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Head, Neck and Neuro Flashcards

1
Q

Olfactory cortex in

bulbs are in…

A

Olfactory cortex is in temporal lobe of brain — part of the limbic system.

Bulbs are in forebrain

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2
Q

Optic canal:

A

Optic nerve Ophthalmic artery Central retinal artery and vein

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3
Q

Superior Orbital Fissure

A

Artery: Lacrimal artery - branch of ophthalmic artery

Veins: Superior and Inferior Ophthalmic Veins (joins cavernosu sinus)

Nerves - CN 3, CN 4, of CN 5 - V1 branches (lacrimal, nasociliary and frontal) CN 6 Sympathetic plexus

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4
Q

Extra occular muscle origin

A

all recti - Annulus of Zin

Superior Olique as well via trochlea

Inf - Maxillary bone

LPS - Sphenoid

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5
Q

Testings eyes

A

Sup/inf Obliques - look laterally and opposite to name

Sup/Inf Recti - look medially and same as name (Lateral rectus is only lateral gaze)

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6
Q

Superior tarsal muscle

A

Smooth muscle Sympathetic supply - superior cervical ganglion, and travel via the internal carotid plexus

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7
Q

Sympathetic and Parasympathetic to eye

A

Sympathetic - super cervical ganglion - long ciliary nerves, dialator

Parasympathetic - Ciliary ganglion - short ciliary nerves - sphincter pupillae

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8
Q

Foramen Ovale

A

Otic ganglion — IX, PS, ITF, parotid

V3 branch of CN5

Accessory middle meningeal artery (aka: pterygomeningeal artery)

Lesser petrosal nerve —from IX, PS, parotid

Emissary veins

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9
Q

What are the branches of the ophthalmic division of the trigeminal nerve?

A
  1. Lacrimal
  2. Frontal
    • Supratrochlear medially
    • Supraorbital laterally
  3. Nasociliary:
    • Infratrochlear
    • Anterior + Post ethmoidal
    • Long ciliary (NO INFRA-ORBITAL)
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10
Q

Branches of the maxillary division of the trigeminal nerve:

A

i) Infraorbital
ii) Zygomatic - zygomaticotemporal and zygomaticofacial
iii) Superior alveolar — anterior, middle and posterior
iv) Palatine — greater, lesser
v) Pharyngeal
vi) Superior labial

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11
Q

Main divisions of the mandibular division of the trigeminal nerve. Before it divides:

A

Tensor Tympani

Tensor Veli Palatini

N to Medial Pterygoid

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12
Q

Divisions of Mandibular

A

Anterior division:

  • Motor - masseteric, deep temporal, lateral pterygoid
  • Sensory - buccal

Posterior division:
• Motor — inferior alveolar; gives off the N to mylohyoid
• Sensory - inferior alveolar, auriculotemporal, lingual

(Buccal is the only anterior in BAIL)

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13
Q

The sensory branches of CN V3:

A

i) Buccal; ii) Auriculotemporal; iii) Inferior alveolar; iv) Lingual ‘BAIL’.

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14
Q

Structures that pass through the inferior orbital fissure:

A

Infraorbital artery and vein

Infraorbital nerve

Zygomatic nerve

Inferior ophthalmic vein (joining pterygoid venous plexus)

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15
Q

Structures that pass through the inferior orbital foramen:

A

Infraorbital artery, vein and nerve (Maxillary branch!)

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16
Q

Foreman Spinosum

A

Middle MENINGEAL artery

MENINGEAL branch of V3 (supplies the dura mater)

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17
Q

Foramen Lacerum

A

GPN (from CN VII) joins with DPN (sympathetic N) to form

The nerve of the pterygoid canal (Vidian nerve)

The ICA runs over it.

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18
Q

Parasympathetic to lacrimal gland and the mucosal glands of the nose, palate, and pharynx.

A

GPN (from CN VII)

Superior salivary nucleus - Preganglionic parasympathetic fibres arise

Join with somatic sensory - Nervus Intermedius

through IAM Through Geniculate ganglion - as GPN

Join DPN (sympathetic N) to form nerve of the pterygoid canal / Vidian Nerve

To reach pterygopalatine ganglion - lacrimal gland and the mucosal glands of the nose, palate, and pharynx.

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19
Q

Parotid Supply

A

Sensory - Greater Auricular Nerve

Preganglionic parasympathetic fibers: The inferior salivatory nucleus in IX via the lesser petrosal nerve (IX), transmitted to the otic ganglion.

There, they synapse with postganglionic fibers which reach the gland by hitch-hiking via the auriculotemporal nerve, a branch of the mandibular nerve.

