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Head and Neck ESA 3 > Key facts > Flashcards

Key facts Flashcards

1
Q

Name the muscle of facial expression

A 
Frontalis
Occipitalis
Orbicularis Oris
Orbicularis Oculi
Buccinator
Zygomaticus
SCM/Platysma/Trapezius
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2
Q

Name the muscles of mastication

A

Temporalis
Masseter
Lateral and medial pterygoid

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3
Q

What nerve innervates the muscles of mastication?

A

Mandibular trigeminal

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4
Q

Name the facial nerve branches

A 
To Zanzibar By Motor Car
Temporal
Zygomatic
Buccal
Mandibular
Cervical
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5
Q

What does the facial nerve travel through externally?

A

Parotid gland

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6
Q

What is Bell’s Palsy?

A

Inflammation of CN 7

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7
Q

What muscle is responsible for the opening of the mouth?

A

Lateral pterygoid/ suprahyoids

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8
Q

What are the branches of the Trigeminal nerve?

A

Ophthalmic
Maxillary
Mandibular

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9
Q

What are the muscles of the neck?

A 
HTC
Hyoid
Thyroid
Cricoid
Platysma
SCM
Trapezius
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10
Q

Where is the thyroid gland located?

A

Underneath the Cricoid muscle

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11
Q

Name the boundaries of the Anterior triangle

A

Imaginary midline, inferior border of mandible, anterior border of SCM

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12
Q

Name the boundaries of the Posterior triangle

A

Anterior trapezius, posterior SCM, superior clavicle

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13
Q

Name the boundaries of the Carotid triangle

A

Posterior belly of digastric, superior belly of omohyoid, anterior SCM

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14
Q

Name the 3 cervical fascial layers of the neck

A

Pre-tracheal
Pre-vertebral
Investing

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15
Q

What does the carotid sheath contain?

A

IJV, common carotid, vagus nerve

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16
Q

Which of the objects within the carotid sheath is medial and which is lateral?

A

Common carotid = medial

IJV = lateral

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17
Q

What is a common site of infection and abscess formation within the neck?

A

Retropharyngeal space

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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

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19
Q

How can a thyroid lump be identified?

A

Moves when swallowing

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20
Q

How can a thyroglossal duct cyst be identified?

A

Moves when tongue move

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21
Q

Why does the thyroid move on swallowing?

A

It is enclosed by pre-tracheal fascia an attached to the hyoid bone

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22
Q

Which of the carotids is the straight one?

A

Internal

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23
Q

Which carotid artery has the carotid sinus?

A

Internal

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24
Q

What are the sinuses that travel from the cavernous sinus to the sigmoid/transverse sinuses?

A

Petrosal sinuses
Superior - Transverse
Inferior - Sigmoid

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25
Q

What can rubbing of the carotid body of the internal carotid sinus do?

A

Relieve Supraventricular tachycardias

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26
Q

What does the external carotid supply?

A

The face

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27
Q

Name 4 of the branches of the external carotid artery

A 
Facial
Superior thyroid
Lingual
Occipital
Posterior auricular
Maxillary
Superficial temporal
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28
Q

Name two terminal branches of the external carotid artery

A

Superficial temporal

Maxillary

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29
Q

What does the internal jugular vein drain into?

A

The subclavian vein

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30
Q

Where is a central line inserted?

A

Into the IJV between its two heads - where the JVP is seen

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31
Q

What does the carotid sheath run deep to?

A

SCM

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32
Q

What supplies the blood to the skull?

A

Middle meningeal artery

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33
Q

Name the dural venous sinuses

A

Superior and inferior sagittal sinuses -> confluence
Transverse venous sinus -> Sigmoid sinus
- > IJV
Cavernous sinus -> Petrosal sinuses -> Sigmoid/Transverse -> IJV

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34
Q

What is lymphoedema?

A

Oedema due to blocked/overloaded lymph nodes

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35
Q

What is lymphadenopathy?

A

Inflamed lymph nodes due to infection/cancer
Hard/matted if cancer
Soft/tender if infection

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36
Q

Name the superficial lymph nodes (9)

A 
Submental
Submandibular
Cervical - superior, anterior, posterior
Post-auricular
Pre-auricular
Occipital
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37
Q

Name the deep lymph nodes

A

Jugulodigastric
Juguloomohyoid
Supraclavicular

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38
Q

What is a very important lymph node for abdominal/thorax cancers?

