Head, Neck and Spine Flashcards
What is the pterion? (4)
Area where the frontal, parietal, temporal and sphenoid bones join together just behind the temple
What bones are found on the cranium? (6)
Frontal, Parietal, Temporal, Occipital, Ethmoid, Sphenoid
What are the facial bones? (8)
Maxilla, zygoma, mandible, lacrimal, palatine bone, conchae, vomer and nasal bone
What travels through the optic canal (2)
Optic nerve (CNII) and the opthalmic artery
What travels through the superior orbital fissure (5)
Oculomotor, trochlear, ophthalmic branch of the trigeminal, abducens (CNIII, IIII, Va, VI), ophthalmic vein
What travels through the foramen rotundum
Maxillary branch of the trigeminal (CNVb)
What travels through the foramen ovale
Mandibular branch of the trigeminal CNVc
What travels through the foramen spinosum (2)
Middle meningeal artery and middle meningeal vein
What travels through the carotid canal?
the internal carotid artery
What travels through the internal acoustic meatus (2)
Facial and vestibulocochlear (CNVII, VIII)
What travels through the jugular foramen (4)
Glossopharyngeal, vagus, accessory (CNIX, X, XI) and the internal jugular vein
What travels through the hypoglossal canal
Hypoglossal (CNXII)
What travels through the foramen magnum (7)
Spinal roots of accessory nerves, (CNXI) meningeal lympathics, spinal cord, spinal meninges, sympathetic plexus of vertebral arteries, vertebral arteries, vertebral artery spinal branches
What travels through the stylomastoid foramen
Facial nerve (CNVII)
What travels through the stylomastoid foramen
Facial nerve (CNVII)
What comprises the yes joint?
Atlanto-occipital joint
The no joint?
Atlanto-axial joint
Where does this travel through: CN 1 (Olfactory nerve)
Cribriform plate
Where does this travel through: CN 2 (Optic nerve)
Optic canal
Where does this travel through: ophthalmic artery
Optic canal
Where does this travel through: CN 3 (oculomotor)
Superior orbital fissure
Where does this travel through: CN 4 (trochlear)
Superior orbital fissure
Where does this travel through: N 5a (ophthalmic branch of trigeminal)
Superior orbital fissure
Where does this travel through: CN 6 (abducens)
Superior orbital fissure
Where does this travel through: ophthalmic vein
Superior orbital fissure
Where does this travel through: CN 5b (maxillary branch of trigeminal)
Foramen rotundum
Where does this travel through: CN 5c (mandibular branch of trigeminal)
Foramen ovale
Where does this travel through: middle meningeal artery
Foramen spinosum
Where does this travel through: middle meningeal vein
Foramen spinosum
Where does this travel through: internal carotid artery
Carotid canal
Where does this travel through: facial nerve (CNVII)
Internal acoustic meatus and exits through the stylomastoid foramen
Where does this travel through: vestibulocochlear (CNVIII
Internal acoustic meatus
Where does this travel through: CN 9 (glossopharyngeal)
Jugular foramen
Where does this travel through: CN 10 (vagus)
Jugular foramen
Where does this travel through: CN 11 (accessory)
Jugular foramen
Where does this travel through: internal jugular vein
Jugular foramen
Where does this travel through: CN 12 (hypoglossal)
Hypoglossal canal
Which vertebral level is: the cervical vertebra with a prominent spinous process
C7
Which vertebral level is: level with the medial end of the scapular spine
T3
Which vertebral level is: level with the inferior angle of the scapula
T7
Which vertebral level is: level of the lowest part of the 12th rib
L2
Which vertebral level is: level of the iliac crest
L4
What is the surface landmark for: L4
level of the iliac crest
What is the surface landmark for: T7
level with the inferior angle of the scapula
What is the surface landmark for: T3
level with the medial end of the scapular spine
What is the surface landmark for: L2
Level of the lowest part of the 12th rib
Where can you inject an epidural
L3-4, or L4-5
Difference between thoracic and lumbar vertebrae in terms of movement?
Thoracic allows rotation but limited extension, lumbar allows extension but limited rotation
How many lines do I feel for lymph nodes?
4, submental to pre-auricular, the down anterior chain, then posterior chain, then occipital
What is at: C3
The body of the hyoid bone
What is at: C4
Upper border of thyroid cartilage
What is at: C6
The cricoid cartilage
Which vertebral level is: the body of the hyoid bone
C3
Which vertebral level is: the upper body of the thyroid cartilage
C4
Which vertebral level is: the cricoid cartilage
C6
What are the borders of the anterior triangle of the neck
Inferior border of the mandible, the SCM, and the midline of the neck
What are the borders of the posterior triangle of the neck
SCM, anterior border of the trapezius and the clavicle
What are the contents of the anterior triangle of the neck (6+4)
Platysma, mylohyoid, digastric, infrahyoid strap muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid), carotid artery and internal jugular vein
What are the contents of the posterior triangle of the neck (7)
External jugular, subclavian artery and vein, trunks of brachial plexus, phrenic nerve, vagus nerve, spinal accessory nerve
Describe the insertion point for a central line into the internal jugular vein
Turn head left, insertion is between medial and lateral head of the SCM. Palpate carotid artery and aim lateral to it. Aim towards ipsilateral nipple.