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20
Q

Internal acoustic meatus

A
  • CNs 7 and 8 Labyrinthine artery (br of basilar artery)
  • Vestibular ganglion

estibular N — Equilibrium

Cochlear N —Auditory information

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21
Q

Parasympathetic to submandibular and sublingual glands

A

Superior salivary nucleus - Preganglionic parasympathetic fibres arise

Through Geniculate ganglion - as GPN

via chorda tympani as lingual nerve to submandibular ganglion

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22
Q

Ramsay Hunt syndrome

A
  • Vesicular rash of the ear or mouth
  • The rash might precede the onset of facial paresis/palsy • Ipsilateral lower motor neuron facial paresis/palsy (CN VII)
  • Vertigo and ipsilateral hearing loss
  • Tinnitus; Otalgia; Headache
  • Dysarthria; Gait ataxia • Fever; Cervical lymphadenopathy

Self remitting: Conservative Supportive

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23
Q

Jugular foramen CN 9, 10 and 11

A

CN 9, 10 and 11

INFERIOR PETROSAL sinus and SIGMOID sinus unite to form the

Internal jugular vein

+ Ascending pharyngeal artery

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24
Q

CNXII

A

Hypoglossal canal

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25
Q

Foramen Magnum

A

Vertebral arteries forming the basilar artery, anterior and

Arteries - posterior spinal arteries

Veins - Spinal veins

Nerves - Spinal accessory nerve

Soft tissue - End of medulla & beginning of spinal cord, meninges

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26
Q

Areas supplied by ACA

A

• Part of the frontal lobe, specifically medial surface and upper border.

(where the legs are for the homunculus!)

Anterior 4/5th the corpus callosum

Anterior limb of the internal capsule, part of the caudate nucleus and globus pallidus.

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27
Q

Lesions of ACA

A

Contralateral paralysis of foot and leg

Contralateral sensory loss in foot and leg

Gait apraxia and foot drop

Abulia (absence of willpower or an inability to act decisively),

confusion, amnesia, apathy, short attention span

Urinary incontinence which with bilateral lesion •

Presence of frontal cortical release reflexes: contralateral grasp reflex, sucking reflex, paratonic rigidity

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28
Q

Areas supplied by MCA

A
  • The bulk of the lateral surface of the hemisphere; except for the superior inch of the frontal and parietal lobe (ACA), and the inferior part of the temporal lobe (PCA).
  • Superior division supplies Broca’s area
  • Inferior division supplies Wernicke’s area • Deep branches supply the basal ganglia and internal capsule
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29
Q

Lesions of MCA

A
  • Paralysis of contralateral face and arm
  • Sensory loss of the contralateral face and arm
  • Dominant hemisphere lesion — aphasia

Non-dominant hemisphere lesion - results in contralateral hemispatial neglect

  • Deviation conjuguee (Prevost’s sign) - horizontal deviation of eyes towards the side of the lesion Contralateral homonymous hemianopia
  • Dysphagia (medial temporal lobes and limbic system control the oral phase)

Neurogenic bladder

MCA occlusion site and resulting aphasia:
Global—trunk of MCA
Broca (expressive) — anterior branch of MCA
Wernicke (receptive/sensory/fluent) — posterior branch of MCA

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30
Q

Lateral medullary syndrome

A

• Blockage in PICA or one of its branches. • AKA: PICA syndrome, vertebral artery syndrome or Wallenberg’s syndrome

A. IPSILATERAL

  1. Xth cranial nerve palsy
  2. Cerebellar signs
  3. Horner’s syndrome
  4. Impaired pain, temperature and touch on the upper half of face

B. CONTRA LATERAL
1.Impaired pain and temperature over the body

Palatal myoclonus due to the central tegmental tract being affected

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31
Q

Lateral Pontine Syndrome

A

similar to the lateral medullary syndrome, but involves CNVII as well.

Caused by occlusion of anterior inferior cerebellar artery.

Stroke in pons.

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32
Q

Areas supplied by PCA

A

• Occipital and occipitoparietal cortices Parts of the midbrain Subthalamic nucleus Basal nucleus Thalamus Medial inferior temporal lobe

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33
Q

Lesions of PCA

A
  • Contralateral loss of pain and temperature.
  • Visual field defects (contralateral hemianopia with macular sparing).
  • Prosopagnosia (face blindness).
  • Superior alternating syndrome (Weber’s syndrome) - ipsilateral CNIII palsy and contralateral hemiparesis

Bálint’s syndrome (inability to perceive visual field as a whole, difficulty in fixating eyes (oculomotor apraxia), and inability to move hand to a specific object by using vision (optic ataxia)

Contralateral deficits of CNs VII, X and XII Horner’s Syndrome

Disorders of reading, colour vision and memory impairment

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34
Q

Medial Medullary Syndrome -

A

contralateral motor loss, contralateral dorsal column and ipsilateral CNXII injury.