A

Supraclavicular lymph nodes

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39
Q

What tonsils are visible in the mouth?

A

Palatine

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40
Q

Name 3 midline neck lump causes

A

Thyroid goitre
Thyroglossal duct cyst
Dermoid cyst

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41
Q

Name 2 lateral neck lump causes

A

Branchial cyst

Supraclavicular lymph node inflammation

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42
Q

Name the bones of the cranial floor

A

Frontal, ethmoid, sphenoid, temporal (+petrous part), parietal, occipital

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43
Q

Name the fontanelles and where they are

A

Bregma (front)

Lambda (back)

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44
Q

Name the sutures of the skull

A

Sagittal
Coronal
Lambdoid - transverse across back

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45
Q

Describe the trilaminar arrangement of skull bones

A

Diploe surrounded by inner and outer tables

The periosteum covers the inner and outer tables and is tightly adhered at the suture lines

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46
Q

What is the role of the covering of the inner and outer tables?

A

The periosteum prevents extradural haemorrhages from leaking

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47
Q

Name the landmarks/ridges of the cranial floor bones

A 
Frontal - supraorbital ridge
Ethmoid - cribriform foramina
Sphenoid - greater and lesser wings
Temporal - petrous part with internal acoustic meatus
Occipital
Parietal
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48
Q

Name 4 signs of basilar skull fracture and where they are a sign of the fracture

A

Anterior: CSF rhinorrhoea (ethmoid), Periorbital echymosis
Middle: Haemotympanum (petrous part of temporal), Battle’s sign (bruising over mastoid process)

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49
Q

Name the canals within the skull base and where they are

A

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

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50
Q

What passes through the foramen rotundum?

A

Trigeminal MAXILLARY

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51
Q

What passes through the foramen ovale?

A

Trigeminal MANDIBULAR

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52
Q

What do both the trigeminal maxillary and mandibular nerves travel through?

A

Pterygopalatine fossa

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53
Q

Name the meningeal layers from outside to inside

A

Dura
Arachnoid
Pia

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54
Q

What is special about the dura?

A

Has two layers, periosteal and meningeal

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55
Q

What are the names of the two layers of the dura?

A

Periosteal and meningeal

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56
Q

What is Xanthocromia?

A

Yellow CSF several hours after bleeding into subarachnoid space
Due to bilirubin in the CSF

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57
Q

What forms the dural folds?

A

The meningeal layer of the dura

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58
Q

Name the 2 dural folds

A

Falx cerebri - top

Tentorium cerebelli - transverse

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59
Q

What drains the subarachnoid space into the dural venous sinues?

A

Bridging veins

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60
Q

What veins drain the scalp?

A

Emissary veins

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61
Q

What is cranial nerve 1?

A

Olfactory nerve

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62
Q

What is the path of CN 1?

A

Nose -> Cribriform formina -> Olfactory bulb -> Forebrain (temporal lobe)

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63
Q

What is cranial nerve 2?

A

Optic nerve

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64
Q

What is the path of CN 2?

A

Retinal ganglion cells -> optic canal -> optic chiasm -> primary visual cortex in the occipital lobe

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65
Q

What is the optic nerve on an ophthalmoscope?

A

White disc

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66
Q

What is papilloedema?

A

Optic nerve inflammation due to raised ICP

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67
Q

What is cranial nerve 3?

A

Oculomotor

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68
Q

What is the path of CN 3?

A

Midbrain -> cavernous sinus -> superior orbital fissure -> motor

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69
Q

What muscles does CN 3 innervate?

A

LPS, Sphincter Pupillae (OS), Ciliary body, Extra-ocular muscles

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70
Q

What does CN 3 damage lead to?

A

Down and out with the eyes, dilated pupil

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71
Q

What is cranial nerve 4?

A

Trochlear nerve

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72
Q

What is the path of CN 4?

A

Midbrain -> cavernous sinus -> superior orbital fissure -> superior oblique

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73
Q

What muscle is innervated by CN 4?

