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HNA-MVST1B > Unit 2 > Flashcards

Unit 2 Flashcards

1
Q

how many layers does the scalp consist of?

A

5

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2
Q

name the 5 layers the scalp consist of

A

Skin

Connective tissue

Aponeurosis

Loose connective tissue

periosteum

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3
Q
A
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4
Q

in the scalp: describe the relationship between the superifcial connective tissue and the underlying aponeurosis

A

superficial connective tissue is fibrous and tighly bound to both the skin and underlying aponeurosis

= no movement between the two

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5
Q

if theres no movement between the superficial connective tissue and underlying aponeurosis, howcome the scalp can move over the cranium?

A

because of the very loose areolar connective tissue tissue between the aponeurosis and the pericranium

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6
Q

give an important clinical implication of the density of the subcutaneous scalp tissue

A

its dense = and tends to hold superficial blood vessels open even when theyre cut = profuse bleeding often requiring sutures

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7
Q

regarding cuts in the scalp:

transver tear vs sagittal tear

A

If a wound penetrates the aponeurosis, a transverse tear will gape due to the pull of the occipitalis and frontalis muscles across the defect,

whereas a sagittal tear is more easily sutured

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8
Q

danger regarding infection in wounds penetrating the aponeurosis?

A

Any wound that penetrates the aponeurosis is serious as infection can enter the subaponeurotic space and spread over the entire surface of the cranial vault with little obstruction.

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9
Q

in the scalp where do the vessels and nerves run?

A

between the aponeurosis and skin

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10
Q

which blood vessels supply the scalp - describe how these interact?

A

The scalp is supplied by branches of the external and internal carotid arteries: superficial temporal and posterior auricular arteries (ECA); supraorbital and supratrochlear arteries (ICA).

All these vessels anastomose freely with each other.

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11
Q

in the scalp; Cutaneous nerves follow the……

A

Cutaneous nerves follow the blood vessels

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12
Q

which nerves supply the posterior of the scalp

A

Posteriorly, the scalp is supplied by the greater occipital and third occipital nerves, branches of the posterior rami of C2 and C3 respectively and laterally by the lesser occipital (C2) and auriculotemporal (branch of Vc) nerves

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13
Q

which nerves supply the anterior of the scalp

A

Anteriorly and up to the vertex, it is supplied by the zygomaticotemporal (branch of Vb) nerve, and the supratrochlear and supraorbital nerves (branches of Va).

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14
Q
A
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15
Q

heres another picture

A
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16
Q

The facial nerve (CN ___) is the ____ paired cranial nerve.

A

The facial nerve (CN VII) is the seventh paired cranial nerve.

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17
Q

The facial nerve is associated with the derivatives of the ____ pharyngeal arch:

A

The facial nerve is associated with the derivatives of the second pharyngeal arch:

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18
Q

describe the following in relation to the facial nerve

motor function

sensory fuction

special sensory function

parasympathetics

A
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19
Q

The facial nerve is the source of branchiomotor innervation to all the muscles that are derived from the ______ pharyngeal arch

A

The facial nerve is the source of branchiomotor innervation to all the muscles that are derived from the second pharyngeal arch

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20
Q

the facial nerve it carries preganglionic parasympathetic fibres destined for the ……….., and taste fibres from the……………of the tongue via its ………….. branch

A

it carries preganglionic parasympathetic fibres destined for the lacrimal, submandibular, sublingual and nasal mucous glands, and taste fibres from the anterior two-thirds of the tongue via its chorda tympani branch

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21
Q

T or F

the facial nerve is also partially responsible for general sensation of the skin lining the external auditory meatus.

A

T

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22
Q

describe where the facial nerve originates?

A

pons of the brainstem

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23
Q

can you visualise the path of the facial nerve?

A
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24
Q

describe how the facial nerve begins

A

2 roots:

larger motor root

and a smaller nervus intermedius containing parasympathetic and sensory fibres

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25
Q

describe the intracranial path of the facial nerve

A

2 roots enter the internal acoustic meatus with the vestibulocochlear nerve (CN VIII), and join to form the facial nerve, which enters the narrow facial canal which lies within the petrous temporal bone.