Caused by occlusion of anterior spinal artery

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35
Q

Medial Pontine Syndrome

A

Liked Medial MEdullary - Minus hypoglossal + abducens

Contralateral motor loss, contralateral dorsal column

ipsilateral CNVI injury.

Caused by occlusion of paramedian branches of the basilar artery. Stroke in pons.

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36
Q

Weber’s Syndrome

A

Like Lateral Medullary + Facial Nerve

ipsilateral CNIII palsy and contralateral hemiplegia.

Caused by occlusion of posterior cerebral artery or its branches.

Stroke in the midbrain.

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37
Q

The following nerves are located in the lateral wall of the cavernous sinus except:

A. Occulomotor nerve B. Trochlear nerve C. Mandibular division of trigeminal nerve D. Maxillary division of trigeminal nerve E. Ophthalmic nerve

A

C. Mandibular division of trigeminal nerve D.

3,4,5(1),5(2)

And through it:

VI INFEROLATERAL to Internal carotid artery

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38
Q

All glossi supplied by

Except…

A

Hypoglossal

Except for Palatoglossus - Supplied Pharyngeal Plexus (Vagus Nerve)

REMEMBER:

(vagus takes one from hypoglossal (palatoglossus) and
glossopharyngeal takes on from vagus (stylopharyngeus)

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39
Q

The five main layers to the scalp are:

A

S :Skin

C: Connective tissue (blood supply lies in this layer)

A: Aponeurosis (lacerations below this layer can gape)

L: Loose areolar tissue

P: Periosteum (skin cancers excised to this layer)

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40
Q

Arterial supply to the scalp:

A

From internal carotid:

  1. Supratrochlear artery: branch of ophthalmic
  2. Supraorbital artery: branch of ophthalmic
  3. Zygomaticotemporal artery: branch of lacrimal (also branch of ophthalmic!)

From external carotid:

  1. Superficial temporal artery
  2. Posterior auricular artery
  3. Occipital artery
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41
Q

External ear
Blood supply and nerves

A

Blood supply: Posterior auricular and superficial temporal arteries.

Nerve supply of external ear:

  1. Great auricular nerve (a branch of the cervical plexus C2 and C3)
  2. Auriculotemporal nerve (branch of the mandibular division of the trigeminal CN V3)
  3. Auricular branch of the vagus nerve (Arnold’s nerve)
  4. Lesser occipital nerve
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42
Q

Kiesselbach’s plexus?

A

Kiesselbach’s plexus (‘Little’s area’) - anteroinferior part of the nasal septum where four arteries anastomose to form a vascular plexus:

  1. Anterior ethmoidal artery (from the ophthalmic artery)
  2. Sphenopalatine artery (terminal branch of the maxillary artery)
  3. Greater palatine artery (from the maxillary artery)
  4. Septa! branch of the superior labial artery (from the facial artery)

90% of all epistaxis arise from this plexus.

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43
Q

Sensory supply to nose:

A

Sensory supply to nose:

Tip: External nasal branch of the anterior ethmoidal nerve (V5.1 NC)
Bridge of nose: Infratrochlear nerve (V5.1 NC)
Sides and ala of nose: Infraorbital nerve (V5.2)

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44
Q

Nerve to lacrimal gland

A

Pons Facial Nerve lacrimatory nucleus runs in

Nervus Intermedius to the geniculate ganglion (but do not synapse)

Pre-G’s fibres run in GPN (joining DPN to make Vidian Nerve)

Through pterygoid canal to pterygopalatine ganglion and psynapse

Post-G’s fibres join Maxillary Nerve, branch off with the zygomatic nerve,

Finally joins lacrimal branch of V5 Opthlamic

V5 Opthlamic (which supplies sensory innervation to the lacrimal gland along with the eyelid and conjunctiva.)

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45
Q

Which amongst the following is the deepest structure in the parotid region?

A

Stylohyoid muscle (other muscles are stylopharyngeus and posterior belly of the digastric)

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46
Q

What are the branches of the facial artery?

