Head, Neck, and Spine Flashcards
Name the bones of the cranium (and be able to identify each on a skull)
Frontal Parietal Sphenoid Temporal Occipital
Name the bones of the face (facial bones)
Zygoma/zygomatic Maxilla Nasal Vomer Lacrimal Inferior Conchae Palatine Mandible
What is the pterion and what bones make up the pterion?
The pterion is a weak spot in the cranium where the middle meningeal artery lies behind. It is where four of the cranial bones meet, making it so weak. The bones that make up the pterion are: Frontal, parietal, temporal, sphenoid.
What are the major foramina of the skull what goes through them?
- Cribriform plate = olfactory nerve fibres (CN I)
- Optic canal = optic nerve (CN II) and ophthalmic artery
- Superior orbital fissure = oculomotor nerve (CN III); trochlear nerve (CN IV); ophthalmic branch of trigeminal nerve (CN V1); abducens nerve (CN VI); superior ophthalmic vein
- Foramen rotundum = maxillary branch of trigeminal nerve (CN V2)
- Foramen ovale = mandibular branch of trigeminal nerve (CN V3)
- Foramen spinosum = middle meningeal artery
- Carotid canal = internal carotid artery
- Internal acoustic meatus = Facial nerve (CN VII) and Vestibulocochlear nerve (CN VIII); labyrinthine artery
- Jugular foramen = glossopharyngeal nerve (CN IX); Vagus nerve (CN X); accessory nerve (CN XI); internal jugular vein
- Hypoglossal canal = hypoglossal nerve (CN XII)
- Foramen magnum = spinal fibres from CN XII; inferior portion of medulla; vertebral arteries; anterior and posterior spinal arteries.
How do you test the sensory functions of the trigeminal nerve?
Obv communicate to patient what you’re doing
Gently touch the neurotip on both left and right sides of the face: on the forehead (Div1); on the cheek next to nose (Div2); and on chin/jaw (Div 3)
How do you test the motor functions of the trigeminal nerve? What are the muscles you are palpating?
Tell patient you will feel their muscles of chewing
Palpate the masseter and temporalis muscle by palpating anterior to the temporomandibular joint (masseter) and the temples/pterion (temporalis) while the patient clenches their jaw
How do you test the motor functions of the facial nerve?
Ask the patient to express different facial expressions (don’t need to know details of branches etc).
- Smile (buccal branch)
- Raise eyebrows (temporal branch)
- Close eyes and squeeze them shut (zygomatic)
- Puff out cheeks, against resistance (mandibular branch)
- Grimace (cervical)
Remember to test both sides and look for asymmetry
How would you test the glossopharyngeal nerve?
By testing the gag reflex (don’t do this in OSPE)
You would take a tongue depressor (a small flat wooden stick) and gently touch the back of the patient’s throat to elicit a gag reflex.
How would you test the motor function of the vagus nerve?
Ask the patient to open their mouth and say ‘aahhh’. This depresses the tongue and elevates the uvula. If the uvula is deviated from the midline there is a lesion on the opposite side. (i.e. the side the uvula moves to is the opposite side of the lesion)
How would you test the motor function of the hypoglossal nerve?
Ask patient to stick their tongue out (protraction of tongue) and look for any deviation from midline. Tongue will deviate towards the lesioned side.
How would you test the motor function of the accessory nerve?
Test their sternocleidomastoid. Do this by asking the patient to look to one side while you resist the movement/rotation of their head the back of your hand. Do the same on other side.
Can also test their trapezius muscle: Ask them to shrug their shoulders or lift their shoulders while you press down on their shoulders.
How do you test the extrinsic muscles of the eyes and what nerves are you testing?
H-test: Superior rectus (CN II oculomotor nerve): lateral then up Lateral rectus (CN VI abducens nerve): just lateral Inferior rectus (CN II oculomotor nerve): lateral then down Medial rectus (CN II oculomotor nerve): just medial Inferior oblique (CN II oculomotor nerve): medial then up Superior oblique (CN IV trochlear nerve) medial then down
A lesion to what cranial nerve would cause a down and out gaze?
Cranial nerve 3: oculomotor nerve
A lesion to what cranial nerve would cause an inwards gaze?
Cranial nerve 6: abducens nerve
A lesion to what cranial nerve would cause an up and in gaze? (or up and out no one seems to know on Google)?
Cranial nerve 4: trochlear nerve
What are the boundaries of the anterior triangle of the neck?
Medial border: midline of the neck
Upper border: Mandible
Lateral border: anterior margin of the sternocleidomastoid
What are the boundaries of the posterior triangle of the neck?
Medial border: Posterior margin of the sternocleidomastoid
Lower border: Superior surface of the middle third of the clavicle
Lateral border: Anterior margin of the trapezius
What are the contents of the anterior triangle of the neck?
- Suprahyoid muscles
- Infrahyoid muscles
- Internal jugular vein
- Common carotid artery
What are the contents of the posterior triangle of the neck?
- External jugular vein
- Subclavian vein
- Subclavian artery
- Phrenic nerve
- Vagus nerve
- Spinal accessory nerve
Where would you put a central line insertion into the jugular vein?
Between the two heads of the SCM just above the clavicle. Then go just lateral to the common carotid artery. Use ultrasound in practice.
Surface mark the external jugular vein
From the angle of the mandible to the middle of the clavicle.
Surface mark the internal jugular vein
Line drawn from the earlobe to upper part of sternal end of the clavicle - just lateral to that line.
Describe the teeth
In each quadrant there is: 2 incisors, 1 canine, 2 pre-molars, 3 molars (3rd one is usually missing in under 20s but generally does not have to be there cuz of removal w/e). 4 quadrants so 32 teeth in total.
Where would you do a tracheostomy?
Incision is made and tube is inserted between the cartilage rings of the trachea - usually between 2nd and 3rd ring
Where would you do a cricothyroidotomy?
Incision is made through the cricothyroid membrane which is between the cricoid and thyroid cartilages.
What are the afferent and efferent arms of the corneal reflex?
Afferent: nasociliary branch of opthalmic branch of trigeminal nerve (i.e. nasociliary branch of V1)
Efferent: Temporal and zygomatic branches of the facial nerve
