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HNS Flashcards

1
Q

what is the pterion?

A

joining of the frontal, sphenoid, parietal and temporal
weak part of skull
middle meningeal artery lies below here –> fracture here can result in epidural haemorrhage

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2
Q

what are the bones in the cranium?

A
  • frontal
  • parietal x2
  • temporal x2
  • sphenoid
  • ethmoid
  • nasal x2
  • maxillary x2
  • mandible
  • inferior nasal concha x2
  • lacrimal x2
  • palatine x2
  • vomer
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3
Q

what are the contents of the cribriform plate?

A

olfactory nerve fibres (CN1)

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4
Q

what are the contents of the optic canal?

A 
optic nerve (CN2)
opthalmic artery
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5
Q

what are the contents of the superior orbital fissure?

A 
oculomotor nerve (CN3)
trochlear nerve (CN4)
opthalmic branch of trigeminal (CN 5,1)
abducens nerve (CN6)
superior opthalmic vein
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6
Q

what are the contents of the foramen rotundum?

A

maxillary branch of trigeminal nerve (CN5,2)

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7
Q

what are the contents of the foramen ovale?

A

mandibular branch of trigeminal nerve (CN5,3)

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8
Q

what are the contens of the foramen spinosum?

A

middle meningeal artery

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9
Q

what are the contents of the carotid canal?

A

internal carotid artery

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10
Q

what are the contents of the internal acoustic meatus?

A 
facial nerve (CN7)
vestibulocochlear nerve (CN8)
labyrinthine artery
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11
Q

what are the contents of the jugular foramen?

A 
glossopharyngeal nerve (CN9)
Vagus nerve (CN10)
Accessory nerve (CN11)
sigmoid sinus --> becomes internal jugular vein
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12
Q

what are the contents of the hypoglossal canal?

A

hypoglossal nerve (CN12)

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13
Q

what are the contents of the foramen magnum?

A

spinal fibres of accessory nerve (CN11)
inferior portion of medulla
vertebral arteries
anterior and posterior spinal arteries

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14
Q

what are the contents of the stylomastoid foramen?

A

facial nerve (CN7)

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15
Q

how do you test the sensory functions of the trigeminal nerve?

A
  • ask pt to close eyes and say yes every time they feel the neurotip touch their skin
  • touch forehead (V1), just under eye (V2), just next to lip (V3)
  • touch on both sides
  • ask pt if it felt the same on both sides
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16
Q

how do you test the motor function of the trigeminal?

A
  • ask pt to clench jaw
  • palpate masseter anterior to temporomandibular joint
  • palpate temporalis muscle over temples (pterion)
  • ask if they are in any pain
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17
Q

what are the branches of the facial nerve?

A
  • temproral
  • zygomatic
  • buccal
  • mandibular
  • cervical
    Two Zebras Bit My Coccyx
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18
Q

how do you test the temporal branch?

A

raise eyebrows/crease forehead

provide resistance to each movement

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19
Q

how do you test the zygomatic branch?

A

closing eyes and squeezing them shut

provide resistance to each movement

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20
Q

how do you test the buccal branch?

A

smile, reveal teeth

provide resistance to each movement

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21
Q

how do you test the mandibular branch?

A

puff out cheeks

provide resistance to each movement

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22
Q

how do you test the cervical branch?

A

grimace

provide resistance to each movement

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23
Q

how do you test the glossopharyngeal nerve?

A

elicit patients gag relfex

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24
Q

what is the physiology of the gag reflex?

A

sensory limb is mediated by glossopharyngeal nerve –> provides sensation to oropharynx and post 1/3 of tongue
motor limb mediated by vagus

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25
Q

how do you test the motor function of the vagus?

A

ask pt to open their mouth and say ahhhh
saying this depresses the tongue and makes uvula easier to see
observe elevation of uvula, see if any deviation from midline

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26
Q

in what direction is ulnar deviation?

A

away from side of lesion

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27
Q

how do you test the motor function of the hypoglossal nerve?

A

ask pt to stick tongue out

look for any deviation from midline

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28
Q

how do you test the motor function of the accessory nerve?