On the medial wall of the middle ear, the facial nerve bends posteriorly.

At the end, there is a swelling, the facial (geniculate) ganglion

On reaching the posterior wall of the tympanic cavity, the nerve runs inferiorly to emerge from the skull at the stylomastoid foramen.

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26
Q

can you remember the hole the facial nerve leaves teh skull from?

A

stylomastoid foramen

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27
Q

describe the extracranial path of the facial nerve

A

After exiting the skull, the facial nerve turns superiorly to run just anterior to the outer ear.

the main trunk of the facial nerve now termes the motor root of the facial nerve, enters the parotid gland and divides into upper and lower divisions.

The upper division gives the temporal, zygomatic and buccal branches,

while the lower division gives the mandibular and cervical branches.

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28
Q

the branches given off by the facial nerve in the paroti gland do what?

A

These branches are responsible for innervating the muscles of facial expression.

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29
Q

what are the 5 branches the facial nerve gives in the parotid gland?

A

The upper division gives the temporal, zygomatic and buccal branches, while the lower division gives the mandibular and cervical branches.

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30
Q

does the facial nerve innervate the parotid gland?

A

the facial nerve does not contribute towards the innervation of the parotid gland, which is innervated by the glossopharyngeal nerve).

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31
Q

give the branches the facial nerve gives before it exits the skull

A

3:

greater petrosal nerve

nerve to stapedius

chorda tympani

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32
Q

describe the greater petrosal branch of the facial nerve

A

greater petrosal nerve, arising at the geniculate ganglion and carrying parasympathetic fibres to the lacrimal gland via the pterygopalatine ganglion;

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33
Q

describe the nerve to stapedius branch of the facial nerve

A

nerve to stapedius, a muscle which dampens over-vibration of the tympanic membrane and ossicles; and the

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34
Q

describe the chorda tympani branch of the facial nerve

A

chorda tympani, which joins the lingual nerve. It mediates taste from the anterior two thirds of the tongue, and also carries preganglionic parasympathetic secretomotor fibres to the submandibular and sublingual glands.

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35
Q

give the branches given by the facial nerve outside of the skull

A

muscular branches to the posterior belly of digastric, stylohyoid and occipitalis;

branches to the muscles of facial expression, namely:

  • *temporal**, to orbicularis oculi and frontalis;
  • *zygomatic**, to the muscles of the eyelid;
  • *buccal**, to buccinator, orbicularis oris and muscles of the external nose;

mandibular, to the muscles of the lower lip and chin; and cervical, to platysma.

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36
Q

facial nerve

A
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37
Q
A
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38
Q
A

just for fun

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39
Q

parasympathetic fibres of the facial nerve are carried by?

A

The parasympathetic fibres of the facial nerve are carried by the greater petrosal and chorda tympani branches.

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40
Q

describe the shape of the bony orbit

A

It is cone- shaped, with the apex pointing posteromedially

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41
Q

bony orbit:

the two medial walls are almost ________ to each other, while the two lateral walls are virtually at….

A

the two medial walls are almost parallel to each other, while the two lateral walls are virtually at right angles.

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42
Q

the roof of the orbit is…. which bone?

A

orbital plate of the frontal bone, which separates the frontal lobes of the brain from the orbital contents

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43
Q

what bones forms the floor of the orbit

A

The floor is formed almost entirely by the maxilla with its air sinus

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44
Q

whart bone forms the lateral wall of the orbit

A

The lateral wall is formed by the zygomatic bone and greater wing of the sphenoid, and separates the temporalis muscle from the eye.

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45
Q

whart bone forms the medial wall of the orbit

A

The medial wall is formed mainly by the labyrinth of the ethmoid.

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46
Q

anteriorly 2 more bones contricute to the orbit - what are they

A

Anteriorly, both the lacrimal bone and the frontal process of the maxilla contribute to the orbit.