A

Superior oblique

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74
Q

What is cranial nerve 5?

A

Trigeminal nerve

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75
Q

What is the path of CN 5 Va?

A

Va = Ophthalmic

Pons -> Cavernous sinus -> Superior orbital fissure

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76
Q

What is the path of CN 5 Vb?

A

Vb = Maxillary

Pons -> Cavernous sinus -> Foramen Rotundum -> Pterygopalatine fossa

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77
Q

What is the path of CN 5 Vc?

A

Vc = Mandibular

Pons -> Foramen Ovale -> Infratemporal fossa (under zygomatic arch)

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78
Q

What is the nerve that is at risk in an Orbital floor fracture? What is it a branch of?

A

Infraorbital

Vb

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79
Q

What does CN V Vc supply?

A

Muscles of mastication

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80
Q

What nerve is vulnerable to injury in mandibular fractures?

A

Inferior alveolar

Vc

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81
Q

What nerve supplies the TMJ and receives sensory from the ear?

A

Auriculotemporal nerve

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82
Q

What is cranial nerve 6?

A

Abducens

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83
Q

What is the path of CN 6?

A

Pons -> Cavernous sinus -> Superior orbital fissure -> Lateral rectus

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84
Q

What does CN 6 supply?

A

Lateral rectus muscle

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85
Q

What is special about the route of CN 6 in the cavernous sinus?

A

Medial

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86
Q

What is cranial nerve 7?

A

Facial nerve

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87
Q

What is the path of CN 7?

A

Pons -> Internal acoustic meatus -> Petrous part of temporal bone -> stylomastoid foramen

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88
Q

What are the 3 branches of CN 7?

A
  • Greater petrosal
  • Chordae tympani
  • Nerve to stapedius
89
Q

What does the greater petrosal do?

A

Glands - tears

90
Q

What does the chordae tympani do?

A

Anterior 2/3 special sensory taste

91
Q

What reflex tests the facial nerve? What are its afferent and efferent limbs?

A

Corneal reflex

Trigeminal Va -> Cranial nerve 7

92
Q

What is cranial nerve 8?

A

Vestibulocochlear nerve

93
Q

What is the path of CN 8?

A

Pons

94
Q

What is presbyacusis?

A

Age-related hearing loss

95
Q

What is a tumour of the vestibulocochlear nerve called?

A

Acoustic neuroma

96
Q

What is cranial nerve 9?

A

Glossopharyngeal nerve

97
Q

What is the path of all Medulla cranial nerves?

A

Jugular foramen (except for hypoglossal canal)

98
Q

What is the role of CN 9?

A

Posterior 1/3 of tongue - special sensory
Parasympathetic to parotid gland
Stylopharyngeus motor
Sensory to oro, carotid body, middle ear

99
Q

What are the afferent and efferent limbs of the gag reflex?

A

9 -> 10

100
Q

What is cranial nerve 10?

A

Vagus nerve

101
Q

What is the role of CN 10?

A

Sensory to pharynx and larynx

Muscles of soft palate, larynx and pharynx (except for stylopharyngeus)

102
Q

Name 2 signs of CN 10 loss

A

Hoarse voice

Uvula deviation away from lesion

103
Q

Where does the left recurrent laryngeal nerve travel?

A

Under arch of the aorta

104
Q

Where does the right recurrent laryngeal nerve travel?

A

Under subclavian

105
Q

What is cranial nerve 11?

A

Spinal accessory

106
Q

What is the role of CN 11?

A

Motor to SCM and Trapezius

107
Q

What is cranial nerve 12?

A

Hypoglossal

108
Q

What is the role of CN 12?

A

Tongue muscle innervation

109
Q

What nerve innervates the TMJ?

A

Auriculotemporal nerve

110
Q

What artery supplies blood to the eye?

A

Ophthalmic artery from the ICA

111
Q

What is exophthalmos?

A

Pressure build up in cavernous sinus, putting pressure on the eyes

112
Q

What do the pharyngeal pouches develop into?

A

Gland development eg. thymus/Parathyroids, tonsils

113
Q

How many pharyngeal arches are there?

A

5 - 1,2,3,4,6

114
Q

What do the pharyngeal clefts develop into?