A

The branches within the neck include the:

  • Ascending palatine artery
  • Tonsillar artery
  • Submental artery
  • Branch to the submandibular gland

The branches within the face include the:
•Inferior labial artery
•Superior labial artery
•Lateral nasal branch
•Angular artery

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47
Q

Boundaries of Infratemporal fossa

A

Boundaries:

  • Medial: Lateral pterygoid plate
  • Lateral: Mandible ramus and coronoid process
  • Anterior: Infratemporal surface of the Maxilla
  • Superior: Greater wing of sphenoid
  • Posterior Mastoid and styloid processes of the temporal bone
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48
Q

Contents of Infratemporal Fossa

A

Muscles: 1. Medial pterygoid 2. Lateral pterygoid 3. Temporalis muscle

Infratemporal Fossa:
Vessels: 1. Maxillary artery 2. Pterygoid venous plexus 3. Retromandibular vein

Nerves: 1. Mandibular Nerve 2. Chorda tympani 3. Lingual nerve 4. Inferior alveolar nerve
Ganglion: Otic

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49
Q

PS Ganglia in the Head

A

PS Ganglia in the Head

  • Ciliary ganglion: Located behind the eye in the posterior orbit, associated with the CNIII; contributes to the pupillary and accommodation reflexes.
  • Pterygopalatine (Sphenopalatine) ganglion: Greater petrosal nerve (branch of VII) supplying the lacrimal gland, paranasal sinuses and glands in the palate and nasal cavity.
  • Submandibular ganglion: Chorda tympani branch of VII and lingual branch of V, suppling submandibular and sublingual glands.
  • Otic ganglion: Located just below foramen ovale in the associated with the IX nerve; secretomotor to the parotid.
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50
Q

Sympathetic Supply

A

Thoracolumbar

T1-L2

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51
Q

Sympathetic Trunks and Splanchnic Nerves

A

a) Greater splanchnic T5 - T9
b) Lesser splanchnic T10 - T11
c) Least splanchnic T12

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52
Q

Bladder Nerve Supply

A

The parasympathetic supply is via the Pelvic Splanchnic Nerve - S2 S3 S4 on vesical plexus. - detrusor muscle contraction, internal sphincter relaxation

Sympathetic supply from T10 to L2, synapsing on inferior mesenteric, hypogastric and vesical plexuses - detrusor muscle relaxation and internal sphincter contraction.

Somatic nerve supply, via Pudendal Nerve S2 S3 S4, may contract or relax external sphincter

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53
Q

In a full bladder

A
  • Sensory pelvic nerves from detrusor muscle, due to stretch, sends fast signal to the sacral spinal cord
  • Signal directly to Pontine micturition centre
  • Parasympathetic fibres are stimulated — contracts the detrusor
  • Hypogastric sympathetic N inhibited — opens the internal sphincter
  • Pudendal N inhibited and relaxes the external sphincter
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54
Q

Bladder nerve receptors

A
  • Sacral PSN: Acts on detrusor muscle muscarinic (M3) receptor—causes contraction of the detrusor
  • Pudendal N (52, 3, 4): Acts on nicotinic receptor in the external sphincter causes contraction of the sphincter

• Sympathetic N: — Hypogastric Nerve
Acts on Beta Adrenergic (83) receptor of the detrusor muscle and causes relaxation of the muscle
Acts on Alpha Adrenergic (A3) receptor of the internal sphincter and contracts the sphincter

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55
Q

Anterior Cord Syndrome

A
  • Complete motor paralysis
  • Loss of pain and temperature sensation
  • Position and vibration sense preserved
  • Associated with severe flexion iniury
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56
Q

Tracts and Decussations

A
  • The dorsal column-medial lemniscal pathway carries tactile sensation, vibration and proprioception — Decussates at level of medulla
  • Anterior spinothalamic tract carries crude touch and pressure —Decussates 1-2 vertebral levels above the spinal nerve entry level (give a fondle from the front)
  • Lateral spinothalamic tract carries pain and temperature - Decussates 1-2 vertebral levels above the spinal nerve entry level (pinch and burn from the side)
  • The lateral corticospinal tract carries motor sensation (fine movements) - Decussates at the level of pyramids in the lower medulla (side step and glide elegantly up the pyramid)
  • The anterior corticospinal tract carries motor sensation (controls central axial and girdle muscles) - Decussates at the level of spinal nerve
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57
Q

Posterior Cord Syndrome

A

• May result from hyper flexion injury.

Profound sensory loss Ataxic presentation without procrioceptive feed back ascending the cord.

• Motor functions is spared.

