Key facts Flashcards
1
Q
Name the muscle of facial expression
A
Frontalis Occipitalis Orbicularis Oris Orbicularis Oculi Buccinator Zygomaticus SCM/Platysma/Trapezius
2
Q
Name the muscles of mastication
A
Temporalis
Masseter
Lateral and medial pterygoid
3
Q
What nerve innervates the muscles of mastication?
A
Mandibular trigeminal
4
Q
Name the facial nerve branches
A
To Zanzibar By Motor Car Temporal Zygomatic Buccal Mandibular Cervical
5
Q
What does the facial nerve travel through externally?
A
Parotid gland
6
Q
What is Bell’s Palsy?
A
Inflammation of CN 7
7
Q
What muscle is responsible for the opening of the mouth?
A
Lateral pterygoid/ suprahyoids
8
Q
What are the branches of the Trigeminal nerve?
A
Ophthalmic
Maxillary
Mandibular
9
Q
What are the muscles of the neck?
A
HTC Hyoid Thyroid Cricoid Platysma SCM Trapezius
10
Q
Where is the thyroid gland located?
A
Underneath the Cricoid muscle
11
Q
Name the boundaries of the Anterior triangle
A
Imaginary midline, inferior border of mandible, anterior border of SCM
12
Q
Name the boundaries of the Posterior triangle
A
Anterior trapezius, posterior SCM, superior clavicle
13
Q
Name the boundaries of the Carotid triangle
A
Posterior belly of digastric, superior belly of omohyoid, anterior SCM
14
Q
Name the 3 cervical fascial layers of the neck
A
Pre-tracheal
Pre-vertebral
Investing
15
Q
What does the carotid sheath contain?
A
IJV, common carotid, vagus nerve
16
Q
Which of the objects within the carotid sheath is medial and which is lateral?
A
Common carotid = medial
IJV = lateral
17
Q
What is a common site of infection and abscess formation within the neck?
A
Retropharyngeal space
18
Q
Where can an infection in the retropharyngeal space come from and where can it spread?
A
Can come from teeth/URT
Can spread to mediastinum
19
Q
How can a thyroid lump be identified?
A
Moves when swallowing
20
Q
How can a thyroglossal duct cyst be identified?
A
Moves when tongue move
21
Q
Why does the thyroid move on swallowing?
A
It is enclosed by pre-tracheal fascia an attached to the hyoid bone
22
Q
Which of the carotids is the straight one?
A
Internal
23
Q
Which carotid artery has the carotid sinus?
A
Internal
24
Q
What are the sinuses that travel from the cavernous sinus to the sigmoid/transverse sinuses?
A
Petrosal sinuses
Superior - Transverse
Inferior - Sigmoid
25
What can rubbing of the carotid body of the internal carotid sinus do?
Relieve Supraventricular tachycardias
26
What does the external carotid supply?
The face
27
Name 4 of the branches of the external carotid artery
```
Facial
Superior thyroid
Lingual
Occipital
Posterior auricular
Maxillary
Superficial temporal
```
28
Name two terminal branches of the external carotid artery
Superficial temporal
| Maxillary
29
What does the internal jugular vein drain into?
The subclavian vein
30
Where is a central line inserted?
Into the IJV between its two heads - where the JVP is seen
31
What does the carotid sheath run deep to?
SCM
32
What supplies the blood to the skull?
Middle meningeal artery
33
Name the dural venous sinuses
Superior and inferior sagittal sinuses -> confluence
Transverse venous sinus -> Sigmoid sinus
- > IJV
Cavernous sinus -> Petrosal sinuses -> Sigmoid/Transverse -> IJV
34
What is lymphoedema?
Oedema due to blocked/overloaded lymph nodes
35
What is lymphadenopathy?
Inflamed lymph nodes due to infection/cancer
Hard/matted if cancer
Soft/tender if infection
36
Name the superficial lymph nodes (9)
```
Submental
Submandibular
Cervical - superior, anterior, posterior
Post-auricular
Pre-auricular
Occipital
```
37
Name the deep lymph nodes
Jugulodigastric
Juguloomohyoid
Supraclavicular
38
What is a very important lymph node for abdominal/thorax cancers?
Supraclavicular lymph nodes
39
What tonsils are visible in the mouth?
