Head Neck And Spine Flashcards
What joins together at pterion
Frontal
Parietal
Temporal
Sphenoid
Cribriform plate
CN 1
Optic canal
CN2
Superior orbital fissure
CN3 CN4 V1 CN5 CN6 Opthalmic vein
Foramen rotundum
V2 CN5
Foramen ovale
V3 CN5
Foramen spinosum
Middle meningeal artery and vein
Carotid canal
Internal carotid artery
Internal acoustic meatus
CN7
CN8
Jugular foramen
CN9
CN10
CN11
Internal jugular vein
Hypoglossal canal
CN12
Foramen magnum
Spinal roots of CN11 Meningeal lymphatics Spinal chord Spinal meninges Vertebral arteries
Styelomastoid foramen
After going through internal acoustic meatus passes CN7 passes through this
Order of fissures
COSROSCIJH
Remembering cranial nerves
Oh Oh Oh To Touch And Feel Virgin Girls Vaginas Ah Heaven
Movements around Atlanto-occipital joint
Neck flexion
YES joint
Movement around Atlanto-axial joint
Head rotation
NO joint
Function of cervical spine
Support weight of head and allow movement of head
Function of thoracic vertebrae
Hold the ribcage
Some limited movements
Possible movements of thoracic vertebrae
Allows flexion and some rotation
Limited extension
Reason for limited movement of thoracic vertebrae
Long spinous processes which extend inferiorly
Also the ribcage
Function of lumbar vertebrae
Bear the weight of the body
Movements of lumbar vertebrae
Flexion and extension with limited rotation
What gives lumbar vertebrae more movement than thoracic
Spinous processes don’t project so far inferiorly and the nature of lumbar facet joints
Feature of lumbar vertebra to match function
Much larger to support body
Main function of sacrum
Connect spine to iliac spines
Main function of coccyx
Provides attachment for ligaments and muscles of pelvic floor
What prevents excessive movement of vertebral bones
Ligaments
What allows back motion
Facet joints in spine
Superficial extrinsic muscles of the back
Traps
Lat dorsi
Levator scapulae
Rhomboids
Intrinsic muscles of back
Iliocostalis
Longissimus
Spinalis
Make up erector spinae
How many cervical vertebrae
Spinal nerves
And relationship between the 2
7
8
C1-7 above C8 below
How many thoracic vertebrae
Spinal nerves
Relationship between the 2
12
12
Below
How many lumbar vertebrae
Spinal nerves
Relationship between the 2
5
5
Below
How many sacral vertebrae
5 but fused
5
Below
How many coccygeal vertebrae
1
1
Below
How to identify C7
Flex neck and becomes prominent
Identify T3
Level with medial end of scapular spine
Identify T7
Level with inferior angle of scapula
How to identify L2
Level of inferior part of 12th rib
How to identify L4
Level of iliac crest
Vertebrae used for lumbar puncture
L3-5
Layers gone through for epidural
Skin Fat Muscle Supraspinous ligament Intraspinous ligament Ligamentum flavum
What is sciatica
Condition characterised by pain radiating from lower back down back of leg caused by a possible disc herniation
How to palpate cervical lymph nodes
start with submental nodesmoving backwards to sublingual, submandibular and then superiorly to parotid and pre auricular. Then move down anterior chain ventral to sternocleidomastoid palpating the deep cervical ganglions. Once that is complete go posterior to sternocleidomastoid muscle palpating the deep cervica nodes (including supraclavicular) starting with post auricular then finally finshing with occipital.
Motion for palpating cervical nodes
Circular
Borders of anterior triangle in neck
Anterior border of sternocleidomastoid muscle, midline and inferior border of mandible
Muscular contents of anterior triangle
Mylohyoid
Platysma
Digastric muscles
Infrahyoid
Vessels of anterior triangle
Internal jugular
Carotid arteries
Borders of posterior triangle in neck
Posterior border of sternocleidomastoid, anterior border of trapezius and superior surface of clavicle
Vessels in posterior neck triangle
Trunks of brachial plexus Phrenic nerve Subclavian artery External jugular artery Spinal accessory nerve
Route of IJV
runs from jugular foramen down neck within the carotid sheath lateral to carotid artery. Terminates posterior to sternoclavicular joint where it enters subclavian vein
Insertion of central line method
Put in traingle formed between 2 heads of sternocleidomastoid and clavicle. Aim towards ipsilateral nipple
Line of IJV
From earlobe to sternoclavicular joint
Line of EJV
From angle of mandible to mid clavicle
Test motor function of sternocleidomastoid
Look over shoulder
Test motor function of upper fibres of trapezius
Shrug shoulders
Sensory skin region of V1
From hairline covering all of forehead, down around eyebrows coming medial to only cover medial portion of nose
Internal sensory regions of V1
Nasal mucosa, conjuctiva and frontal sinus
Sensory skin region of V2
Thin line coming from temple under eye to cover lateral edge of nose and everything down to lower border of upper lip
Internal areas covered by V2
Upper teeth, gum and roof of mouth
Sensory region of V3
A strip of skin running from the middle part of the temple then anterior to the ear and down to the chin. In addition it supplies the lower teeth, gums and lip, the lining of the cheeks, the floor of the mouth and the buccal part (anterior two-thirds) of the tongue.
Internal sensory region of V3
Lower teeth and lips, lining of cheeks and anterior 2/3 of tongue
Test motor function of mandibular branch of trigeminal
Clench teeth and palpate for bulge of masseter on ceeks and bulge of temporalis on temple
Test motor function of facial nerve
Get patient to try and pull various facial expressions such as smiling, frowning and raising eyebrows and look for asymmetry
How does facial nerve affect secretions from sublingual and submandibular salivary glands
Parasympathetic innervation via chorda tympani
Motor test for glossopharyngeal nerve
Evoke a gag reflex using tongue depressor
Sensory test for glossopharyngeal nerve
Posterior 1/3 of tounge and oropharynx
Test for motor function of vagus
Ask patient to open mouth and say AHHH- look for deviation of uvula
What will happen if there is unilateral lesion of vagus nerve
Uvula will deviate away from lesioned side
Motor test for hypoglossal nerve
Stick tongue out- mainly controlled by genioglossus and intrinsic muscles of tongue which are hypoglossal mediated
Breakdown of normal teeth in healthy adult
32 teeth 8 incisors 4 canines 8 premolars 8 molars 4 wisdom teeth
What should be in each quadrant
2 incisors 1 canine 2 premolars 2 molars 1 wisdom teeth
Why are wisdom teeth normally removed
to prevent displacement of other teeth
Performing cricothyroidectomy
incsion made in cricothyroid membrane
Advantages of cricothyroidectomy
Easier and quicker than tracheostomy
Nomanipulation of cervical spine
No damage to highly vascularised thyroid
Less complications
Ipsilateral pupillary reflex
Shine light in ipsilateral and look for constriction of pupil
Consensual pupillary reflex
Shine light in eye and look for constriction in other eye
How to carry out relative afferent pupillary defect test
Swing light between both eyes rapidly
What happens when light swung to undamaged side in RAPD test
Both constrict
What happens when light swung to damaged side in RAPD test
paradoxically dilate
Afferent pathway of accommadation test
retina -> optic nerve (CN2) -> optic chiasm -> optic tract -> lateral geniculate body -> optic radiation -> visual cortex
Efferent pathway of accommadation test
visual cortex -> pretectal nuclei -> Edinger-Westphal nucleus -> CN3 -> sphincter pupillae
Afferent nerve accommadation
2
Efferent nerve accommadation test
3
Afferent corneal reflex
CN 5a
Efferent corneal reflex
CN 7
