerve?

A

Temporal, zygomatic, buccal, mandibular and cervical

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36
Q

When does the facial nerve become extracranial?

A

When it enters the stylomastoid foramen

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37
Q

What gives special sensory innervation to the anterior 2/3 of the tongue?

A

Chorda tympani

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38
Q

What is given parasympathetic supply via the facial nerve?

A

Salivary and lacrimal glands

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39
Q

What is Bell’s palsy?

A

Idiopathic one-sided facial paralysis

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40
Q

How can Bell’s palsy be differentiated from a stroke on examination?

A

Forehead is spared in a stroke

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41
Q

How is the facial nerve tested clinically?

A

Test facial expression and ask about taste

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42
Q

Describe the path of the vestibulocochlear nerve.

A

Cerebellopontine angle –> IAM –> vestibular nerve goes to vestibular ganglion and semicircular canals, cochlear nerve goes to spiral ganglion in cochlea

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43
Q

Which two nerves travel together through the facial canal?

A

Facial and vestibulocochlear

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44
Q

What is vestibular schwannoma?

A

Benign neoplasm of Schwann cells that causes sensorineural hearing loss

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45
Q

What is the difference between sensorineural and conductive hearing loss?

A

Sensorineural is due to nerve damage whereas conductive is due to blockage of sound waves

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46
Q

How is the vestibulocochlear nerve tested clinically?

A

Whisper in each ear whilst making noise in the other. Rinne and Weber tests

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47
Q

Should sound conduct better through air or bone?

A

Air

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48
Q

Describe the path of the glossopharyngeal nerve.

A

Medulla oblongata –> jugular foramen –> tongue, Otic ganglion to parotid gland, carotid and,stylopharyngeus

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49
Q

What innervation does the glossopharyngeal nerve give?

A

Sensation to oropharynx, posterior 1/3 of tongue and carotid sinus/body. Motor to stylopharyngeus muscle. Parasymapthatetic to parotid gland

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50
Q

How is the afferent branch of the glossopharyngeal nerve tested clinically?

A

Gag reflex

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51
Q

What happens in a carotid sinus massage?

A

Increase in pressure is detected and signal via vagus nerve to decrease heart rate

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52
Q

What is the difference in neural supply to carotid sinus and aortic arch receptors?

A

Carotid sinus –> CNIX, aortic arch receptors –> CNX

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53
Q

Describe the path of the vagus nerve.

A

Medulla –> jugular foramen –> laryngopharynx, ear, pharynx, heart and lungs

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54
Q

What do the left and right recurrent laryngeal nerves hook around respectively?

A 
Left= arch of aorta
Right = R. Subclavian artery
55
Q

What innervation does the vagus nerve provide?

A

Sensation to the laryngopharynx and ear. Motor to muscles of pharynx and larynx. Parasympathetic innervation to the heart, lungs and GI tract

56
Q

What does vagus stimulation cause in the lungs?

A

Bronchoconstriction

57
Q

Where, other than the tonsils, can the gag reflex be stimulated?

A

EAM

58
Q

What tests the efferent branch of the vagus nerve?

A

Carotid sinus massage

59
Q

How might an aortic aneurysm present in relation to the left recurrent laryngeal nerve?

A

Hoarseness of voice

60
Q

Describe the path of the accessory nerve.

A

Spinal nerve roots C1-5/6 –> up through foramen magnum –> down jugular foramen –> along ICA –> SCM and trapezius

61
Q

What is the cranial portion of the accessory nerve often considered as?

A

Part of the vagus nerve

62
Q

How is the accessory nerve assessed clinically?

A

SCM and trapezius wasting, rotate head against resistance, shrug shoulders against resistance

63
Q

Describe the path of the hypoglossal nerve.

A

Hypoglossal nucleus in the medulla –> hypoglossal canal –> emerges just inferior to tongue

64
Q

What innervation does the hypoglossal nerve provide?

A

Motor to intrinsic and extrinsic muscles of tongue

65
Q

How is the hypoglossal nerve assessed clinically?

A

Fasciculations of the tongue, deviation towards site of lesion

66
Q

Why does the tongue deviate to the side of the lesion in hypoglossal nerve damage?

A

Tongue is bilaterally innervated and usually muscles contract against each other therefore in damage opposition is lost

67
Q

Which cranial nerves are exclusively sensory?

A

Olfactory, optic, vestibulocochlear

68
Q

Which cranial nerves are exclusively motor?