Palatine
40
Name 3 midline neck lump causes
Thyroid goitre
Thyroglossal duct cyst
Dermoid cyst
41
Name 2 lateral neck lump causes
Branchial cyst
| Supraclavicular lymph node inflammation
42
Name the bones of the cranial floor
Frontal, ethmoid, sphenoid, temporal (+petrous part), parietal, occipital
43
Name the fontanelles and where they are
Bregma (front)
| Lambda (back)
44
Name the sutures of the skull
Sagittal
Coronal
Lambdoid - transverse across back
45
Describe the trilaminar arrangement of skull bones
Diploe surrounded by inner and outer tables
| The periosteum covers the inner and outer tables and is tightly adhered at the suture lines
46
What is the role of the covering of the inner and outer tables?
The periosteum prevents extradural haemorrhages from leaking
47
Name the landmarks/ridges of the cranial floor bones
```
Frontal - supraorbital ridge
Ethmoid - cribriform foramina
Sphenoid - greater and lesser wings
Temporal - petrous part with internal acoustic meatus
Occipital
Parietal
```
48
Name 4 signs of basilar skull fracture and where they are a sign of the fracture
Anterior: CSF rhinorrhoea (ethmoid), Periorbital echymosis
Middle: Haemotympanum (petrous part of temporal), Battle's sign (bruising over mastoid process)
49
Name the canals within the skull base and where they are
ROSL
Rotundum, Ovale, Spinosum (Middle meningeal), Lacerum
Hypoglossal canal - either side of foramen mangum
Superior orbit fissure - below optic canal
Jugular foramen - next to hypoglossal canal
50
What passes through the foramen rotundum?
Trigeminal MAXILLARY
51
What passes through the foramen ovale?
Trigeminal MANDIBULAR
52
What do both the trigeminal maxillary and mandibular nerves travel through?
Pterygopalatine fossa
53
Name the meningeal layers from outside to inside
Dura
Arachnoid
Pia
54
What is special about the dura?
Has two layers, periosteal and meningeal
55
What are the names of the two layers of the dura?
Periosteal and meningeal
56
What is Xanthocromia?
Yellow CSF several hours after bleeding into subarachnoid space
Due to bilirubin in the CSF
57
What forms the dural folds?
The meningeal layer of the dura
58
Name the 2 dural folds
Falx cerebri - top
| Tentorium cerebelli - transverse
59
What drains the subarachnoid space into the dural venous sinues?
Bridging veins
60
What veins drain the scalp?
Emissary veins
61
What is cranial nerve 1?
Olfactory nerve
62
What is the path of CN 1?
Nose -> Cribriform formina -> Olfactory bulb -> Forebrain (temporal lobe)
63
What is cranial nerve 2?
Optic nerve
64
What is the path of CN 2?
Retinal ganglion cells -> optic canal -> optic chiasm -> primary visual cortex in the occipital lobe
65
What is the optic nerve on an ophthalmoscope?
White disc
66
What is papilloedema?
Optic nerve inflammation due to raised ICP
67
What is cranial nerve 3?
Oculomotor
68
What is the path of CN 3?
Midbrain -> cavernous sinus -> superior orbital fissure -> motor
69
What muscles does CN 3 innervate?
LPS, Sphincter Pupillae (OS), Ciliary body, Extra-ocular muscles
70
What does CN 3 damage lead to?
Down and out with the eyes, dilated pupil
71
What is cranial nerve 4?
Trochlear nerve
72
What is the path of CN 4?
Midbrain -> cavernous sinus -> superior orbital fissure -> superior oblique
73
What muscle is innervated by CN 4?
Superior oblique
74
What is cranial nerve 5?
Trigeminal nerve
75
What is the path of CN 5 Va?
Va = Ophthalmic
| Pons -> Cavernous sinus -> Superior orbital fissure
76
What is the path of CN 5 Vb?
Vb = Maxillary
| Pons -> Cavernous sinus -> Foramen Rotundum -> Pterygopalatine fossa
77
What is the path of CN 5 Vc?
Vc = Mandibular
| Pons -> Foramen Ovale -> Infratemporal fossa (under zygomatic arch)
78
What is the nerve that is at risk in an Orbital floor fracture? What is it a branch of?
Infraorbital
| Vb
79
What does CN V Vc supply?
Muscles of mastication
80
What nerve is vulnerable to injury in mandibular fractures?
Inferior alveolar
| Vc
81
What nerve supplies the TMJ and receives sensory from the ear?
Auriculotemporal nerve
82
What is cranial nerve 6?
Abducens
83
What is the path of CN 6?
Pons -> Cavernous sinus -> Superior orbital fissure -> Lateral rectus
84
What does CN 6 supply?
Lateral rectus muscle
85
What is special about the route of CN 6 in the cavernous sinus?
Medial
86
What is cranial nerve 7?
Facial nerve
87
What is the path of CN 7?
Pons -> Internal acoustic meatus -> Petrous part of temporal bone -> stylomastoid foramen
88
What are the 3 branches of CN 7?