A

Internal acoustic meatus - only first 2

115
Q

What cranial nerves are created from the pharyngeal arches?

A

1 - 5
2 - 7
3 - 9
4 + 6 - 10

116
Q

What embryological components is the facial skeleton made from?

A
  • 1st pharyngeal arch - maxillary prominences + mandibular prominences (both x2)
  • FNP
117
Q

What are the muscles of facial expression derivatives from? (arches wise)

A

2nd - CN 7

118
Q

Describe the fusion of the face

A

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
Q

Describe how Cleft lip and Palate occurs

A

Failure of fusion of medial nasal prominences and maxillary prominences
Failure of fusion at the midline of the palatal shelves

120
Q

What blood vessels do the sympathetics follow?

A

ICA and ECA

121
Q

What do sympathetics following the ICA to the eye innervate?

A

Dilator pupillae

Superior tarsal of LPS

122
Q

Describe the difference between Horner syndrome (sympathetics impingement) and Oculomotor nerve lesion

A

Horner syndrome - partial ptosis (loss of superior tarsal), constricted pupil, anihidrosis (no sweating)
Oculomotor nerve - ptosis (loss of LPS), dilated pupil

123
Q

What does the parasympathetic system innervate in the head and neck?

A

LPS
Salivary glands
Lacrimal glands
Smooth muscle of resp and GI tract

124
Q

What are the nerves which carry parasympathetic neurones from the brainstem?

A

3, 7, 9, 10

125
Q

After hitchhiking on cranial nerves, what do the parasympathetics hitchhike on?

A

CN 5

126
Q

Name all of the Nuclei from which the parasympathetics of the head and neck travel

A

Edinger westphal
Superior salivary
Inferior salivary
Dorsal motor

127
Q

Name all of the Ganglia through which these parasympathetics travel and where they end up

A

Edinger westphal -> 3 -> Ciliary ganglion -> Eyes
Superior salivary -> 7 -> Submandibular + Pterygopalatine -> Greater petrosal and Chordae tympani
Inferior salivary -> 9 -> Otic -> Parotid gland

128
Q

Describe the consensual light reflex

A

Optic -> Pre-tectal -> EW -> Oculomotor nerve

129
Q

What is Otalgia?

A

Ear pain

130
Q

What nerves provide sensory innervation to the ear?

A

Glossopharyngeal + Trigeminal auriculotemporal

131
Q

What is the name of the communication between the inner ear and the mastoid air cells?

A

Mastoid antrum

132
Q

Name 3 Pinna abnormalities

A
  • Ramsay Hunt syndrome - shingles of the ear
  • Chondritis - inflammation of the cartilage
  • Pinna haematoma - blood trapped in perichondrium
133
Q

What is Otosclerosis?

A

Ossicles fused, acquired hearing loss

134
Q

What is a Cholesteatoma?

A

Growth of epithelial cells in the pars flaccida of the tympanic membrane that proliferate and erode

135
Q

Give a potential cause of a Cholesteatoma

A

Eustachian tube dysfunction

136
Q

Give a complication of a Cholesteatoma

A

Causes painless smelly discharge and can lead to bone erosion

137
Q

What is Otitis media with effusion?

A

Glue ear
Fluid build up of the inner ear without infection
Caused by Eustachian tube dysfunction

138
Q

What is a cure for Otitis media with effusion?

A

Grommets

139
Q

What is Acute Otitis Media?

A

Fluid build up in the inner ear due to infection

140
Q

What can cause Acute Otitis Media?

A

Passage of infection up the nasopharynx and into the eustachian tube, most commonly strep pneumoniae

141
Q

Give 2 complications of Acute Otitis Media

A

Perforation of the eardrum
Mastoiditis
Facial nerve involvement

142
Q

What nerve is closely linked to the middle ear?

A

Facial nerve

143
Q

What is the difference between sensorineural and conductive hearing loss?