Describe the position of the internal jugular vein
Line from the earlobe to the SC joint, lateral and parallel to the common carotid
Describe the position of the external jugular vein
Line from the earlobe to the mid-clavicle
Test the accessory nerve
Contract the sternocleidomastoid by turning neck or the upper fibres of the trapezius by shrugging the shoulders
How many of which teeth in an adult male
32 total, 8 incisors, 4 canines, 8 premolars, 8 molars, 4 wisdom teeth
What are the bones of the nasal cavity (7+2)
Nasal bone, superior, middle and inferior nasal conchae, vomer, maxilla, palatine bone, cribiform plate, sphenoid bone
What is the thyroid isthmus
Middle bit of the thyroid gland
What are the paranasal sinuses
Frontal sinus, ethmoid sinus/air cells, maxillary sinus, sphenoid sinus
Where is the mastoid air cells
In the mastoid process behind the external ear
What is a tracheostomy
Tracheostomy is the formation of an opening into the trachea, usually between the 2nd and 3rd tracheal cartilage ring
What is a cricothyroidectomy
Incision made through the cricothyroid membrane (between thyroid and cricoid cartilage)
Identify the features of the external auditory meatus and eardrum (4 and 8)
External auditory meatus (foreign body, wax, skin, shape) tympanic membrane (pars tensa, pars flaccida, handle of malleus, short process of malleus, umbo, cone of light, anterior and posterior malleolar folds), behind TM (not always visible)
What to do before examining the ear canal
Pull the ear up and back
Which nerves control the eye movement? How to test
3, 4, and 6. Move finger in the H shape and then move close to face to test accommodation
Test ipsilateral and consensual pupillary light reflex
Ipsilateral - Ask subject to look at distant target. Shine one eye with penlight, observe pupillary constriction in the same eye.
Consensual - Ask subject to look at distant target. Shine one eye with penlight, observe pupillary constriction in the fellow eye.
Swinging torch – RAPD – both pupils constrict when light swings to undamaged side, both pupils paradoxically dilate when light swings to damaged side.
What direction do CN III, IV and VI move the eye
III - adduction (towards middle) and up
IV - adduct and down
VI - abduction
Afferent pathway of the accommodation reflex? (7)
Afferent from the primary visual pathway: retina -> optic nerve (CN2) -> optic chiasm -> optic tract -> lateral geniculate body -> optic radiation -> visual cortex.
Efferent pathway of the accommodation reflex?
visual cortex -> pretectal nuclei -> Edinger-Westphal nucleus -> CN3 -> sphincter pupillae.
What muscle and nerve controls the pupil?
Sphincter pupillae, CNIII
Afferent and efferent arms of the corneal reflex?
Afferent – nasociliary branch of ophthalmic branch of trigeminal (V1)
Efferent – temporal and zygomatic branches of facial nerve (VII)
Test the sensory functions of the three divisions of the trigeminal
Trigeminal is the sensory nerve of the face
To the eyelids is the ophthalmic
Anterior temple, middle part of the face to the corners of the mouth is the maxillary
Middle part of the temple anterior to the ear and down to the chin is the mandibular branch, as is the lower teeth, gums, lips, inside of cheeks, floor of mouth and anterior 2/3rds of the tongue
Test the motor function of the accessory nerve
Shrug shoulders to move trapezium and turn head to test SCM
Test the motor function of the mandibular division of the trigeminal nerve
Palpate masseter (cheeks) and temporalis (temples) muscles
Test motor function of the facial nerve
Ask patient to adopt various expressions and look for assymetry - smile, frown, close eyes tightly, lift eyes, show teeth, puff cheeks.
What are the functions of the facial nerve
Supplies motor muscles of facial expression & via chorda tympani, parasympathetic to submandibular/sublingual salivary glands
Test function of the glossopharyngeal nerve
Use 2 tongue depressors (1 to hold tongue down and other to touch back of mouth) and evoke a gag reflex.
It is the sensory nerve of the posterior 1/3rd of the tongue and oropharynx
Test motor function of the vagus
Ask the subject to open their mouth and say “ahh” and observe the elevation of the uvula to see if there is any deviation from the midline (away from the lesioned side)
Test the motor function of the hypoglossal nerve
Protract (stick out tongue) deviation goes towards lesioned side
What is the motor function of the hypoglossus
The tongue