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58
Q

Central Cord Syndrome

A

UL Motor Loss > LL Limb

Older people can occur - hyperextension injuries

UL - LMN signs

LL - UMN signs

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59
Q

Brown-Sequard Spinal Cord Hemi Section

A

IPSILATERAL

  1. UMN Weakness
  2. Loss of position and vibration

CONTRALATERAL

  1. LOSS OF PAIN AND TEMPERATURE
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60
Q

Neurogenic shock

A
  • Lesions at T6 level or higher
  • Hypotension and bradycardia
  • Warm peripheries
  • Dry skin below injury level
  • Management- IV fluids +/- vasopressors
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61
Q

Posterior Triangle of the Neck

A

Contents Nerves and plexuses:

  • Spinal accessory nerve
  • Branches of the cervical plexus
  • Roots and trunks of the brachial plexus

• Phrenic nerve
Arteries : Third part of the subclavian artery
(transverse cervical and suprascapular arteries)

Veins: External jugular vein
Others: Lymph nodes Omohyoid muscle

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62
Q

All intrinsic muscles of the larynx supplied by…

With exception of…

A

All are supplied by the recurrent laryngeal nerve

Except for the cricothyroid

Which is supplied by the external branch of superior laryngeal nerve

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63
Q

From midline of the neck

Level
• Hyoid bone

Thyroid cartilage ….corresponds to
• Cricothyroid membrane — important for ….
• Cricoid cartilage — level of …
• Thyroid gland — isthmus over the …

A

From midline of the neck

3,4,6

• Hyoid bone — level of C3 vertebrae

  • Thyroid cartilage — level of C4 vertebrae — C4 corresponds to bifurcation of common carotid arteries
  • Cricothyroid membrane — important for cricothyroidectomy (surgical airway)
  • Cricoid cartilage — level of C6 vertebrae, — junction of larynx with the trachea — junction of the pharynx with the oesophagus
  • Thyroid gland — isthmus over the 2nd and 3rd tracheal rings
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64
Q

Cricothyroid

A

External Branch of Superior Laryngeal Nerve

Originates form cricoid

Pulls thyroids cartialge down and out

Tenses the vocal cord

Increases pitch

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65
Q

Cricoarytenoid

  • Posterior and Lateral
A

Cricoid has 2 depressions - 2 muscle groups

Arytenoid - muscle procress posterolaterally
Arytenoid - vocal process anterior

Posterior Cricoarytenoid - lateral rotation - widens the rimma glottidis - only muscle. Vocal Cord Abduction.

Lateral cricoarytenoid - from the upper part of cricoid arch, inserts the same place.
But as it sits infront of the muscular process, it will INTERNALLY rotate,
closing the rimma glottidis, thus ABDUCTING the cords.

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66
Q

Thyroarytenoid

A

https://www.youtube.com/watch?v=GEMquo7qxpg

Thyroarytenoid muscle - thryoid cartialage to A/L of A.C.

(Vocalis) - runs lateral to vocal ligament.

Thyroarytenoid - upwards fibres - thyro-epiglottic muscle

When it contracts - it brings A.C. closure to T.C.

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67
Q

Surgical considerations
• Superior thyroid artery —
• Superior laryngeal artery —
• Inferior laryngeal artery and inferior thyroid artery—

A

Surgical considerations
• Superior thyroid artery — external laryngeal nerve
• Superior laryngeal artery — internal laryngeal nerve
• Inferior laryngeal artery and inferior thyroid artery— recurrent laryngeal nerve

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68
Q

All Muscles of the Pharynx Supplied by…

Except…

A

All by pharyngeal branch of Vagus

Except for Stylopharyngeus which is supplied by Glossopharyngeal Nerve

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69
Q

Ant 2/3 Tongue…

A

Nucleus Tractus Solitarius

Geniculuate Ganglion

Chorda tympania Nerve

Affarent taste fibres.

General Sensation - Lingual branch of CN 5.3

With it (Superior salivatory nucleus fibres that synapse on the submandibular ganglion.

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70
Q

Lymphatic drainage of the tongue

A

Tip: Submental nodes

Anterior 2/3 lateral border Ipsilateral Submandibular node

ANTERIOR 2/3 CENTRALLY Submandibular nodes on both sides

Posterior 1/3 Jugulo-omohyoid nodes

FINAL NODES TO BE INVOLVED ARE Jugulo-omohyoid and deep cervical nodes

71
Q

Thyroid Lobe Levels

A
  • Secretes thyroxine and calcitonin.
  • Upper lobe - level of C5 vertebrae
  • Lower lobe - C7/T1 vertebrae.
  • Sternothyroid and sternohyoid muscles lie superficial to the thyroid gland.

