Shelf Notes

Question 1

Cribriform plate/anterior cranial fossa fracture

Answer 1

May cause anosmia (olfactory nerve), periorbital bruising, CSF leakage from the nose

Question 2

Epidural hematoma

Answer 2

Skull fracture near pterion often causes this because of a torn meningeal artery
Causes unconsciousness and death quickly because bleeding dissects a large space as it strips dura mater from the inner surface of the skull

Question 3

What passes through the cavernous sinus

Answer 3

Internal carotid artery and internal carotid plexus
Abducens nerve
Structures on lateral wall of sinus:
Oculomotor nerve
Trochlear nerve

Question 4

What is a route of infection to the cranial fossa

Answer 4

Ophthalmic vein- pass through superior and inferior orbital fissures, drain into cavernous sinus

Question 5

Symptoms of bells palsy

Answer 5

Unable to close lips and eyelids on affected side
Eye on affected side is dry
Unable to whistle, blow a wind instrument or chew effectively
Facial distortion due to contractions of unopposed contralateral facial muscles
Will also affect taste from anterior 2/3rds of tongue carried by chorda tympani
Loss of secretion from submandibular/sublingual

Question 6

Arteries in kiesselbachs area

Answer 6

Sphenopalatine, anterior ethmoidal, greater palatine and superior labial

Question 7

Infection oh sphenoid sinus

Answer 7

May erode walls to reach cavernous sinuses, pituitary gland, optic nerves or optic chiasma

Question 8

Gag reflex absence

Answer 8

Caused by injury to glossopharyngeal nerve because it is the afferent limb to the oropharynx
Efferent limb is vagus nerve

Question 9

Palatine tonsillectomy risk

Answer 9

May injury glossopharyngeal nerve- loss of taste and feeling from posterior 1/3rd of tongue
Hemorrhage typically caused from hitting the tonsillar branch of facial artery
If superior constrictor is penetrated, a high facial artery or tortuous internal carotid artery could be injured

Question 10

Palatine tonsil lymph drains where

Answer 10

Jugulodigastric lymph node, the bodies most commonly enlarged node

Question 11

Nerve supply to tonsils

Answer 11

Tonsillar plexus formed by CN IX and X

Question 12

Submental lymph nodes receive lymph from

Answer 12

Tip of tongue
Lower incisors
Central lips

Question 13

Submandibular nodes receive lymph from

Answer 13

Front of scalp
Nose, adjacent cheek
Upper/lower lip
Frontal, maxillary and ethmoid air sinuses
Upper/lower teeth
Anterior 2/3rds of tongue
Floor of mouth, gums and vestibule

Question 14

Blow out fracture of the orbit may damage what

Answer 14

Inferior rectus
Infraorbital nerve/artery
Not common in children because maxillary sinus is small and orbital floor is not a weak point

Question 15

Oculomotor nerve palsy

Answer 15

Affects most of extraocular muscles
Ptosis
Fully dilated pubil
Eye is depressed and abducted- down and out
OcuLOVEmotor palsy- not lovable when you are down and out

Question 16

Trochlear nerve palsy

Answer 16

Paralysis of superior oblique impairs ability to turn the eyeball inferomedially- pupil will look superolaterally
Double vision when looking downwards
Compensated by inclining head anteriorly and laterally toward side of normal eye

Question 17

Abducens nerve palsy

Answer 17

Inability to abduct due to lateral rectus dysfunction

Eye is fully adducted

Question 18

Corneal reflex

Answer 18

Blinking in response to touching cornea
Involves reflex connections b/w sensory afferent fibers in the ophthalmic nerve that make synaptic connections with motor fibers of facial nerve which supplies orbicularis oculis muscle

Question 19

Horner syndrome

Answer 19

Can be caused by penetrating injury to neck, thyroid carcinoma or Pancoast tumor
Interrupting ascending preganglionic sympathetic fibers anywhere b/w their origin in upper thoracic spinal cord and their synapse in the superior cervical ganglion
Constriction of pupil
Ptosis
Redness and increased temp of skin (vasodilation)
Absence of sweating

Question 20

Otitis media

Answer 20

Taste can be altered because chorda tympani is affected
Infection spreading posteriorly causes mastoiditis
Infection spreading to middle cranial fossa can cause meningitis or temporal lobe abscess
Infection through floor can produce sigmoid sinus thrombosis

Question 21

TM perforation

Answer 21

Chorda tympani directly relates to posterior surface of TM, it could be damaged resulting in loss of taste of anterior 2/3 of tongue and secretion of sublingual/submandibular glands

Question 22

Common carotid artery in relation to thyroid gland

Answer 22

Posterolateral