A

to test SCM ask pt to look to one side whilst you gently resist movement of head with back of hand

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29
Q

what innervates the superior oblique?

A

CN 4

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30
Q

what innervates the lateral rectus?

A

CN 6

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31
Q

what innervates all the other extraocular muscles?

A

CN 3

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32
Q

what is the primary, secondary and tertiary action of superior oblique?

A
  1. depression
  2. abduction
  3. medial rotation of eyeball
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33
Q

what is the primary, secondary and tertiary action of inferior oblique?

A
  1. elevation
  2. abduction
  3. lateral rotation of eyeball
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34
Q

what is the primary function of the medial rectus?

A

adduction

35
Q

what is the primary function of lateral rectus?

A

abduction

36
Q

what is the primary, secondary and tertiary action of the superior rectus?

A
  1. elevation
  2. adduction
  3. medial rotation of eyeball
37
Q

what is the primary, secondary and tertiary action of the inferior rectus?

A
  1. depression
  2. adduction
  3. lateral rotation of eyeball
38
Q

how do you exam the extrinsic eye muscles?

A

H test 30cm in front of pt face
ask pt to keep head still and cover one eye
begin in middle, move finger fully to one side to abduct eye
move up and down and then back to middke
repeat movement to other side to adduct eye

39
Q

how do you test the ipsilateral and consensual pupillary light reflex?

A
  • shine light into one eye, check ipsilateral shrinking
  • move light away from eye for 3 seconds
  • shine light into same eye, check consensual shrinking of pupil in other eye
  • do on both eyes
40
Q

what is the afferent pathway for pupillary constriction?

A
  • ganglion cells in eye
  • optic nerve
  • optic tracts
  • pretectal nucleus
  • EW nucleus (processing done here)
41
Q

what is the efferent pathway for pupillary constriction?

A
  • EW nuclei
  • PNS fibres along occulomotor nerve
  • ciliary ganglion
  • PNS fibres along ciliary nerves
  • sphincter pupillae –> constriction
42
Q

how do you carry out the corneal reflex?

A

place some cotton wool on sclera

produces rapid eye closure to protect eye

43
Q

what is the afferent pathway of the corneal reflex?

A

touch sensation sent as impulse along ophthalmic branch of trigeminal nerve

44
Q

what is the efferent pathway of corneal reflex?

A

from facial motor nucleus along facial nerve to orbicularis oculi (quickly shutting eye)

45
Q

what is in each quadrant in a complete adult set of teeth?

A 
x2 incisors
x1 canine
x2 premolars
x3 molars 
= 8 teeth in each quadrant
46
Q

what is C7?

A

vertebrae prominens

47
Q

what do you feel move up and down with swallowing?

A

hyoid bone

48
Q

what is between the superior thyroid cartilage and inferior cricoid cartilage?

A

laryngeal prominence

49
Q

where can the lateral mass of the atlas found?

A

b/ mastoid processes (inferior part of temporal bone) and ramus of mandible (vertical aspect)

50
Q

what is a cricothyroidotomy?

A

transverse incision made b/ cricoid and thyroid cartilages

cut into cricothyroid membrane

51
Q

what is a tracheostomy?

A

transverse incision made b/ cartilage rings of trachea

palpable below cricoid cartilage

52
Q

where does the EAM begin and end?

A

opening of ear canal and ends at tympanic membrane

53
Q

what instrument is used to look at tympanic membrane?

A

otoscope

54
Q

where can you find the carotid pulse?

A

anterior border of SCM at level of superior border of laryngeal prominence

55
Q

how do you palpate the cervical lymph nodes?

A
  • always palpate from behind
  • move fingers along in circular motions and don’t lift them off the patient
  • start below jaw and work posteriorly to submandibular nodes
  • then head down anterior border of SCM feeling for paratracheal nodes and ant cervical nodes
  • head back along posterior borderof SCM towards pre-auricular nodes
  • palpate above ears and back down to post auricular nodes
  • move down to posterior cervical nodes
  • finally medial to occipital nodes
56
Q

what is the triangle used for central line access?

