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Medicine > Head and neck super deck > Flashcards

Head and neck super deck Flashcards

1
Q

What is the route of the external jugular vein in the neck?

A

Over the sternocleidomastoid muscle

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2
Q

Under what muscle is the route of the internal jugular vein?

A

sternocleidomastoid muscle

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3
Q

What is the route of the carotid arteries?

A

Aorta -> brachiocephalic trunk -> common carotid artery -> external and internal carotid arteries

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4
Q

What are the first 3 branches off the right subclavian artery in order?

A

1) Vertebral artery
2) Thyrocervical trunk
3) Internal thoracic artery

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5
Q

What are the branches off the thyrocervical trunk in order of inferior to superior?

A

1- Suprascapular
2- Transverse cervical
3- Ascending cervical artery
4- Inferior thyroid artery

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6
Q

Does the common carotid artery give off any branches in the neck?

A

No, it bifurcates to give the external and internal carotid arteries.

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7
Q

Through which cranial foramen does the vertebral artery go through?

A

Foramen magnum

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8
Q

Through what in the skull does the internal carotid artery go through and what is the bone?

A

Carotid canal in the temporal bone - the petrous part of it.

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9
Q

Which vertebral foramen does the vertebral artery go through?

A

Transverse foramina on both sides

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10
Q

The combination of the internal carotid artery and the vertebral artery makes which loop in the cranium?

A

Circle of Willis

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11
Q

What is more lateral: internal jugular vein or the common carotid artery?

A

Internal Jugular Vein

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12
Q

At which cervical level does the common carotid bifurcate and which cartilages superior border is the landmark?

A

C4

Superior border of the thyroid cartilage

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13
Q

What are the borders of the carotid sheath?

A

SCM
Posterior belly of the digastric muscle
Superior belly of the omohyoid muscle

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14
Q

What is the contents of the carotid triangle?

A

ECA

IJV

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15
Q

What is the carotid sinus and what is the clinical significance?

A

Swelling at region of bifurcation

Location of baroreceptors for detecting changes in arterial BP

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16
Q

What is the carotid body?

A

Peripheral chemoreceptors which detect arterial O2

Glossopharyngeal nerve

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17
Q

What is the result of a carotid sinus massage?

A

Increases Innervation of the PNS
Decreases innervation of SNS
Slows the HR

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18
Q

What nerves can be accessed via the carotid triangle?

A

Vagus and hypoglossal nerves

In addition to the glossopharyngeal nerve

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19
Q

Route of the internal carotid artery from when it enters the cranium

A

1- Enter skull through the carotid canal in petrous part of temporal bone
2- Turns medially and horizontally
3- Enters cranial cavity then makes S-shaped bend
4- Courses through the cavernous sinus

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20
Q

Apart from the ICA what is also in the cavernous sinus?

A
  • Internal carotid a
  • CNIII
  • CNIV
  • CNVI
  • 2 Branches of trigeminal: 1- CNV1 ophthalmic and CNV2 maxillary
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21
Q

What artery does ophthalmic artery arise from?

A

ICA

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22
Q

What are the relevant branches of the ophthalmic artery?

A
  • Ethmoidal arteries in canals in ethmoid bone
  • Supratrochlear artery
  • Supra-orbital artery
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23
Q

What is the mnemonic and its meanings for the branches of the external carotid artery?

A 
Mnemonic:
Some Anatomists Like Freaking Out poor Medical Students
1- Superior thyroid
2- Lingual
3- Facial
4- Ascending pharyngeal
5- Occipital
6- Posterior auricular

Plus 2 terminal branches:
1- Superficial temporal
2- Maxillary

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24
Q

What is the blood supply to the scalp from which main arteries and their branches

A

Internal carotid artery:
1- supra-orbital artery
2- supratrochlear artery

External carotid artery:
1- Superficial temporal artery
2- Posterior auricular artery
3- Occipital artery

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25
Q

What does scalp stand for?

A 
Skin
Connective tissue (dense)
Aponeurosis
Loose connective tissue
Periosteum
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26
Q

What layer of the scalp do the vessels lie in?

A

Subcutaneous connective tissue layer

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27
Q

Clinical relevance of blood supply to scalp?

A
  • Numerous anastomoses profuse bleeding
  • Blood supply to skull mostly middle meningeal artery but due to anastomoses loss of blood doesn’t lead to osteonecrosis
  • Walls of arteries are closely attached to connective tissue which limits their constriction - leading to profuse bleeding
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28
Q

What are the superficial arteries of the face in order from inferior to superior?

A 
Superior thyroid
Lingual
Facial branches: Sup. Inf. labial arteries, lateral nasal, angular
Maxillary
Transverse facial

ICA branches: Supraorbital and supratrochlear.

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29
Q

What does the middle meningeal artery (MMA) branch off?

A

ECA -> Maxillary -> MMA

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30
Q

What artery does the sphenopalatine artery originate from?

A

Maxillary artery (3rd part)

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31
Q

What is the blood supply to nasal septum ant and post areas.

A

Ant. area: Kisselbalch area
-Greater palatine artery to Septal branch of sup. Labial artery + ant. And post. Ethmoidal arteries + sphenopalatine artery.

Post area: Septal branch of sphenopalatine artery

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32
Q

What compartment of the cranium does the foramen spinosum sit in and what goes through it?

A

Middle compartment

Middle meningeal artery passes through it

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33
Q

Rupture of which artery forms an extradural haemorrhage?

A

Middle meningeal artery

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34
Q

Fracture of which part of the bone can rupture the middle meningeal artery?

A

Pterion

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35
Q

What type of shape does an extradural haemorrhage take?

A

Lentiform

Bleeding only goes up to the sutures of that bone that is affected.

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36
Q

What is the venous drainage of the scalp into?

A

Superficial temporal vein
Occipital vein
Posterior auricular vein

Supraorbital and supratrochlear veins unite at medial angle of the eye to form the angular vein which drains into the facial vein.

Deep parts of the scalp (temporal region) drain into the pterygoid venous plexus

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37
Q

What vein does the facial vein drain into?

