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OSPE 2020 > HNS > Flashcards

HNS Flashcards

1
Q

What is the pterion?

A

where the frontal, parietal, zygomatic and sphenoid bones meet. The middle meningeal artery lies behind this so trauma can cause haemorrhage

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2
Q

What goes through the cribiform plate of the ethmoid?

A

Olfactory nerve fibres (CN1)

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3
Q

What goes through the optic canal?

A

The Opthalmic nerve (CN2) and opthalmic artery

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4
Q

WHat goes through the superior orbital fissure?

A

Oculomotor nerve (CN3), trochlear nerve (CN4), opthamic branch of trigeminal nerve (CN5div1), abducens nerve (CN6) and superior opthamic vein

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5
Q

WHat goes through the foramen rotundum?

A

Maxillary division of the trigeminal nerve (CN5div2)

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6
Q

What goes through the foramen ovale?

A

mandibular division of the trigeminal nerve (CN5div3)

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7
Q

What goes through the foramen spinosum?

A

Middle meningeal artery and vein

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8
Q

WHat goes through the foramen lacerum (sphenopetrousal fissure)?

A

Internal carotid artery

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9
Q

What goes through the carotid canal (internal aperture)?

A

Internal carotid artery

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10
Q

What goes through the internal acoustic meatus?

A

Facial nerve (CN7) entry, Vestibulocochlear Nerve (CN8), labrythine artery

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11
Q

What goes though the Jugular foramen?

A

Glossopharyngeal Nerve (CN9), Vagus Nerve (CN10), Accessory Nerve (CN11), sigmoid sinus -> internal jugular vein

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12
Q

WHat goes through the hypoglossal canal?

A

Hypoglossal nerve (CN12)

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13
Q

What goes through the foramen magnum

A

Spinal roots of accessory nerve, medulla of brain, vertebral arteries:anterior/posterior spinal arteries

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14
Q

What are the divisions of the trigeminal nerve and test?

A

opthalmic, maxillary and mandibular. Cotton bud test with eyes closed on each region on either side. ‘Did that feel the same on both sides?’

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15
Q

How do you assess motor function of the Trigeminal nerve?

A

Ask patient to bite down whilst holding the masseter muscle over termpor-mandibular joint and temporalis muscle

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16
Q

What are the motor branches of the facial nerve?

A

Temporal, zygomatic, buccal, mandibular, cervical

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17
Q

Temporal facial nerve test?

A

Open eyes wide and crease the forehead

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18
Q

Zygomatic facial nerve test?

A

Close eyes shut and squeeze. Examiner try to open them/show resistance (obicularis oculi muscle)

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19
Q

Buccal facial nerve test?

A

Smile/reveal the teeth

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20
Q

Mandibular facial nerve test?

A

Puff out cheeks ( obicularis oris muscle)

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21
Q

Cervical facial nerve test?

A

Grimace, sag face (platysma muscle)

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22
Q

How do you test the glossopharyngeal nerve?

A

Inform patient that this will be uncomfortable. use a tongue depressor to touch the back of the throat to generate a gag reflex

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23
Q

How do you test motor function of the vagus nerve?

A

Ask patient to push down their tongue and say ‘ahh’ exposing the uvula. Look for deviations as uvula will deviate away from lesion

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24
Q

How do you test hypoglossal nerve?

A

Ask patient to protract their tongue; look for deviations , these will be towards the lesion