A
  • medial, sternal head of SCM
  • medial third of clavicle
  • lateral, clavicular head of SCM
57
Q

at which point of the triangle do you insert the needle?

A

superior apex of triangle

58
Q

at what angle is the needle inserted?

A

inserted at 30 degree angle

needle directed towards ipsilateral nipple

59
Q

why is the R sided jugular preferred?

A

R internal jugular is wider in diameter and more superficial than L internal jugular vein
easier access

60
Q

what are the anterior triangle boundaries?

A
  • midline of neck
  • inferior border of mandible
  • anterior border of SCM
61
Q

what are the posterior triangle boundaries?

A
  • posterior border of SCM
  • anterior border of trapezius
  • middle 1/3 of clavicle
62
Q

what are the contents of the anterior triangle?

A
  • hyoid bone
  • common carotid artery
  • internal jugular vein
  • supra-hyoid muscles (stylohyoid, digastric, mylohyoid, geniohyoid)
  • infra-hyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid)
63
Q

what are the contents of the posterior triangle?

A
  • external jugular vein
  • subclavian vein
  • subclavian artery
  • trunks of brachial plexus
  • phrenic nerve
  • vagus nerve
  • spinal accessory nerve
64
Q

where does the internal jugular vein run?

A

parallel and lateral to common carotid artery

65
Q

where does the external jugular vein run?

A

runs from angle of mandible to middle of clavicle

66
Q

what does the nasal septum consist of?

A

vomer bone inferiorly
perpendicular plate of the ethmoid bone superiorly
septum cartilage

67
Q

where does the spinal cord end? what do the nerves continue down as?

A

ends at L1/L2

nerves continue down individually (cauda equinae)

68
Q

why does it reduce the risk of damage to do injects below L1/L2?

A

nerves in cauda equina will displace upon injection

69
Q

at what spinal levels are injections carried out?

A

L3/L4

or L4/L5

70
Q

how do you find the level of L4?

A

found medially from superior iliac crests

level of L4 is line that joins b/ superior aspects of iliac crests

71
Q

where would you do injections in children?

A

sacral injections used into sacral foramina since spinal cord isn’t fully developed

72
Q

what are subarachnoid injections for? compared to epidurals?

A 
subarachnoid = anaethesia
epidurals = analgesia
73
Q

what does the pedicle of a vertebra do?

A

connects body of vertebra to arch

74
Q

what does the lamina of the vertebra do?

A

connects spinous process with transverse process

75
Q

describe the levels of flexion/ extension (bending forward and back) in the different sections of the vertebral column

A

C1-C7: large range
T1-T7: no range
T7-T12: very limited range
L1-S4: large range of motion

76
Q

describe the levels of lateral flexion (bending side to side) in the different sections of the vertebral column

A

C1-C7: large range
T1-T7: limited range
T7-T12: large range
L1-S4: limited range

77
Q

describe the levels of rotation in the different sections of the vertebral column

A

C1-C7: large range
T1-T7: very limited
T7-T12: large range
L1-S4: no range

78
Q

describe why the cervix has this range of movement

A

atlanto-occipital joint and atlanto-axial joint allow full range of movement

79
Q

describe why the upper thorax has this range of movement

A

movement is restricted by ribs

flexion/extension is prevented due to long articular processes of vertebra –> prevent vertebrae pivoting on one another

80
Q

describe why the lower thorax has this range of movement

A

here ribs are floating

so restrict movement LESS

81
Q

describe why the lumbo-sacrum has this range of movement

A

vertebral processes are optimised for flexion/extension

articulations with each vertebra prevent rotation since they are vertical

82
Q

describe the atlanto-occipital joint

A

atlas (C1) forms special joint w/ occipital bone
superior articular surfaces of C1 articulate with occipital condyles
joint responsible for flexion/extension of head and neck
YES JOINT

83
Q

describe the atlanto-axial joint

A

axis (C2) forms a special joint with atlas
axis has protruding part (dens)
dens articulates with anterior arch of atlas
responsible for lateral rotation of head around neck –> rotating head side to side
NO JOINT

OSPE (8 decks)

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