A

Oculomotor, trochlear, abducens, accessory and hypoglossal

69
Q

Which cranial nerves have both sensory and motor function?

A

Trigeminal, facial, glossopharyngeal and vagus

70
Q

Which cranial nerves have associated autonomic fibres?

A

Oculomotor, facial, glossopharyngeal and vagus

71
Q

How are nerves classified?

A

By general function (somatic or autonomic/visceral) and direction of conduction (afferent/sensory or efferent)

72
Q

Which cranial nerves contain special visceral efferents?

A

CNV, VII, IX and X

73
Q

What function do special somatic afferents have in the cranial nerves?

A

Equilibration, hearing and sight

74
Q

What functions do the special visceral afferents of the cranial nerves give?

A

General taste and temperature of food and special test (sweet, sour etc)

75
Q

How does a lesion of the spinal cord above the thoracic vertebral level present differently to a lesion below?

A

Above –> quadriplegia

Below –> paraplesia

76
Q

Describe the overall structure of the parasympathetic nervous system.

A

High brain structures –> brainstem (medulla and midbrain)/spinal cord –> ganglia on wall of effector organ –> short post-ganglionic fibres to effector organ

77
Q

Describe the general overall structure of the sympathetic nous system.

A

High brain structures –> spinal cord –> short preganglionic fibres to para-/prevertebral chain –> effector organ

78
Q

How do efferent fibres of the ANS supply the head and neck?

A

Accompany visceral branches of sympathetic plexuses

79
Q

Describe the passage of parasympathetic fibres from the Edinger-Westphal nucleus.

A

Enters orbit with inferior division of optic nerve, synapses at ciliary ganglion just lateral to optic nerve giving post-ganglionic fibres with short ciliary nerves to the eye

80
Q

What function does the parasympathetic portion of CNIII have?

A

Constrict pupil and accommodation

81
Q

Which ganglia are supplied by the superior salivatory nucleus?

A

Pterygopalatine and submandibular

82
Q

What structures do fibres from the pterygopalatine ganglion innervate?

A

Lacrimal gland, mucus glands of neck and mucus glands of palate

83
Q

What branches do fibres from the submandibular ganglion form?

A

Submandibular and sublingual salivary

84
Q

Which ganglion is associated with the inferior salivatory nucleus?

A

Otic

85
Q

What is the nerve called that travels between the inferior salivatory nucleus and Otic ganglion?

A

Lesser petrosal

86
Q

What is the name of the nerve that travels between the Otic ganglion and oropharynx/parotid gland?

A

Auriculotemporal nerve

87
Q

How is the oropharynx supplied by the auriculotempral nerve?

A

Via the pharyngeal plexus synapsing at postganglionic cells in its wall

88
Q

At what level do the postganglionic sympathetic fibres become associated with CNIII?

A

Ciliary ganglion

89
Q

What do the postganglionic sympathetic fibres associated with CNIII supply?

A

Levator palpebrae superioris

90
Q

Describe the path of fibres from the dorsal vagal motor nucleus.

A

Move into neck –> postganglionic cells in walls of target organs supplying glands of laryngopharynx, larynx, oesophagus and trachea

91
Q

State the nucleus, organs and action of the parasympathetic autonomic division of CNIII.

A

Edinger-Westphal. Eye, pupil and ciliary. Pupillary constriction

92
Q

State the nucleus, organs and action of the parasympathetic autonomic division of CNVII

A

Superior salivatory. Nasal, lacrimal, submandibular and sublingual glands. Serous secretions

93
Q

State the nucleus, organ and action of the parasympathetic autonomic division of CNIX.

A

Inferior salivatory. Parotid. Serous secretions

94
Q

State the nucleus, organs and action of the parasympathetic autonomic division of CNX.

A

Dorsal vagal motor nucleus, many and laryngeal function

95
Q

Where does all CNS outflow originate from?

A

Entirely spinal, T1-L2/3

96
Q

Where do axons of most preganglionic sympathetic ANS neurones terminate?

A

Immediately in the paravertebral sympathetic chain of ganglia (sympathetic trunk)

97
Q

Where are sympathetic autonomic ganglia found?

A

All in peripheral nervous system

98
Q

Where is the paravertebral chain located?

A

Bilaterally alongside vertebral column

99
Q

Where is the prevertebral chain located?

A

Anterior to vertebral bodies in relation to carotids and anterior to the abdominal aorta

100
Q

Where do the para- and prevertebral chains extend from and to?