A 
Sensorineural = damage to vestiulocochlear apparatus
Conductive = outer/middle ear blocked
144
Q

Name 4 inner ear diseases and give a short description of each

A
  • 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
Q

Describe how a Weber’s test would lateralise from a sensorineural hearing loss

A

Away

146
Q

Describe how a Weber’s test would lateralise from an obstructive hearing loss

A

Towards

147
Q

Describe a normal Rinne’s test

A

Air > Bone conduction

148
Q

Describe a conductive hearing loss Rinne’s test

A

Bone > Air conduction

149
Q

What is the vestibule of the nose?

A

The nare - small -> large area, slows down area for heating and humidifying

150
Q

What do noses have to cause turbulence and increase surface area?

A

Turbulence = meatuses

Surface area = conchae

151
Q

How do the paranasal air sinuses communicate with the nose?

A

Via the meatuses

152
Q

How do the paranasal air sinuses communicate with the nose?

A

Via the Ostia into Meatuses

153
Q

What is the word for a nose bleed?

A

Epistaxis

154
Q

Name two nasal pathologies

A

Nasal Polyps

Rhinorrhoea

155
Q

What is the difference between a tamponade and a cauterisation?

A 
Tamponade = block pipe with pressure
Cauterisation = heat
156
Q

Name the 4 paranasal air sinuses

A

Ethmoid
Maxillary
Frontal
Sphenoid

157
Q

Which air sinus is most commonly infected?

A

Maxillary, since it has to drain up into the nose and is vulnerable from teeth abscesses

158
Q

Which air sinus can infect the orbit of the eye?

A

Ethmoid

159
Q

Describe the pathophysiology of acute sinusitis

A

Primary infection leads to reduced drainage from sinuses and a huge breeding ground for bacteria
Streptococcus pneumoniae most common

160
Q

What is at the back of the mouth?

A

Palatoglossal arches and uvula

161
Q

What does the Uvula dangle from?

A

Soft palate

162
Q

Which intrinsic tongue muscle is not innervated by CN 12, but by CN 10?

A

Palatoglossus

163
Q

What nerve does “lick the wound” test?

A

Hypoglossal

164
Q

What is a complication of tonsilitis?

A

Peritonsilar abscess

165
Q

What nerve innervates all but one of the pharyngeal muscles?

A

Vagus

166
Q

Which pharyngeal longitudinal muscle is not innervated by the vagus nerve and what is its innervation?

A

Stylopharyngeus -> CN 9

167
Q

Name the two types of pharyngeal muscle

A

Longitudinal - main ones

Constrictors (superior, middle, inferior)

168
Q

Name a pharyngeal issue and its symptoms

A

False diverticulum, caused by loss of UOS, can lead to dysphagia and bad breath

169
Q

Name the swallowing phases

A

Oral
Pharyngeal
Oesophageal

170
Q

What travels through the optic canal? (2)

A

Optic nerve

Ophthalmic artery

171
Q

Which paranasal air sinus is most likely to be damage in an orbital blowout fracture?

A

Maxillary

172
Q

What is it called when the eye is hit at high speed and the floor of the orbit collapses?

A

Orbital blowout fracture

173
Q

What nerve is likely to be damaged in an orbital blowout fracture?

A

Infraorbital nerve

174
Q

Name 3 symptoms of an orbital blowout fracture

A

Peri-orbital swelling, anaesthesia in cheek, diplopia

175
Q

What is the difference between a meibomian cyst and a stye?

A

Meibomian cyst = menbomian gland blocked

Stye = sebacious glands blocked

176
Q

What separates the orbit from the outside?

A

The orbital septum

177
Q

What are the two types of Cellulitis?

A

Peri-orbital

Orbital

178
Q

What is Peri-orbital cellulitis?

A

Pre-septal cellulitis

179
Q

What is Peri-orbital cellulitis?

A

Pre-septal cellulitis

Infection within the eyelid, sometimes from sinusitis

180
Q

What is orbital cellulitis?

A

Infection within the orbit of the eye

181
Q

What are the symptoms of Orbital cellulitis?

A
  • Exophthalmos
  • Reduced eye movements
  • Painful eye movements
  • Optic nerve can be involved
182
Q

Where is Orbital cellulitis most commonly from?

A

Ethmoid sinus

183
Q

Name 2 complications of orbital cellulitis

A

Cavernous sinus thrombosis

Optic nerve damage

184
Q

Name the components of the outer layer of the eye

A

Sclera
Conjunctiva
Cornea

185
Q

name the components of the middle layer of the eye

A

Iris
Ciliary body
Choroid

186
Q

What is Uveitis?