Hyoid bone — level of C3 vertebrae

Thyroid cartilage — level of C4 vertebrae — C4 corresponds to bifurcation of common carotid arteries

72
Q

Thyroid arterial and venous

A

Arterial supply

  • Superior thyroid arteries (from the external carotid artery) supply the upper lobes.
  • Inferior thyroid arteries (from the thyrocervical trunk) supply the lower lobes.
  • Thyroid ima artery (from brachiocephalic artery) is present in some.

Venous drainage
• Superior thyroid veins (drains into IJV)
• Middle thyroid veins (drains into IJVV)

• Autonomic supply from cervical sympathetic ganglia

Lymphatic drainage • Into prelaryngeal, pretracheal, paratracheal, deep cervical lymph nodes • Sometimes into the brachiocephalic lymph nodes or into thoracic duct.

• Inferior thyroid veins (drains into brachiocephalic vein)

73
Q

Tongue drainage

A

o Posterior tongue – BL Deep C Nodes, Anterior ipsilateral

o Tip – submental – DCNs

o Mid tongue – submandibular – DCNs

74
Q

V3 - Lingual nerve – 3rd molar - anaesthesia

A

of the ipsilateral anterior ant 2/3 general sensation of tongue

75
Q

Post tonsillectomy otalgia – damage to

A

Post tonsillectomy otalgia – glossopharyngeal

76
Q

Pleomorphic adenoma – superficial thyroidectomy – conserve

A

superficial thyroidectomy – conserve facial nerve

77
Q

Tumour with highest P() perineural spread – facial pain + weakness

A

denoid cystic carcinoma – highest P() perineural spread – facial pain + weakness

78
Q

Mastoid infection surgery – altered taste –

A

chorda tympani (facial nerve)

79
Q

Subclavian vein behind

anterior to …

with what behind that..

A

Subclavian vein behind middle third of clavicle, anterior to scalane, subclavian artery behind it.

80
Q

Sensation to lateral nose

A

lateral nasal branches of anterior ethmoidal nerve.

81
Q

Cervical rib – elongation of

A

C7 transverse process

82
Q

Scalenus anterior separates

A

subclavian artery and veins

83
Q

External tympanic membrane is made of…

A
  • stratified squamous epithelium
84
Q

Lymphatic drainage of the auricle

A

o Lateral surface of upper half drains - superficial parotid lymph nodes

o Cranial surface of superior half - mastoid nodes + deep cervical lymph nodes

o Lower half and lobule - superficial cervical lymph nodes.

85
Q

Inf thyroid artery feeds thyroid @

A

Inf thyroid artery feeds thyroid @ C6

86
Q

Para supply to parotid

A

– Inf salivary nucleus – IX - >less petrosal – otic ganglion – auricotemporal of v3

87
Q

unaffected by facial nerve division in parotidectomy…

A

Facial nerve chorda tympani branch in facial canal

88
Q

artery supplies lacrimal apparatus

A

Opthalmic artery supplies lacrimal apparatus

89
Q

reactionary haemorrhage post-tonsillectomy (immediately lateral)

A

External palantine vein – reactionary haemorrhage post tonsillectomy (immediately lateral.

90
Q

Mandibular V3 Muscles:

A

Mandibular V3 Muscles: Masseter, Temporalis, Medial + Lateral pterygoids

91
Q

Other Mandibular V3 Muscles (2 Anteriors and 2 Tensors):

A

o Tensor veli palatini (soft palate)

o Tensor tympani (tympanic membrane)

o Anterior belly of digastric

o Mylohyoid – I’m not tense

92
Q

Angle of the jaw - supplied by…

A

Angle of the jaw - Greater auricular nerve (C2-C3) NOT V3

93
Q

Divide what to access the ansa crvicalis C1 + (C2/3)

A

Divide pretracheal fascia for ansa crvicalis C1 + (C2/3) – ant to carotid sheath

94
Q

Type of joint for teeth

A

Gamphoses – peg/socket fibrous joint – teeth

95
Q

Vertebral artery

A

Vertebral artery – transverse process of C1-6, vertebral canal + f. magnum. NOT intervertebral foramen.

The vertebral arteries travel across the posterior arch of C1 and through the suboccipital triangle before entering the foramen magnum.