A

IJV

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38
Q

What vein does the confluence of sinuses turn into?

A

Transverse sinus -> sigmoid sinus -> IJV

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39
Q

What 3 veins make the left brachiocephalic vein?

A
  • Subclavian v.
  • Suprascapular v. + EJV + ant jugular vein
  • IJV
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40
Q

What veins connect the scalp to sinuses?

A

Emissary veins

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41
Q

Do emissary veins have valves, if not what’s the clinical relevance?

A

No, infections of the scalp can spread to the cranial cavity and affect meninges.

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42
Q

Venous drainage of the face is by which main veins?

A

Supraorbital + supratrochlear = angular vein + sup. Inf. labial veins -> facial vein -> common facial vein -> IJV and EJV

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43
Q

What two veins communicate at the medial angle of the eye to drain into which sinus?

A

Facial v and sup ophthalmic v draining into the cavernous sinus.

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44
Q

Combination of deep facial veins + inf ophthalmic vein and cavernous sinus drain into which sinus?

A

Pterygoid venous plexus

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45
Q

Through which foramina does the IJV leave the skull?

A

Jugular foramina

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46
Q

What vein is seen in an JVP examination?

A

IJV

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47
Q

Which two layers of the meninges makes the venous sinuses

A

Meningeal and periosteal layer of dura

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48
Q

Which veins within the subarachnoid space drain into dural venous sinuses

A

Bridging veins traverse the subdural space and into the dural venous sinus

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49
Q

Name the 3 types of intracranial haemorrhage

A

Extradural
Subdural
Subarachnoid

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50
Q

Of the 3 intracranial haemorrhages which are due to the middle meningeal artery?

A

Extradural

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51
Q

What shape gives an extradural haemorrhage on CT scan?

A

Lensiform shape

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52
Q

Between which layers of the meninges does the blood accumulate in an subdural haemorrhage?

A

Between the meningeal layer of the dura and the arachnoid mater. AKA subdural space

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53
Q

What shape on CT is characteristic of the subdural haemorrhage?

A

Banana shape

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54
Q

What type of bleed is a SAH arterial or venous?

A

Arterial

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55
Q

What are the parts of the brain stem?

A

Midbrain (mesencephalon)
Pons
Medulla

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56
Q

What is the function of the midbrain?

A

Eye movements and reflex responses to sound and vision

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57
Q

What is the function of the pons?

A

Feeding reflex

Sleep

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58
Q

What is the function of the medulla?

A

Cardiovascular and resp centres

Contains a major motor pathway (medullary pyramids which ultimately decussate)

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59
Q

Which is the name of the largest sulcus that we use as a landmark on the lateral view?

A

Central sulcus

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60
Q

What is the name of the gyrus infront and behind the central sulcus?

A

Precentral gyrus

Post central gyrus

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61
Q

What is the main function of the precentral gyrus?

A

Motor pathways

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62
Q

What is the main function of the post central gyrus?

A

Sensory pathway

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63
Q

Where is the calcarine sulcus?

A

At the back of the brain above the cerebellum. Separating cuneus superiorly, and parietal lobe anteriorly, and cerebellum inferiorly.

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64
Q

Where is the parieto-occipital sulcus?

A

Ant. Is the parietal lobe
Post. Occipital lobe
Inf. cerebellum

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65
Q

Function of each: frontal lobe, parietal lobe, temporal lobe, occipital lobe, cerebellum?

A

Frontal lobe= higher cognition, motor function, speech, behaviour
Parietal lobe= sensation, spatial awareness
Temporal lobe= memory, smell, hearing
Occipital lobe= vision
Cerebellum= co-ordination of movement and motor learning

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66
Q

What is the function of the medullary pyramids?

A

Location of descending motor fibres - each has around 1 million axons

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67
Q

What is the function of the corpus callosum, thalamus, hypothalamus?

A

Corpus callosum= fibres connect the two cerebral hemispheres - Damage leading to alien hand syndrome
Thalamus= sensory relay station projecting to sensory cortex
Hypothalamus= essential centre for homeostasis

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68
Q

Cranial nerves in order and mnemonic?

A

Mnemonic= Oh Oh Oh To Touch And Feel A Girls Vagina Ahh Heaven

Olfactory, Ophthalmic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, (spinal) Accessory, Hypoglossal

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69
Q

How many cranial nerves do we have?

A

12 Pairs

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70
Q

Where do the cranial nerves originate?

A

Brain - 2 CN’s
Midbrain - 2 CN’s
Pons - 4 CN’s
Medulla - 4 CN’s

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71
Q

Cranial nerve I - Olfactory nerve- what is the 5 step route it takes?

A

Olfactory nerves -> cribriform plate of ethmoid bone -> olfactory bulb -> olfactory tract -> temporal lobe

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72
Q

Olfactory nerve is which of the following? Special sensory, general sensory, Motor, Autonomic

A

Special sensory

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73
Q

Loss of smell is called?

Most common cause of loss of smell?

A

Anosmia

URTI

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74
Q

Cranial nerve II - Optic nerve.

What route does it take?

A

Retinal ganglion cells -> axons form optic nerve -> exits back of orbit via optic canal -> fibres cross and merge at optic chiasm

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75
Q

What is the difference between optic nerve and optic tract

A

Optic nerve is before chains

Optic tract is post chiasm and is a mixing of the sensory fibres from right and left optic nerves

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76
Q

How would you clinically test the optic nerve?

A

Visual acuity test- snellen chart
Visual field test - cover one eye and ask how much they see compared to the other eye
Pupillary light reflexes - optic nerve has to be working

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77
Q

What is the medical term for swollen optic disc

A

Papilloedema

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78
Q

How does the pupillary light reflex work?

A

Optic tracts communicate with the brain stem (midbrain) to allow for the visual reflex

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79
Q

Which 2 nerves originate from the midbrain?

A

Oculomotor

Trochlear

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80
Q

Route of the oculomotor nerve

A

Midbrain -> cavernous sinus -> superior orbital fissure

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81
Q

Which of the below is the optic nerve: special sensory, general sensory, motor, autonomic?