A

Inflammation of the choroid layer

187
Q

Where are there no photoreceptors within the eye?

A

Optic disc, where the optic nerve is

188
Q

Where are there most photoreceptors?

A

Macula

189
Q

What is presbyopia?

A

Age related degeneration of ability of lens to change shape

190
Q

Name 2 visual pathologies of the eye

A

Cataracts

Diabetic retinopathy

191
Q

What does a pinhole test test?

A

Whether it is a refractive issue or a retina/optic nerve issue

192
Q

Describe the accommodation reflex

A 
CCC
To see near things
- Convergence of the eyes
- Contraction of the ciliary body to stretch out the lens
- Constriction of the iris
193
Q

Name the 3 chambers of the eye and what they contain

A

Anterior - aqueous humour
Posterior - aqueous humour
Vitreous - vitreous humour

194
Q

What separates the anterior and posterior chambers of the eye?

A

The iris

195
Q

What secretes the aqueous humour

A

Ciliary body

196
Q

How is aqueous humour drained from the anterior chamber?

A

Down the iridocorneal angle and through the trabecular meshwork

197
Q

What is the difference between chronic and acute glaucoma?

A 
Chronic = trabecular meshwork degeneration with age - get optic disc "cupping"
Acute = blockage of the iridocorneal angle, emergency
198
Q

Name 5 symptoms of acute glaucoma

A

Painful, red eye, blurred vision, no pupil response, nausea and vomiting, halos

199
Q

What are cataracts?

A

Degradation of the proteins in the lens with age - can be checked via red reflex

200
Q

What does the superior oblique muscle do and what is it innervated by?

A

Depresses the eye
Abducts the eye
Intorsion of the eye - main action (?) (inferior extorts)

201
Q

Name 2 causes for extrinsic muscle of the eye palsies

A

Raised ICP
Microvascular damage from diabetes
Stroke (?)

202
Q

Describe an oculomotor nerve palsy

A

“Down and out”
Pull of Superior Oblique - down + abduction + intorsion
Pull of Lateral Rectus - abducts

203
Q

Describe a Trochlear nerve palsy

A

Superior Oblique lost
Loss of down pull and loss of abduction
Up and In

204
Q

Describe an Abducens nerve palsy

A

Lateral Rectus lost

Adducted

205
Q

Where does the larynx lie?

A

Below the hyoid bone

206
Q

Name the cartilages of the larynx from top to bottom

A

Epiglottis
Thyroid
Arytenoid cartilages on back
Cricoid

207
Q

What is punctured in a cricothyoidotomy?

A

Cricothyroid membrane

208
Q

What is the name of the false vocal cords?

A

Vestibular ligament

209
Q

What is the name of the true vocal cords?

A

Vocal ligament

210
Q

What is the only abductor of the vocal cords?

A

Cricoarytenoid

211
Q

What nerve supplies most of the muscles of the larynx?

A

Recurrent Laryngeal

212
Q

What is the singular muscle supplied by the superior Laryngeal?

A

Cricothyroid

213
Q

How is a voice made more high pitched by the vocal cords?

A

Adducted, higher tension inwards - by cricothyroid

214
Q

How does the cricothyroid cause higher tension in the vocal cords?

A

Adducts vocal cords and tilts thyroid forward on cricoid

215
Q

How does the epiglottis prevent aspiration?

A

Suprahyoids elevate larynx
Aryepiglottic muscles shut epiglottis
Adduction of vocal cords

216
Q

How could the recurrent laryngeal nerve be damaged?

A

During thyroid surgery
Cancer of the apex of the lung
Aortic arch aneurysm

217
Q

What is the embryological origin of the anterior pituitary?

A

Rathke’s pouch

218
Q

What is a branchial cyst?

A

Remnant of the pharyngeal cleft, will not move with tongue

219
Q

Name 2 first arch syndromes and what they involve

A

Treacher Collins - loss of mandible structure

DiGeorge - loss of thymus and no PTH glands

Head and Neck ESA 3 (1 decks)

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