96
Q

Relation of common carotid to inferior thyroid

A

Common carotid – lateral to inferior thyroid

97
Q

Post carotid endarectomy – tongue weakness secondary to

A

hypoglossal nerve damage

98
Q

Submandibular swelling + halitosis = Blocked wharton’s

A

Submandibular swelling + halitosis

99
Q

External Carotid branches

A

Sup Thyroid, Asc Pharyngeal, Lingual, Facial, Occip, post auricular, Maxillary, Sup temporal

100
Q

Origin of inferior thyroid and thyroid ima

A

Inf thyroid via thyrocervical trunk, thyroid ima via brachiocephalic

101
Q

Middle meningeal – branch of

A

Middle meningeal – branch of maxillary

102
Q

Posterior Triangle Nerves and Vessels

A

Posterior Triangle Nerves – PLAG

o Phrenic, Lesser Occipital, Accessor and Greater auricular

o Vessels: External Jugular Vein + Subclavian artery

103
Q

C6: Sympathetic change between carotid sheath and prevertebral fascia?

A
104
Q

Carotid sheath closely related to which muscles…

A

Carotid sheath closely related to: sterno hy/thyroid + sup of omohyoid + X11

105
Q

when tying MMA…

A

Auricotemporal temporal nerve damage – ipsi ear

106
Q

Submandibular – % of spit

A

Submandibular – 70% of spit

107
Q

Laynx sensation –

A

vagus.

108
Q

basal skull # - lacrimation, no tears!

A

Greater petrosal nerve injry – basal skull # - lacrimation, no tears!

109
Q

Branchial cyst excision at risk:

A

Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.

110
Q

Inferolateral lump on nose that cracks

A

Ameloblastoma

111
Q

22 months – posterior triangle neck lump that transluminates =

A

22 months – posterior triangle neck lump that transluminates = cystic hygroma

112
Q

Idiopathic epistaxis -

A

Kiesselbachs plexus supply derived from both carotids

113
Q

The posterior scalp is supplied by

A

GOC C2-C3

114
Q

Hypoglossal nerve – supplies all intrinsic and extrinsic muscles of the tongue except

A

palatoglossus (accessory and vagal)

115
Q

Parotid duct…

A

stenson’s duct – opens at 2nd upper molar

116
Q

Otalgia, facial nerve palsy without hearing loss

A

– malignant otitis externa - Usually pseudomonas

117
Q

Chordia typani runs medially to

A

Chordia typani runs medially to pars flaccida not tensa

118
Q

External branch Superior laryngeal supplies…

A

Cricothyroid – not recurrent

119
Q

Internal carotid branches

A

Internal carotid – only press carotid arteries momentarily

Ophthalmic, post comm, choroidal, anterior cerebral, middle cerebral

120
Q

Common carotid bifurcation at

A

Common carotid bifurcation at C4

121
Q

Secondary haemorrhage post tonsillectomy – between days

A

Secondary haemorrhage post tonsillectomy – between days 5-10

122
Q

Transverse cervical nerve lies within

A

Transverse cervical nerve lies within the posterior triangle

123
Q

Middle Thyroid drains into

A

Middle Thyroid drains into internal jugular

124
Q

Space between vocal cords –

A

Space between vocal cords – Rima Glottidis

125
Q

Retromandibular vein is a confluence of…

A

Retromandibular vein = maxillary + superficial temporal

126
Q

Parotid penetrates the

A

Parotid penetrates the buccinator

127
Q

External jugular lies superficial to

A

to head and neck

128
Q

Syringomyelia – loss of

A

oss of spinothalamic tract / pain and temperature

129
Q

herniates causing back/leg pain

A

Nucleous polyposis

130
Q

LPs – subarachnoid space, first encounter

A

supraspinous ligament

131
Q

suspends SC in dural sheath (pia continuation)

A

Denticulate ligament

132
Q

Ligamentum Flava –

A

– anterior to the spinous process

133
Q

Adult SC terminates at

dural sac…

A

Adult SC terminates at L1, dursal sac at S2

134
Q

Posterior longitudinal ligament separates

A

Posterior longitudinal ligament separates intervertebral disk from SC

135
Q

Craniopharyngiomas – compression from above

A

Lower > upper quadrant defect

136
Q

Lateral medullary syndrome – post/inf cerebellar artery –

A

Ipsi facial numbness, dysphagia, nystagmus + contra sensory loss

137
Q

Loss of baroreceptor firing in

A

Loss of baroreceptor firing in hypotension

138
Q

Neurological signs + abdominal pain =

A

Neurological signs + abdominal pain = acute intermittent porphyria or lead poisoning until proven otherwise.