- Greater petrosal
- Chordae tympani
- Nerve to stapedius
89
What does the greater petrosal do?
Glands - tears
90
What does the chordae tympani do?
Anterior 2/3 special sensory taste
91
What reflex tests the facial nerve? What are its afferent and efferent limbs?
Corneal reflex
| Trigeminal Va -> Cranial nerve 7
92
What is cranial nerve 8?
Vestibulocochlear nerve
93
What is the path of CN 8?
Pons
94
What is presbyacusis?
Age-related hearing loss
95
What is a tumour of the vestibulocochlear nerve called?
Acoustic neuroma
96
What is cranial nerve 9?
Glossopharyngeal nerve
97
What is the path of all Medulla cranial nerves?
Jugular foramen (except for hypoglossal canal)
98
What is the role of CN 9?
Posterior 1/3 of tongue - special sensory
Parasympathetic to parotid gland
Stylopharyngeus motor
Sensory to oro, carotid body, middle ear
99
What are the afferent and efferent limbs of the gag reflex?
9 -> 10
100
What is cranial nerve 10?
Vagus nerve
101
What is the role of CN 10?
Sensory to pharynx and larynx
| Muscles of soft palate, larynx and pharynx (except for stylopharyngeus)
102
Name 2 signs of CN 10 loss
Hoarse voice
| Uvula deviation away from lesion
103
Where does the left recurrent laryngeal nerve travel?
Under arch of the aorta
104
Where does the right recurrent laryngeal nerve travel?
Under subclavian
105
What is cranial nerve 11?
Spinal accessory
106
What is the role of CN 11?
Motor to SCM and Trapezius
107
What is cranial nerve 12?
Hypoglossal
108
What is the role of CN 12?
Tongue muscle innervation
109
What nerve innervates the TMJ?
Auriculotemporal nerve
110
What artery supplies blood to the eye?
Ophthalmic artery from the ICA
111
What is exophthalmos?
Pressure build up in cavernous sinus, putting pressure on the eyes
112
What do the pharyngeal pouches develop into?
Gland development eg. thymus/Parathyroids, tonsils
113
How many pharyngeal arches are there?
5 - 1,2,3,4,6
114
What do the pharyngeal clefts develop into?
Internal acoustic meatus - only first 2
115
What cranial nerves are created from the pharyngeal arches?
1 - 5
2 - 7
3 - 9
4 + 6 - 10
116
What embryological components is the facial skeleton made from?
- 1st pharyngeal arch - maxillary prominences + mandibular prominences (both x2)
- FNP
117
What are the muscles of facial expression derivatives from? (arches wise)
2nd - CN 7
118
Describe the fusion of the face
Medial nasal prominences from the FNP fuse with the maxillary prominences to form the nose
The palatal shelves then grow from the maxillary prominences towards the midline and fuse
119
Describe how Cleft lip and Palate occurs
Failure of fusion of medial nasal prominences and maxillary prominences
Failure of fusion at the midline of the palatal shelves
120
What blood vessels do the sympathetics follow?
ICA and ECA
121
What do sympathetics following the ICA to the eye innervate?
Dilator pupillae
| Superior tarsal of LPS
122
Describe the difference between Horner syndrome (sympathetics impingement) and Oculomotor nerve lesion
Horner syndrome - partial ptosis (loss of superior tarsal), constricted pupil, anihidrosis (no sweating)
Oculomotor nerve - ptosis (loss of LPS), dilated pupil
123
What does the parasympathetic system innervate in the head and neck?
LPS
Salivary glands
Lacrimal glands
Smooth muscle of resp and GI tract
124
What are the nerves which carry parasympathetic neurones from the brainstem?
3, 7, 9, 10
125
After hitchhiking on cranial nerves, what do the parasympathetics hitchhike on?
CN 5
126
Name all of the Nuclei from which the parasympathetics of the head and neck travel
Edinger westphal
Superior salivary
Inferior salivary
Dorsal motor
127
Name all of the Ganglia through which these parasympathetics travel and where they end up
Edinger westphal -> 3 -> Ciliary ganglion -> Eyes
Superior salivary -> 7 -> Submandibular + Pterygopalatine -> Greater petrosal and Chordae tympani
Inferior salivary -> 9 -> Otic -> Parotid gland
128
Describe the consensual light reflex
Optic -> Pre-tectal -> EW -> Oculomotor nerve
129
What is Otalgia?
Ear pain
130
What nerves provide sensory innervation to the ear?
Glossopharyngeal + Trigeminal auriculotemporal
131
What is the name of the communication between the inner ear and the mastoid air cells?