A

Special sensory

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82
Q

Which of the below is the oculomotor nerve: Special sensory, General sensory, Motor, Autonomic or a combination of each?

A

Motor and Autonomic

Autonomic - parasympathetic fibres

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83
Q

What is the function of the oculomotor nerve?

A

Most of the muscles that move the eyeball - extraocular muscles

Muscles of the eyelid - Levator Palpebrae Superioris (LPS)

Innervates the sphincter pupillae muscle (constricts the pupil)

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84
Q

What muscle lifts the eyelid?

A

Levator palpebrae superioris

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85
Q

What nerve innervates sphincter pupillae muscle and what is the action?

A

Oculomotor nerve
Innervation to the pupil and lens (autonomic, parasympathetic) - constriction when activated

+ other effects of nerve :
Innervation to the upper eyelid (somatic)
Innervation of the eye muscles that allow for visual tracking and gaze fixation (somatic)

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86
Q

Between which structures is the oculomotor nerve vulnerable to compression between?

A

Tentorium cerebelli and part of the temporal lobe (the uncus)

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87
Q

How do you clinically test for the oculomotor nerve?

A

Inspect eyelids and pupil size

Test eye movements and pupillary reflexes (e.g. to light)

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88
Q

What can pathology of the oculomotor nerve cause in clinical symptoms?

A

Pupillary dilation and/or diplopia

Down and out position with severe ptosis (eyelid drooping)

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89
Q

Trochlear nerve is numerically which cranial nerve?

A

CN IV

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90
Q

Which of the below describes the Trochlear nerve: Special sensory, General sensory, Motor, Autonomic?

A

Purely motor

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91
Q

What is the route of the trochlear nerve?

A

Midbrain -> cavernous sinus -> superior orbital fissure

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92
Q

What is the function of the trochlear nerve (CN IV)?

A

(Remember LR6 SO4)

SO4 portion is superior oblique muscle

Innervation of this muscle moves the eyeball

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93
Q

What is special about the exiting of the trochlear nerve from the brain stem and what is the special about the route of the nerve?

A

It is the only nerve to emerge from the dorsal aspect of the brain stem.

It also has the longest intracranial course of any of the cranial nerves - simply because it comes off from the dorsal aspect of the brain stem.

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94
Q

How do you clinically test for the trochlear nerve and what are the signs seen in pathology?

A
  • Test eye movements but this would be done with the other cranial nerves (CN 3, 4 and 6)
  • Diplopia; correction with tilt of the head
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95
Q

What 4 nerves exit from the Pons?

A

Trigeminal (CN V)
Abducens (CN VI)
Facial (CN VII)
Vestibulocochlear (CN VIII)

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96
Q

CN V - trigeminal nerve has which branches?

A 
Ophthalmic nerve (CN Va)
Maxillary nerve (CN Vb)
Mandibular nerve (CN Vc)
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97
Q

What is the route of the first branch of the trigeminal nerve?

A

Pons -> Trigeminal ganglion -> Va -> Supraorbital fissure -> orbit

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98
Q

What is the route of the second branch of the trigeminal nerve?

A

Pons -> Trigeminal ganglion -> Vb -> foramen rotundum -> pterygopalatine fissure

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99
Q

What is the route of the third branch of the trigeminal nerve?

A

Pons -> Trigeminal ganglion -> Vc -> Foramen ovale -> inferotemporal fossa

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100
Q

Which of the following is the trigeminal nerve: general sensory, special sensory, motor, autonomic or a combination of them?

A

General sensory:

  • Main sensory nerve supplying skin of face and part of the scalp
  • Sensory to deeper structures within the head e.g. paranasal air sinuses, nasal and oral cavity, anterior part of the tongue (general sensation NOT taste) and meninges

Motor:
- Muscles of mastication (Vc only)

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101
Q

What is the clinical testing of the trigeminal nerve?

A
  • Checking sensation (to touch) in areas of its dermatomes (Va/b/c)
  • Va = touch forehead (ophthalmic)
  • Vb = touch the cheek (maxillary)
  • VC = touch the jaw (mandibular)
  • Test muscles of mastication (jaw jerk) and corneal reflex.
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102
Q

What areas does the ophthalmic division of the trigeminal nerve innervate?

A

Frontal, lacrimal and nasocilliary

Frontal continues out of orbit as supraorbital and supratrochlear nerves (+veins and arteries of the same nerve name)

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103
Q

What areas does the maxillary branch of the trigeminal nerve innervate?

A

Infraorbital nerve and superior alveolar nerves (anterior, middle and posterior)
Alveolar means teeth and so the upper teeth are innervated by this nerve

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104
Q

What areas does the mandibular division of the trigeminal nerve innervate?

A
  • Inferior alveolar (lower teeth and jaw) which continues as the mental nerve
  • Auriculotemporal nerve
  • Lingual nerve
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105
Q

In the event of an orbital floor fracture what nerve can be damaged?

A

Branch of the maxillary division of the trigeminal nerve - the infraorbital nerve.

Sensory afferent from cheek and lower eye lid

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106
Q

What nerve is blocked by local anaesthetic by dentists on dental extraction?

A

Trigeminal nerve -> maxillary nerve -> superior alveolar nerves

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107
Q

What is the route of the inferior alveolar nerve? And what is the exiting nerve called?

A

Through a bony canal in the mandible exiting as the mental nerve via the mental foramen

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108
Q

If a patient sustained a mandibular fracture what nerve would potentially be injured?

A

Inferior alveolar nerve or mental nerve

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109
Q

What branch of the mandibular division carries general sensory from the tongue?

A

Lingual nerve

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110
Q

What branch of the mandibular division carries general sensory from the ear, temple area/ lateral side of the head and scalp, temperomandibular joint

A

Auriculotemporal nerve

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111
Q

What areas are innervated by the auriculotemporal nerve?

A

General sensory from part of the ear, temple area/lateral side of the head and scalp and TMJ

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112
Q

Abducens nerve is which one numerically?