139
Q

first to go in raised ICP due to long intracranial course

A

CN VI first to go in raised ICP due to long intracranial course

140
Q

CSF finding in bacterial meningitis

A

CSF Neutrophilia in bacterial meningitis

141
Q

Frontal lesion crossing midline with central necrosis

A

Frontal lesion crossing midline with central necrosis – glioblastoma

142
Q

Hyperhydrosis of hands and arms – divide sympathetic ganglia of

A

Hyperhydrosis of hands and arms – divide sympathetic ganglia of T2/T3

143
Q

Large branch of Basilar artery-

A

Large branch of Basilar artery- post inf cerebellar artery

144
Q

Nerve regrowth at a rate of..

A

Nerve regrowth 1mm/d

145
Q

Lumbar vertebrae – have no…

A

Lumbar vertebrae – no transverse process

146
Q

Spinous process – formed by

A

Spinous process – formed by 2 laminae posteriorly

147
Q

Orbital apex syndrome =

A

Orbital apex syndrome = superior orbital fissure syndrome + optic nerve compression (+ipsilateral afferent pupillary defect).

148
Q

Removing a parietal lobe tumour? CUSA device!

A

Cavitron ultrasonic surgical aspirator (CUSA) and …

149
Q

3rd Nerve palsy, headache, meningism – exclude

A

3rd Nerve palsy, headache, meningism – exclude Post com artery aneurysm

150
Q

separates optic chiasm from ant pituitary

A

Dural fold separates optic chiasm from ant pituitary

151
Q

to test for CSF rhinorrhoea

A

Beta2 tranferrin assay - CSF rhinorrhoea

152
Q

Origin of Trigeminal..

A

Trigeminal – broad base including pons

153
Q

2yo with tumour on the floor of the 4th ventricle

A

Ependymoma

Can cause syringeomyelia

NFII

154
Q

Parsonage-Turner syndrome

A

post viral peripheral neuropathy

155
Q

Normal ICP is…

The Brain can tolerate up to…

A

Normal ICP 7 and 15 mm Hg. The brain can accommodate increases up to 24 mm Hg

156
Q

Facial nerve – internal acoustic meatus to get to temporal bone, exits via …

A

Facial nerve – internal acoustic meatus to get to temporal bone, exits via stylomastoid foramen

157
Q

Horners – spinal level

A

Horners – C8 T1

158
Q

RA, recurrent dental sepsis symmetrically enlarged of both parotid and submandibular glands

A

Sjogren’s syndrome –

159
Q

In a young adult with parotid swelling and pancreatitis/orchitis/reduced hearing/meningoencephalitis suspect

A

suspect mumps.

160
Q

Bilateral parotid enlargement + facial nerve palsies + malaise =

A

Bilateral parotid enlargement + facial nerve palsies + malaise = Sarcoidosis!

161
Q

Painless anterior lump (high altitude or COPD)

A

Painless anterior lump – carotid body tumour – sporadic, hyperplastic (high altitude or COPD), familial. MEN II, NF1

162
Q

Neck Lump

above hyoid - multiloculated and heterogeneous, no swallowing movement

A

Dermoid cysts – above hyoid - multiloculated and heterogeneous, no swallowing movement

163
Q

Neck Lump

A

thyroglossal cysts – below hyoid, tongue movement-

Sistrunk procedure (+ track)

o resection of cyst, associated track, central portion of the hyoid and wedge of tongue muscle behind the hyoid

164
Q

EBV - tonsillitis presentation

Puts you at risk of…

A

EBV - tonsillitis, oropharyngeal petechial haemorrhages + splenomegaly

Penicillin rash,

all lymphomas and nasopharyngeal carcinoma.

165
Q

to divide posteromedial thyroid…

be careful of…

A

Bipolar to divide posteromedial thyroid, avoid thermal recurrent LN damage.

166
Q

Parathyroid cancers rates

A

nly 5% carcinoma, 85% adenomas, 10% ectopic, encapsulated

167
Q

Berry’s sign –

A

carotid pulse absence due to thryomegaly

168
Q

Peritonsellar abscess – typically cased by

A

Peritonsellar abscess – strep pyogenes

169
Q

Carotid body tumours – usually

A

Carotid body tumours – usually paragangliomas

170
Q

Most common parotid presentation

A

– mass posterior to angle of mandible

171
Q

Post thyroid lobectomy – unable to sing high notes?

A

Cricothryoid – damage to superior laryngeal nerve. (Superior singers sing high notes)

172
Q

psomoma bodies – clusters of calcification

A

Papillary carcinomas – psomoma bodies – clusters of calcification

173
Q

Biphasic and mucinous mass

A

Biphasic and mucinous – pleomorphic adenoma

Backup Gen (15 decks)

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