Mastoid antrum
132
Name 3 Pinna abnormalities
- Ramsay Hunt syndrome - shingles of the ear
- Chondritis - inflammation of the cartilage
- Pinna haematoma - blood trapped in perichondrium
133
What is Otosclerosis?
Ossicles fused, acquired hearing loss
134
What is a Cholesteatoma?
Growth of epithelial cells in the pars flaccida of the tympanic membrane that proliferate and erode
135
Give a potential cause of a Cholesteatoma
Eustachian tube dysfunction
136
Give a complication of a Cholesteatoma
Causes painless smelly discharge and can lead to bone erosion
137
What is Otitis media with effusion?
Glue ear
Fluid build up of the inner ear without infection
Caused by Eustachian tube dysfunction
138
What is a cure for Otitis media with effusion?
Grommets
139
What is Acute Otitis Media?
Fluid build up in the inner ear due to infection
140
What can cause Acute Otitis Media?
Passage of infection up the nasopharynx and into the eustachian tube, most commonly strep pneumoniae
141
Give 2 complications of Acute Otitis Media
Perforation of the eardrum
Mastoiditis
Facial nerve involvement
142
What nerve is closely linked to the middle ear?
Facial nerve
143
What is the difference between sensorineural and conductive hearing loss?
```
Sensorineural = damage to vestiulocochlear apparatus
Conductive = outer/middle ear blocked
```
144
Name 4 inner ear diseases and give a short description of each
- Meniere's - too much inner ear fluid, hearing loss, tinnitus
- Benign paroxysmal vertigo - vertigo with sudden head movements - crystals
- Labyrinthitis - viral ear inflammation, vertigo, tinnitus, hearing loss
- Acoustic neuroma - Vestibulocochlear nerve cancer
145
Describe how a Weber's test would lateralise from a sensorineural hearing loss
Away
146
Describe how a Weber's test would lateralise from an obstructive hearing loss
Towards
147
Describe a normal Rinne's test
Air > Bone conduction
148
Describe a conductive hearing loss Rinne's test
Bone > Air conduction
149
What is the vestibule of the nose?
The nare - small -> large area, slows down area for heating and humidifying
150
What do noses have to cause turbulence and increase surface area?
Turbulence = meatuses
| Surface area = conchae
151
How do the paranasal air sinuses communicate with the nose?
Via the meatuses
152
How do the paranasal air sinuses communicate with the nose?
Via the Ostia into Meatuses
153
What is the word for a nose bleed?
Epistaxis
154
Name two nasal pathologies
Nasal Polyps
| Rhinorrhoea
155
What is the difference between a tamponade and a cauterisation?
```
Tamponade = block pipe with pressure
Cauterisation = heat
```
156
Name the 4 paranasal air sinuses
Ethmoid
Maxillary
Frontal
Sphenoid
157
Which air sinus is most commonly infected?
Maxillary, since it has to drain up into the nose and is vulnerable from teeth abscesses
158
Which air sinus can infect the orbit of the eye?
Ethmoid
159
Describe the pathophysiology of acute sinusitis
Primary infection leads to reduced drainage from sinuses and a huge breeding ground for bacteria
Streptococcus pneumoniae most common
160
What is at the back of the mouth?
Palatoglossal arches and uvula
161
What does the Uvula dangle from?
Soft palate
162
Which intrinsic tongue muscle is not innervated by CN 12, but by CN 10?
Palatoglossus
163
What nerve does "lick the wound" test?
Hypoglossal
164
What is a complication of tonsilitis?
Peritonsilar abscess
165
What nerve innervates all but one of the pharyngeal muscles?
Vagus
166
Which pharyngeal longitudinal muscle is not innervated by the vagus nerve and what is its innervation?
Stylopharyngeus -> CN 9
167
Name the two types of pharyngeal muscle
Longitudinal - main ones
| Constrictors (superior, middle, inferior)
168
Name a pharyngeal issue and its symptoms
False diverticulum, caused by loss of UOS, can lead to dysphagia and bad breath
169
Name the swallowing phases
Oral
Pharyngeal
Oesophageal
170
What travels through the optic canal? (2)
Optic nerve
| Ophthalmic artery
171
Which paranasal air sinus is most likely to be damage in an orbital blowout fracture?
Maxillary
172
What is it called when the eye is hit at high speed and the floor of the orbit collapses?
Orbital blowout fracture
173
What nerve is likely to be damaged in an orbital blowout fracture?
Infraorbital nerve
174
Name 3 symptoms of an orbital blowout fracture
Peri-orbital swelling, anaesthesia in cheek, diplopia
175
What is the difference between a meibomian cyst and a stye?