A

CN VI

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113
Q

What is the route of the CN VI?

A

Lower Pons (junction between pons and medulla) -> runs upwards before being able to pass into the cavernous sinus -> enters into orbit via superior orbital fissure

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114
Q

CN VI is which one of the following: general sensory, special sensory, motor, autonomic or a combination of any?

A

Purely motor

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115
Q

What is the action of CN VI?

A

Innervation of one muscle that moves the eye (extra ocular muscle) - Lateral rectus.

(Remember LR6 SO4) - LR6 portion of this

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116
Q

How to test Abducens nerve?

A
  • Tested using eye movements (with CN 3, 4 and 6)

- Patients presenting with diplopia

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117
Q

What is the route of the facial nerve?

A

Lower pons junction between pons and medulla -> enters petrous bone via the internal acoustic meatus -> three branches within petrous bone -> exits through base of skull at the stylomastoid foramen -> geniculate ganglion

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118
Q

What is the function of the facial nerve?

A

Nerve supplying muscles of facial expression

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119
Q

Which of the following explains the facial nerve: general sensory, special sensory, motor, autonomic or a combination of them?

A

Special sensory - anterior 2/3 of tongue (taste)

Autonomic (PNS) - lacrimal glands (tears), mucosal glands of nose and roof of mouth, salivary glands (all except the parotid gland)

Motor - Muscles of facial expression (and scalp), nerve to stapedius (in middle ear)

General sensory - small area of the external ear

120
Q

Which nerve branches from the geniculate ganglion to innervate the lacrimal gland, nasal glands and palatine glands?

A

Greater petrosal nerve

121
Q

What is the name of the nerve that innervates the tongue, sublingual gland and submandibular gland and ganglion?

A

Chorda tympani nerve

122
Q

What is the clinical relevance of parotitis and the facial nerve?

A

The facial nerve passes through the parotid gland and so inflammation of the parotid gland can affect muscles of facial expression and therefore facial expressions.

123
Q

Through which foramen does the greater petrosal nerve pass through?

A

Foramen lacerum

124
Q

How do you test the facial nerve?

A
  • Testing muscles of facial expression
  • testing the corneal reflex
  • Questions about hyperacusis, dry eyes, altered taste
125
Q

Middle ear pathology (in petrous bone) can sometimes involve which nerve?

A

Facial nerve

126
Q

Which nerve does the facial nerve closely relate to and in which cranial fossa?

A

Vestibulocochlear nerve and in the posterior cranial fossa.

Both has close relationship with the internal acoustic meatus

127
Q

Which nerve is affected in Bell’s palsy?

A

Facial nerve

128
Q

What is the numerical number of the Vestibulocochlear nerve?

A

CN VIII

129
Q

Which one of the following is the Vestibulocochlear nerve: general sensory, special sensory, motor, autonomic or a combination of any.

A

Special sensory

130
Q

What is the route of the Vestibulocochlear nerve?

A

Cochlea + semicircular canals (vestibular system) -> vestibulocochlear nerve -> internal acoustic meatus-> lower pons (junction between pons and medulla)

131
Q

What is the function of the vestibulocochlear nerve?

A

Hearing and balance

132
Q

How would you test the vestibulocochlear nerve?

A

Crude hearing test (whispering 99 in each ear) and enquiring about balance

133
Q

Damage to which areas of the head would lead to a sensorineural hearing loss?

A

Cochlea, cochlear component of vestibulocochlear nerve, or brain stem nucleus

134
Q

Damage to which structures of the vestibulocochlear nervous system would causes vertigo (disturbance of balance)

A

Semicircular canals, vestibular component of vestibulocochlear nerve, or brain nucleus

135
Q

What is the medical word for old-age related hearing loss?

A

Presbyacusis

136
Q

What are common signs and symptoms of an acoustic neuroma?

A
  • Unilateral hearing loss
  • Tinnitus
  • Vertigo
  • Numbness, pain or weakness down one half of face
137
Q

What is an acoustic neuroma?

A

Benign tumour of the Schwann cells surrounding (vestibular component) of CN VIII. The physical presence causes compression of the whole nerve +/- CNs in close proximity

138
Q

What 4 CN’s exit from the medulla?

A

Glossopharyngeal - CN IX
Vagus - CN X
Accessory - CN XI
Hypoglossal - CN XII

139
Q

What nerves exit via the jugular foramen with the IJV?

A

Glossopharyngeal

Vagus

140
Q

What nerves exit through the hypoglossal canal?

A

Accessory

Hypoglossal

141
Q

Which 4 cranial nerves exit the base of the skull?

A

CN IX, X, XI, XII

142
Q

Which cranial nerve runs the length of the carotid sheath?

A

Vagus (CN X)

143
Q

Which foramen of the skull does the vagus nerve leave?

A

Jugular foramen

144
Q

Where do the right and left recurrent laryngeal nerves run under?

A 
Right = under the subclavian artery
Left = under the arch of the aorta
145
Q

How do you test the vagus nerve?

An example of a recurrent laryngeal nerve defect and symptom?

A
  • Note patients speech, cough and ability to swallow
  • Note movement of the uvula and soft palate when saying Aaah
  • Gag reflex (efferent limb)
  • Isolated lesions are rare
  • Injury to recurrent laryngeal nerve during surgery or a pancoast tumour can cause hoarseness and dysphonia
146
Q

What cranial nerve number is Accessory?

A

CN XI

147
Q

What 3 nerves exit the cranium via the jugular foramen with the IJV?

A

Glossopharyngeal
Vagus
Accessory

148
Q

What canal does the hypoglossal nerve leave through?

A

Hypoglossal canal

149
Q

What of the following describes the spinal accessory nerve: Special sensory/ General sensory/ Motor/ Autonomic?

A

Motor

150
Q

What does the spinal accessory nerve do?

A

Motor innervation to the sternocleidomastoid muscle and trapezius muscle

151
Q

What muscle does the accessory nerve pass deep to?