A

Base of skull to coccyx

101
Q

Why is there a difference between the number of neural levels and number of ganglia in the vertebral chains?

A

Some ganglia fuse

102
Q

How many cervical ganglia are there in comparison to the number of neural levels there?

A

2/3 ganglia from 8 neural levels

103
Q

How are somatic targets reached by fibres from the vertebral ganglia?

A

Along segmental nerves

104
Q

How are visceral targets reached by fibres from the vertebral chains?

A

Along ganglionated trunks (like pre-ganglionic fibres of PSNS)

105
Q

Is there sympathetic outflow from the cervical spinal cord?

A

No

106
Q

Which 3 cervical ganglia supply the head and neck?

A

Superior, middle and inferior (Stellate)

107
Q

Are the cervical ganglia supplying the head from the cervical spinal cord?

A

No, they are displaced thoracic ganglia

108
Q

Where do each of the cervical ganglia lie in relation to other structures?

A

Superior: anterior to C1-4 (carotids)
Middle: anterior to C6 and inferior thyroid artery
Inferior: anterior to C7 (vertebral arteries)

109
Q

What ascends along the ICA into the cranium to form the internal carotid plexus?

A

Internal carotid nerve

110
Q

Which structures are associated with the internal carotid plexus?

A

Ophthalmic nerve, trochlear nerve, CNIII, CNIX, vessels from ICA, abducens nerve and pterygopalatine ganglion

111
Q

How do sympathetic post-ganglionic fibres reach the head and neck targets?

A

Via walls of common, external and internal carotids outside of the carotid sheath

112
Q

What is the somatic function of the superior cervical ganglion travelling along ICA and ECA?

A

Trigeminal Dermatome sweat glands

113
Q

What is the visceral function of the superior cervical ganglion travelling along the ICA and ECA?

A

Dilator pupillae, smooth muscle of LPS, nasal glands and salivatory glands

114
Q

What are the targets of the middle cervical ganglion fibres?

A

Lower larynx, trachea, hypo-pharynx and upper oesophagus

115
Q

What are the targets of the inferior cervical ganglion fibres?

A

Posterior head and neck structures

116
Q

What does a neurone consist of?

A

Dendrites, 1 cell body and 1 axon

117
Q

What gives arterial supply to the extraocular muscles?

A

ICA via ophthalmic artery that becomes the central artery to retina

118
Q

What provides venous drainage to the extraocular muscles?

A

Tributaries of the ophthalmic veins that drain via the superior ophthalmic vein into the cavernous sinus

119
Q

What gives innervation to the extraocular muscles?

A

CNIII, IV and VI

120
Q

What gives innervation to the orbital structures?

A

CNII, CNV-ophthalmic division

121
Q

What are the seven muscles of the eye?

A

Superior rectus, superior oblique, lateral rectus, medial rectus, inferior rectus, inferior oblique and levator palpebrae superioris

122
Q

What is the name of the small smooth muscle portion of the muscle that raises the superior eyelid with sympathetic innervation?

A

Superior tarsal portion of LPS

123
Q

Which muscles closes the eye?

A

Obicularis oculi

124
Q

What gives innervation to obicularis oculi?

A

CNVII

125
Q

How are the recti muscles attached to the eye?

A

Arise from common tendinous ring surrounding the optic canal that attaches to the sclera on its anterior half

126
Q

Why does occlusion of the central retinal artery cause ischaemia?

A

The terminal branches are end arteries

127
Q

Where do the terminal branches of the central retinal artery travel?

A

Through the optic canal

128
Q

How does the retina appear in central retinal artery occlusion?

A

Pale

129
Q

Why does the macula/fovea still appear dark in central retinal artery occlusion?

A

It receives its blood supply from the choroid

130
Q

Describe the mechanism by which papilloedema arises.

A

Raised ICP (tumour, haemorrhage, increased CSF pressure) –> impaired venous drainage –> oedema in retina –> optic disc swelling

131
Q

How might a patient with papilloedema present?

A

Visual loss and headaches

132
Q

How might a patient with central retinal vein occlusion present?

A

Slow, painless loss of vision

133
Q

Why is central retinal vein occlusion said to give a ‘stormy sunset appearance’ on fundoscopy?

A

Stasis of blood causes formation of small haemorrhages with a normal sized optic disc

134
Q

What can cause central retinal vein occlusion?

A

Dehydration, thrombophlebitis

Semester 4 (33 decks)

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