Meibomian cyst = menbomian gland blocked
| Stye = sebacious glands blocked
176
What separates the orbit from the outside?
The orbital septum
177
What are the two types of Cellulitis?
Peri-orbital
| Orbital
178
What is Peri-orbital cellulitis?
Pre-septal cellulitis
179
What is Peri-orbital cellulitis?
Pre-septal cellulitis
| Infection within the eyelid, sometimes from sinusitis
180
What is orbital cellulitis?
Infection within the orbit of the eye
181
What are the symptoms of Orbital cellulitis?
- Exophthalmos
- Reduced eye movements
- Painful eye movements
- Optic nerve can be involved
182
Where is Orbital cellulitis most commonly from?
Ethmoid sinus
183
Name 2 complications of orbital cellulitis
Cavernous sinus thrombosis
| Optic nerve damage
184
Name the components of the outer layer of the eye
Sclera
Conjunctiva
Cornea
185
name the components of the middle layer of the eye
Iris
Ciliary body
Choroid
186
What is Uveitis?
Inflammation of the choroid layer
187
Where are there no photoreceptors within the eye?
Optic disc, where the optic nerve is
188
Where are there most photoreceptors?
Macula
189
What is presbyopia?
Age related degeneration of ability of lens to change shape
190
Name 2 visual pathologies of the eye
Cataracts
| Diabetic retinopathy
191
What does a pinhole test test?
Whether it is a refractive issue or a retina/optic nerve issue
192
Describe the accommodation reflex
```
CCC
To see near things
- Convergence of the eyes
- Contraction of the ciliary body to stretch out the lens
- Constriction of the iris
```
193
Name the 3 chambers of the eye and what they contain
Anterior - aqueous humour
Posterior - aqueous humour
Vitreous - vitreous humour
194
What separates the anterior and posterior chambers of the eye?
The iris
195
What secretes the aqueous humour
Ciliary body
196
How is aqueous humour drained from the anterior chamber?
Down the iridocorneal angle and through the trabecular meshwork
197
What is the difference between chronic and acute glaucoma?
```
Chronic = trabecular meshwork degeneration with age - get optic disc "cupping"
Acute = blockage of the iridocorneal angle, emergency
```
198
Name 5 symptoms of acute glaucoma
Painful, red eye, blurred vision, no pupil response, nausea and vomiting, halos
199
What are cataracts?
Degradation of the proteins in the lens with age - can be checked via red reflex
200
What does the superior oblique muscle do and what is it innervated by?
Depresses the eye
Abducts the eye
Intorsion of the eye - main action (?) (inferior extorts)
201
Name 2 causes for extrinsic muscle of the eye palsies
Raised ICP
Microvascular damage from diabetes
Stroke (?)
202
Describe an oculomotor nerve palsy
"Down and out"
Pull of Superior Oblique - down + abduction + intorsion
Pull of Lateral Rectus - abducts
203
Describe a Trochlear nerve palsy
Superior Oblique lost
Loss of down pull and loss of abduction
Up and In
204
Describe an Abducens nerve palsy
Lateral Rectus lost
| Adducted
205
Where does the larynx lie?
Below the hyoid bone
206
Name the cartilages of the larynx from top to bottom
Epiglottis
Thyroid
Arytenoid cartilages on back
Cricoid
207
What is punctured in a cricothyoidotomy?
Cricothyroid *membrane*
208
What is the name of the false vocal cords?
Vestibular ligament
209
What is the name of the true vocal cords?
Vocal ligament
210
What is the only abductor of the vocal cords?
Cricoarytenoid
211
What nerve supplies most of the muscles of the larynx?
Recurrent Laryngeal
212
What is the singular muscle supplied by the superior Laryngeal?
Cricothyroid
213
How is a voice made more high pitched by the vocal cords?
Adducted, higher tension inwards - by cricothyroid
214
How does the cricothyroid cause higher tension in the vocal cords?
Adducts vocal cords and tilts thyroid forward on cricoid
215
How does the epiglottis prevent aspiration?
Suprahyoids elevate larynx
Aryepiglottic muscles shut epiglottis
Adduction of vocal cords
216
How could the recurrent laryngeal nerve be damaged?
During thyroid surgery
Cancer of the apex of the lung
Aortic arch aneurysm
217
What is the embryological origin of the anterior pituitary?
Rathke's pouch
218
What is a branchial cyst?
Remnant of the pharyngeal cleft, will not move with tongue
219
Name 2 first arch syndromes and what they involve
Treacher Collins - loss of mandible structure
| DiGeorge - loss of thymus and no PTH glands