A

SCM and Trapezius

152
Q

In the posterior triangle what is the track of the accessory nerve?

A

Runs posterolaterally across the posterior triangle

153
Q

How do you test the spinal accessory nerve?

A
  • Shrug shoulders against resistance (trapezius)

- Turn head against resistance (SCM)

154
Q

Which of the following best describes the hypoglossal nerve: Special sensory/ General Sensory/ Motor/ Autonomic?

A

Motor

155
Q

What cranial nerve number is the hypoglossal nerve?

A

CN XII

156
Q

What are the actions of the hypoglossal nerve (CN XII)?

A

Muscles of the tongue (all except one)

157
Q

What is the route of the hypoglossal nerve in relation to the face and neck?

A

Medial to the angle of the mandible

Cross internal and external carotid arteries in neck.

158
Q

How do you test the CN XII?

A

Inspection and movement of the tongue

159
Q

What is the result of hypoglossal nerve injury?

A

Damage to the nerve will cause weakness and atrophy of the tongue muscles on the ipsilateral side

160
Q

What is interesting about week 4 of the embryonic life?

A

What week during the embryonic life is the face not distinguishable but the head and neck are 50% of the length of the embryo?

161
Q

What are the pharyngeal arches?

A

System of mesenchymal proliferation’s in the neck region of the embryo

162
Q

How many pharyngeal arches are there?

A

5 in total however numbering system there are 6 (5th one doesn’t form in humans)

163
Q

Together with which area make up the building blocks of the head and neck region?

A

Frontonasal prominence (FNP)

164
Q

Within each arch what is else is important in the development of that arch?

A

Artery, nerve and cartilage bar

165
Q

What is the stomadeum?

A

An area of the embryo which will form the oral cavity

166
Q

What are the lens and optic placode?

A

Thickened portion of ectoderm that serves as the precursor of the lens of the eye

167
Q

What is the pharyngeal cleft?

A

The gap between the pharyngeal arches

168
Q

What does each pharyngeal arch correlate to in terms of cranial nerves?

A

Pharyngeal arch 1 - CN V
Pharyngeal arch 2 - CN VII
Pharyngeal arch 3 - CN IX
Pharyngeal arch 4 - CNX

169
Q

What is the action of the pharyngeal arch cranial nerves?

A

Mixed sensory and motor functions

170
Q

What are the muscular derivatives of the pharyngeal arches?

A

Ph Arch 1 = muscles of mastication
Ph Arch 2 = muscles of facial expression
Ph Arch 3 - Stylopharyngeus
Ph Arch 4 = Cricothyroid, levator palatine, constrictors of the pharynx
Ph Arch 6 = Intrinsic muscles of the larynx

171
Q

What pharyngeal arch does Meckel’s cartilage come from?

A

Ph Arch 1

172
Q

What pharyngeal arch does Reichert’s cartilage come from?

A

Ph Arch 2

173
Q

What pharyngeal arches do the cartilages of the larynx derive from?

A

Ph Arch 4 and 6

174
Q

What are pharyngeal pouches?

A

Endoderm lined pockets in the pharynx

175
Q

What does the first pharyngeal pouch become?

A

It is the largest and becomes the tympanic cavity

176
Q

What structures are derived from the pharyngeal pouches?

A

Palatine tonsils and parathyroid gland and thymus

177
Q

What is left after development of the pharyngeal arches in normal people?

A

1st arch is all that remains and becomes the external acoustic meatus
2nd arch grows down to cover others, obliterating all other clefts

178
Q

If a pharyngeal arch doesn’t close properly what is the result?

A

Bronchial cysts or fistulae can occur if there are remnants

179
Q

What is the contents of a branchial cyst?

A

Serous fluid into the sac

180
Q

Where is a branchial cyst found?

A

Around the SCM anteriorly

181
Q

What drives the development of the face?

A
  • Expansion of the cranial neural tube

- Appearance of a complex tissue system associated with: -the cranial gut tube and - the outflow of the developing heart

182
Q

What structures develop into the face?

A

1st Ph Arch and the frontonasal prominence (FNP)

They surround the ventero-lateral part of the forebrain

183
Q

What are the branches of the 1st Ph arch?

A

Maxillary and mandibular

184
Q

What part of the face is produced from the FNP?

A

Forehead, bridge of nose, nose, philtrum

185
Q

What parts of the face are derived from the maxillary Ph Arch?

A

Cheeks, lateral upper lip, lateral upper jaw

186
Q

What structures are derived from the Mandibular division of the first pharyngeal arch?

A

Lower lip and jaw

187
Q

What appears on the FNP to suggest production of the nose?

A

Nasal placodes which then sink to become the nasal pits.

Medial and lateral nasal prominences form on either side of the pits

188
Q

How does the nose go from a lateral to a medial structure in the embryo?

A

Maxillary prominences grow medically, pushing the nasal prominences closer together in the midline.
Maxillary prominences fuse with medial nasal prominence
Medial nasal prominences then fuse in the midline

189
Q

What structure is produced by the fusion of the medial nasal prominences?

A

Intermaxillary segment=

  • labial component - philtrum
  • Upper jaw - 4 incisors
  • Palate - primary palate
190
Q

How is the hard palate formed?

A

Maxillary prominences give rise to two palatal shelves
These grow vertically downwards into the oral cavity on each side of developing tongue
The mandible grows large enough to allow the tongue to drop therefore the palatine shelves grow towards each other
The palatal shelves then grow towards each other and fuse in the midline
The nasal septum develops as a midline downgrowth and ultimately fuses with palatal shelves

191
Q

What is the cause of a lateral cleft lip?

A

Failure of fusion of medial nasal prominence and maxillary prominence

192
Q

What is the cause of a cleft lip and cleft palate?

A

Combination of failure of fusion of medial nasal prominence and maxillary prominence with failure of palatal shelves to meet in the midline

193
Q

What Ph Arches do the ossicles develop from?

A

Cartilages from 1st and 2nd Pharyngeal Arches

194
Q

What Ph arch forms the middle ear cavity?