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25
What are the 6 extraoculars?
Superior/inferior obliques. Medial, lateral, superior and inferior rectus
26
WHat innervates these extraocular muscles?
Superior oblique = trochlear nerve Lateral rectus = abducens nerve The rest = ocuolomotor nerve
27
What is superior oblique function?
Sepression, abduction and medial rotation
28
WHat is inferior oblique function?
Elevation, adduction and lateral rotation
29
Wha is medial rectus formation?
adduction
30
What is lateral rectus function?
Abduction
31
What is Superior rectus function?
Elavation, adduction and medial rotation
32
What is inferior rectus function?
Depression, abduction and lateral rotation
33
What is the ipsilteral response?
ANy reflex observed on the same side of the body i.e. shine a light on left causes left pupil contraction
34
WHat is the consensual response?
Reflex observed on one side of the body when the other has been stimulated
35
Why does the consenual reflex occur?
Afferent infromation converges at the pretectal nucleu so it activate both parasympathetic nerves of the left and right eye
36
Where is the lesion in resposne to right eye but no consensual left pupil response?
parasympathetic nerve of left eye
37
Describe afferent pathway for pupil constriction?
1) ganglion cells in eye 2) optic nerve (nasal + teproal fibres leave eye and nasal cross at optic chiasm) 3) optic tracts 4) pretectal nucleus 5) Edinger-westphal nucleus
38
Describe the efferent pathway for pupillary constriction?
1) EW nucleus 2) nparasympathetic fibres along oculomotor nerve 3) ciliary ganglion 4) Parasympathetic fibres along ciliary nerves in CNV1 5) spincter pupillae = constriction
39
What coordinates the lens thickening/pupil constriction/eyes converging?
in accomodation reflex, the supraoculomotor area (SOA) in rostral midbrain
40
Describe afferent and efferent arms of the corneal reflex?
1) sensory stimuli ti cornea e.g. touch = sensory effetcs via opthamic division of trigeminal 2) afferents reach the trgeminal sensory nucleus 3) sensory afferents synapse with spinal trgeminal interneurons 4) these project to facial motor nucleus 5) fibres of facial nerve innervate circular orbicularis oculi muscles to close eye
41
Which teeth in each quadrant?
2 incisors, 1 canine, 2 pre-molars, 3 molars
42
What is a cricothyrodetomy?
Transverse incision between the thyroid and cricoid cartilages in the cricothyroid membrane
43
What is a tracheostomy?
transverse incision between the cartilage rings of the trachea (usually 2/3). palpble between the cricoid cartilage. thryoid isthmus can be divided for better access
44
Describe the central line insertion?
Into the IJV than runs lateraly to internal carotid. Triangle used is medial heaf of SCM, medial 1/3 of clavicle, lateral clavcular head of SCM. Apex of triangle used for access. 30 degree needle insertion. directed towards the ipsilateral nipple
45
What are the boundaries of the anterior triangle?
Medial: midline of neck Superior: inferior border of mandible Lateral: medial border of SCM
46
What are the boundaries of posterior triangle?
Medial: lateral border of SCM Inferiorly: Middle 1/3 of clavicle Laterally: anteior border of trapezius
47
What are the contents of the anterior triangle?
hyoid bone, Common carotid, internal jugular vein, suprahyoid muscles, infrahyoid muscles
48
WHat are the suprhyoid muscles?
Mylohyoid, digastric, stylohyoid and geniohyoid
49
WHat are the infrahyoid muscles?
TOSS | Thyrohyoid, omahyoid, sternthyroid and sternohyoid
50
What are the contents of the posterior triangle?
External jugular vein, subclavian vein, subclavian artery, trunks of brachial plexus, phrenic nerve, vagus nerve and spinal accessory nerve
51
What is the route of the IJV?
Runs latersl to common carotid artery and parallel
52
What is the route of teh EJV?
From angle of mandible to middle of clavicle
53
What are the paranasal sinuses?
Frontal sinus, ethmoid air cells, maxillary sinus, ethmoid sinus
54
WHat are the other air cells?
Mastoid air cells in mastoid process
55
How do you find L4?
Line that joins the superior aspect of iliac crests (supracristal plane)
56
Describe range of motion in flexion/extension?
C1-7: large Upper T1-T7: none Lower T7-12: very limited Lumbosacral L1-S4: large
57
Describe range of motion in lateral flexion?
C1-7: large Upper T1-T7: limited Lower T7-12: large Lumbosacral L1-S4: limted
58
Describe range of motion in rotation?
C1-7: large Upper T1-T7: limited Lower T7-12 :large Lumbosacral L1-S4: none
59
What are the featres if the atlanto-occopital joint?
Yes joint with connection between superior articular processes of atlas and occipital condoyles
60
WHat are the features of the antlanto-axial joint?
NO joint as dens of acis (dentoid process) with articulation of anterior arch f atlas. Lateral rotation of the head

OSPE 2020 (6 decks)

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