A

Ph Arch 1

195
Q

Describe the development of the positioning of the ears?

A

External ears develop initially in the neck
As mandible grows the ears ascend to the side of the head to lie in line with the eyes
(All common chromosomal abnormalities have associated external ear anomalies)
(Hypoplasia of the jaw - lower set ears)

196
Q

How does foetal alcohol syndrome present in children?

A
  • Small head
  • Epicanthal folds
  • Flat midface
  • Smooth philtrum
  • Underdeveloped jaw
  • Low nasal bridge
  • Small eye openings
  • Short nose
  • Thin upper lip
197
Q

What cell population does the facial skeleton derive from?

A

Neural crest cells populating the pharyngeal arches

198
Q

From which spinal levels is the parasympathetic outflow and what are the segments called?

A

Cranial - four cranial nerves

Sacral (S2-S4) - pelvic splanchnics

199
Q

From which spinal levels is the sympathetic outflow?

A

Segments are T1-L2 of spinal cord only

Cell bodies within lateral horn of grey matter of spinal cord

200
Q

How do thoracic sympathetic nerves reach the head?

A

They hitch-hike onto blood vessels. Post-ganglionic sympathetic nerves join common carotid artery and follows the external carotid artery up to the face and internal carotid artery to the orbit

201
Q

Describe the 3 signs of Horners syndrome and why they happen?

A

Partial ptosis - occulomotor n. Innervates the LPS muscle which due to unopposed parasympathetic innervation causes the drooping of the eyelid.
Myosis - more constricted pupils due to the reduced sympathetic innervation
Anhydosis- reduced sweating on the ipsilateral side again due to decreased sympathetic innervation

202
Q

What areas of pathology will cause the following cluster of signs: Anyhydrosis, partial ptosis, myosis

A

Pathology involving the apex of the lung and common carotid artery and its branches can cause autonomic dysfunction in the eye and face

203
Q

Which cranial nerves carry parasympathetic fibres from the brain stem?

A

CN III (occulomotor), CN VII (facial), CN IX (glossopharyngeal), CN X (vagus)

204
Q

What is the rule of 4’s for the PS innervation to the head and neck?

A
  • 4 cranial nerves that arise from the brainstem from the parasympathetic nuclei
  • Hitchhike onto one of 4 CNs
  • 4 PS ganglia
  • Hitchhike on branches of CN V (exception to this is CN X)
  • To reach the target tissues
205
Q

Where is the location of the Edinger Westphal nucleus?

A

In the brain stem

206
Q

What CN is associated with the Edinger Westphal Nucleus and what is the name of the parasympathetic ganglion?

A

CN III

Ciliary

207
Q

What is the action of the CN III on the target tissues?

A

Smooth muscle and ciliary muscle control

Sphincter pupillae constriction - pupil constrictor
Ciliary muscle - controls lens shape

208
Q

What is the ganglion and target tissues for CN VII?

A
  • Submandibular ganglion

- Lacrimal gland innervation

209
Q

What is the ganglion name for CN IX and the target tissue?

A
  • Pterygopalatine ganglion

- Mucosal gland in nasal/oral/mucosa/ respiratory tract

210
Q

What is the parasympathetic ganglion name and the target tissues of CN X?

A
  • Otic ganglion

- Salivary glands

211
Q

What does anisocoria mean?

A

Unequal size of the pupils

212
Q

What 2 branches of the facial nerve arise from te petrous bone and are parasympathetic?

A

Greater petrosal nerve

Chorda tympani nerve

213
Q

What nerve supplies sensory to the middle ear?

A

Tympanic nerve branch of glossopharyngeal nerve

214
Q

What is the name of the parasympathetic nerve exiting the middle ear?

A

Lesser petrosal nerve

215
Q

What is the post ganglionic innervation of the lesser petrosal nerve (which is preganglionic)?

A

Parotid gland

216
Q

What are the 3 parts of the ear?

A

External
Middle
Inner

217
Q

Name 4 signs and symptoms of ear disease?

A 
Otalgia
Tinnitus
Discharge
Vertigo
Hearing loss (sensorineural or conductive)
Facial nerve palsy
218
Q

What type of cells line the external ear?

A

Skin-lined=

Keratinising, stratified squamous epithelium continuous onto the lateral surface of the tympanic membrane

219
Q

What cells line the middle ear?

A

Respiratory epithelium

220
Q

What 2 structures form the inner ear?

A

Cochlea

Semicircular canals

221
Q

What is the name of the tube connecting the middle ear and the oropharynx?

A

Pharyngotympanic tube

222
Q

What is the main structure in the middle ear?

A

Ossicles

223
Q

What fills the middle ear air or fluid?

A

Air

224
Q

What fills the inner ear fluid or air?

A

Fluid

225
Q

What nerves carry general sensation from the ear?

A 
Cervical spinal nerves (C2/3)
Vagus
Trigeminal (auriculotemporal n.)
Glossopharyngeal (tympanic n.)
Small contribution from CN VII
226
Q

What nerve does pharyngitis refer the pain to?

A

Glossopharyngeal nerve

227
Q

Name 3 non-otological causes of otalgia?

A

1- TMJ dysfunction (CN Vc)
2- Disease of the oropharynx (CN IX)
3- Disease of the larynx and pharynx

228
Q

Is the tympanic membrane external ear, middle ear or inner ear?

A

External ear

229
Q

What deformity is caused by a subperichondrial haematoma of the ear?

A

Cauliflower deformity

230
Q

Why does cauliflower ear develop?

A

Blunt force trauma to the pinnacle of the ear
The haematoma deprives the cartilage of blood supply
Pressure necrosis of the tissue
Fibrosis
Asymmetrical cartilage development

231
Q

How to treat a subperichondrial haematoma?

A

Drainage of the haematoma
Prevent re-accumulation
Re-apposition of the two layers by tamponading the bleeding and pushing the two layers together

232
Q

What is the name of the gland that produces ear wax?

A

Ceruminous glands

233
Q

What is the self cleaning function of the ear?

A

Desquamation and skin migration laterally off tympanic membrane out of the canal - epithelial migration

234
Q

Name 5 functions of the nose

A

1- Sense of smell
2- Provide a route for inspired air (mainly at rest the nose is used)
3- Filters inspired air - trapping particles in nasal hair and mucous
4- Moistens (humidifies) and warms inspired air
5- Resonating chamber for speech

235
Q

What type of cell is found in the nose?

A

Pseudostratified columnar epithelium with goblet cells

The vestibule is lined with skin containing sebaceous/ sweat glands and hair - filters inspired air

236
Q

What bone forms the bridge of the nose?

A

Nasal bone

237
Q

What is the most fractured bone of the face?

A

Nasal bone

238
Q

What is the nasal vestibule?

A

The entrance fo the nose

239
Q

What makes up the roof and floor of the nasal cavity?

A

Roof - cribriform plate

Floor - Hard palate (roof of the oral cavity)

240
Q

Where does the Eustachian tube exit?

A

Nasopharynx posteriorly in line with the inferior conchae

241
Q

What are the names of the bony projections on the nasal lateral wall and what is the name given to the gap between them and the nasal lateral wall?

A

Superior, middle and inferior conchae

Superior, middle and inferior meatus

242
Q

Where does the paranasal sinuses communicate with the nasal cavity?

A

Middle meatus

243
Q

Where does the lacrimal gland spill into the nasal cavity?

A

Via the lacrimal duct at the inferior meatus

244
Q

Where does the maxillary sinus communicate with the nasal cavity?

A

At the inferior meatus

245
Q

What bone are the conchae from?

A

Ethmoid bone

246
Q

What causes a saddle-nose deformity?

A

Untreated septal haematoma leading to a vascular necrosis of the cartilaginous septum of the nose which causes a saddling of the nasal dorsum

247
Q

What nerve innervates the nose and nasal cavity?

A

Trigeminal nerve

248
Q

What is a nasal polyp and what patient group mostly develops them?

A

> 40 year olds develop it
Usually bilateral in nature
Pale or yellow in appearance/ fleshy and reddened
Commonly found in middle meatus = much less pain when compared to touching the middle conchae.

249
Q

Name 3 symptoms of a nasal polyp and one red flag

A

1- Blocked nose and watery rhinorrhoea
2- Post nasal drip
3- Decreased smell and reduced taste

Red-flag symptoms= unilateral polyp +/- blood-tinged secretion may suggest tumour

250
Q

What is the treatment of a nasal polyp?

A

Steroids

251
Q

What is rhinitis?

A

Inflammation of the nasal mucosal lining

252
Q

What are the symptoms of rhinitis?

A
  • Nasal congestion
  • Rhinorrhoea
  • Sneezing
  • Nasal irritation
  • Postnasal dip
253
Q

What is a common cause of rhinitis?

A
  • Simple acute infective rhinitis (viral - common cold)

- Allergic reaction

254
Q

What is the medical term for nose bleeding?

A

Epistaxis

255
Q

What arteries carry blood to nasal cavity?

A

Branches of ophthalmic artery and maxillary artery

256
Q

What is the name given to the anastomoses of arteries supplying the anterior septum of the nose?

A

Kisselbach’s plexus

257
Q

What is acute sinusitis?

A

Symptomatic inflammation of mucosal lining of nasal cavity and paranasal air sinuses

258
Q

What are common causes of acute sinusitis?

A
  • secondary to viral infection of nasal cavity (last <10/7)
259
Q

How would you diagnose acute sinusitis?

A
  • Recent URTI
  • Blocked nose and rhinorrhoea +/- green/yellow discharge
  • Pyrexia
  • Headache / facial pain (in area affected sinus worse on leaning forward
260
Q

When would you suspect a acute bacterial sinusitis?

A
  • Symptoms particularly severe at onset
  • Symptoms >10/7 without improvement (but <4/52)
  • Symptoms that worsen after an initial improvement (suggest secondary bacterial infection)
261
Q

What are the 4 steps of pathophysiology of acute sinusitis?

A

1- Primary infection leads to reduced ciliary function, oedema of nasal mucosa and sinus Ostia and increased nasal secretions
2- Drainage from sinus is impeded
3- Maxillary sinus is the most commonly affected
4- Stagnant secretions within the sinus becomes ideal breading ground for bacteria - secondary infection ensues

262
Q

What 3 bacteria are causes for acute bacterial sinusitis?

A

Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis

263
Q

What is the vestibule of the oral cavity?

A

The part of the oral cavity in front o the teeth

264
Q

What is the medical term for the gums?

A

Gingiva

265
Q

What two arches make up the fauces of the oral cavity?

A

Palatoglossal arch

Palatopharyngeal arch

266
Q

What is the soft palate?

A

The uvula

267
Q

What is the ridge of tissue that connects the tongue to the floor of the mouth?

A

Lingual frenulum

268
Q

How many of each teeth do we have?

A

2 incisors
1 canine
2 premolars
3 molars

269
Q

What are the muscles of the tongue?

A 
Intrinsic muscles=
4 paired muscles
Extrinsic muscles=
1-Genioglossus
2-Hypoglossus 
3-Styloglossus (hypoglossal nerve)
4- Palatoglossus (Vagus nerve)
270
Q

What nerves innervate the tongue and what areas?

A

Anterior 2/3 = sensation - trigeminal nerve (V3)
Taste -facial nerve

Posterior 1/3 = Sensation and taste - glossopharyngeal (IX)

271
Q

What is the name of the duct that comes out of the base of lingual frenulum and what two glands secrete through it?

A

Wharton Duct

Submandibular and sublingual glands

272
Q

What tooth is lateral to the parotid duct?

A

2nd premolar

273
Q

What are the borders of the parotid gland?

A

Superior border= zygomatic arch
Posterior border= sternocleidomastoid muscle
Anterior border= Masseter muscle
Buccinator is pierced by the parotid gland duct

274
Q

Sialolithiasis is what?

A

Stones in the salivary ducts

275
Q

What is the most common duct that gets blocked in sialolithiasis?

A

Submandibular glands

276
Q

What are 3 common symptoms of sialolithiasis?

A

Pain in gland
Swelling
Infection
(Eating stimulates the problem)

277
Q

Causes of tonsillitis?

A

Viral cause - most common

Bacterial causes - up to 40% of cases - Strep pyogenes

278
Q

What are the 4 most common symptoms of tonsillitis?

A

Sore throat
Pain/ difficulty swallowing
Cervical lymph nodes
Bad breath

279
Q

What is a good distinguishing feature between tonsillitis and peritonsillar abcess?

A

Drooling with peritonsillar abcess
PTA - difficulty opening mouth but tonsillitis - pain/difficulty swallowing
PTA - uvula deviation but tonsilitis no uvula deviation

280
Q

What are the boundaries of the nasopharynx?

A

Base of skull to upper border of soft palate-
Posterior (C1, C2)
Anterior (nasal cavity)
Contains - pharyngeal tonsil/ aka adenoids

281
Q

What are the boundaries of the oropharynx?

A

Soft palate to epiglottis

Ant= oral cavity
Posterior = C2, C3

Contains palatine tonsils

282
Q

What are the boundaries of the laryngopharynx?

A 
Boundaries=
- Oropharynx to oesophagus
- Epiglottis to cricoid cartilage
Anterior- Larynx
Posterior - C4-C6

Contains - piriform fossa

283
Q

What is the piriform fossa?

A

The gap between the tracheal inlet and the aryepiglottic folds

284
Q

What muscles elevate the pharynx and larynx during swallowing and what are their innervation?

A

Stylopharyngeus - styloid process - posterior border of thyroid cartilage - Glossopharyngeal nerve (CN IX)

Palatopharyngeus - hard palate - post. Border of thyroid cartilage - Pharyngeal branch of vagus (CN X)

Salpingopharyngeus - cartilaginous part of ET - merges with palatopharyngeus - opens the ET tube to balance the pressures too - Pharyngeal branch of vagus (CN X)

285
Q

What are the pharyngeal constrictors and where d0 they insert?

A

3x circular muscles - constrict walls of pharynx when swallowing

1- Superior pharyngeal constrictor - origin - pterygomandibular raphe
2- Middle pharyngeal constrictor - Origin - Hyoid bone
3- Inferior pharyngeal constrictor
- has 2 parts a) thyropharyngeal (origin-thyroid cartilage) b) cricopharyngeal (origin - cricoid cartilage)

Insertion point - Pharyngeal raphe

286
Q

What is a pharyngeal pouch and what is the cause of the symptoms?

A

Posteromedial (false) diverticulum- arises in weakness between the two parts of the inferior constrictors - Killian’s dehiscence

Food material collecting in pouch or disruption of swallow

287
Q

What are the phases of swallowing?

A

1- oral
2- pharyngeal
3- oesophageal

288
Q

Describe the oral phase of swallowing?

A

Voluntary
Preparatory phase- making bolus
Transit phase - bolus compressed against palate and pushed into oropharynx by tongue and soft palate

289
Q

Describe the pharyngeal phase of swallowing?

A
  • Involuntary
  • Tongue positioned against hard palate
  • Soft palate elevated sealing off nasopharynx
  • Suprahyoid and longitudinal muscles shorten - pharynx widens and shortens to receive bolus
  • larynx elevated and sealed off by vocal folds
  • Epiglottis closes over larynx sequential contraction of constrictors
  • Relaxation of UOS
290
Q

Describe the oesophageal phase of swallowing

A
  • involuntary
  • upper striated muscle of oesophagus
  • lower smooth muscle
291
Q

What are the usual symptoms of dysphasia?

A
  • Coughing + choking
  • Sialorrhoea (drooling)
  • Recurrent pneumonia - problems coordination swallow
  • Change in voice/ speech (wet voice)
  • Nasal regurgitation - soft palate not working
292
Q

What are the anatomical relations of the orbit

A
  • Paranasal air sinuses (maxillary and ethmoid)
  • Nasal cavity - nasolacrimal duct - drains tears into nose
  • Anterior cranial fossa - sits superior to orbit
293
Q

What are the components of the eye lid?

A

Skin, cutaneous tissue, tarsal plate, muscles=

  • orbicularis oculi - palpebral part -> closes the eye lid
  • Levator palpebrae superioris -> lifts the eye lid

Glands -
Meibomian glands - halo rise exocrine glands - produce meibum an oily substance that prevents evaporation of liquid eye film
Sebaceous glands associated with lash follicle - allows waterproof coating to coat the eye lash as it sits around the follicle.

294
Q

What are the glands of the eye and what problems does it cause?

A

Meibomian gland blockage - meibomian cyst= not painful, difficult to treat. Wash eye w/ baby shampoo.

Eyelash follicle or its associated sebaceous gland can block - (staph infection) causing styes

Blepharitis - inflammation of lids (including skin, lashes and meibomian glands)

295
Q

Difference between pre-septal cellulitis and post-septal cellulitis

A

Ocular functions remains unaffected in pre-septal but visual acuity and movement (proptosis/ exophthalmos) are found in

Post- septal more likely to lead to permanent damage to optic nerve as it is generally to do with locality of the infection/ inflammation behind protective septum, pre-septal - generally to do with trauma/ wounds but in front of protective septum

Post-septal = can track to affect the cavernous sinus causing thrombosis or even meningitis

296
Q

Structures involved in tear film production?

A

Lacrimal gland - tear production, lacrimal sac and ducts (tear drainage) - ducts= canaliculi and nasolacrimal duct

Blinking - orbicularis oculi distributes tear film across front of eye, rinsing and lubricating conjunctivae and cornea

Tears are ultimately drained into nasal cavity

297
Q

Name the layers of the eyeball

A

Outer: sclera - continuous anteriorly as transparent cornea - continuous with dura

Middle: choroid, ciliary body and iris (vascular)

Inner: retina (inner photosensitive layer lining on an outer pigmented layer)

Medicine (15 decks)

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