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47
Q

describe the lacrimal fossa and what it houses

A

Posterior to the inferomedial angle of the orbital rim is a depression, the lacrimal fossa, which houses the lacrimal sac

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48
Q

describe teh nasolacrimal duct

A

The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner)

carries excess tears into the nasal cavity

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49
Q
A
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50
Q

give the 3 groups of muscles which are involved in the eye

A

intraocular muscles and pupillary dilators and constrictors

6 extraocular muscles which move the eye ball

levator palpebrae superioris which elevates the upper eyelid

51
Q

which muscle lifts the eye lid

A

levator palpebrae superioris

52
Q

describe the 6 extraocular muscles which move the eye

A

small skeletal muscles

4 straight - recti

2 oblique (superior and inferior)

53
Q

where do the recti of the eye arise from?

A

tendinous ring at the back of the bony orbit

54
Q

where do the recti attach to the eye

A

just behind the junction of the cornea and sclera, i.e. just anterior to the equator of the eyeball

55
Q

which muscles of the eye are supplied by the oculomotor nerve (CNIII)

A

Three recti (superior, inferior and medial) and inferior oblique are supplied by the oculomotor nerve

56
Q

superior oblique is supplied by what?

(muscles of the eye)

A

trochlear nerve (CN IV)

57
Q

what supplied the eye muscle - lateral rectus

A

abducent nerve (CN VI)

58
Q

The medial rectus ______ the eyeball, and lateral rectus _______ it

A

The medial rectus adducts the eyeball, and lateral rectus abducts it

59
Q

superior rectus has 2 actions. what are they

can you think why? its visually quite simple

A

Due to the different long axes of the orbit and eyeball, superior rectus elevates and adducts the eyeball

60
Q

inferior rectus has 2 actions on the eye - what are they

A

inferior rectus depresses and adducts it

61
Q

superior oblique has 2 actions on the eye - what are they

so does inferior oblique - what are they

A

Due to their attachments posterior to the equator of the eyeball,

superior oblique depresses and abducts the eyeball,

and inferior oblique elevates and abducts it.

62
Q

Any coordinated movement of the eyeballs involves at least ____ muscles.

A

3

63
Q

list the 7 extraocular muscles

A

the levator palpebrae superioris, superior rectus, inferior rectus, medial rectus, lateral rectus, inferior oblique and superior oblique

64
Q

whats special about the levator palpebrae superioris

A

A small portion of this muscle contains a collection of smooth muscle fibres – known as the superior tarsal muscle. In contrast to the LPS, the superior tarsal muscle is innervated by the sympathetic nervous system.

65
Q

attachments of levator palpebrae superioris

A

Originates from the lesser wing of the sphenoid bone, immediately above the optic foramen.

It attaches to the superior tarsal plate of the upper eyelid (a thick plate of connective tissue).

66
Q

innervation of Levator palpebrae superioris

A

Oculomotor nerve (CN III)

The superior tarsal muscle (located within the LPS) is innervated by the sympathetic nervous system.

67
Q

picture of levator palpebrae superioris

A
68
Q

recti muscles characteristically originate from ….

A

recti muscles characteristically originate from the common tendinous ring

69
Q

describe the common tendinous ring

A

ring of fibrous tissue, which surrounds the optic canal at the back of the orbit

70
Q

the recti muscles attach to where on the eye ball

A

to the sclera

(behind the junction of the cornea and sclera)

71
Q

recti muscles have a ______ path from origin to attachment

A

recti muscles have a direct path from origin to attachment

72
Q

innervation of lateral rectus muscle

A

abducens nerve (CN VI)

73
Q
A
74
Q

attachments of the superior oblique muscle

A

body of sphenoid.

Its tendon passes through a trochlea and then attaches to the sclera of the eye, posterior to the superior rectus.

75
Q

actions of superior oblique muscle of the eye

A

Depresses, abducts and medially rotates the eyeball.

76
Q

innervation of superior oblique

A

trochlear nerve (CN IV)

77
Q

attachements of inferior oblique

A

Originates from the anterior aspect of the orbital floor.

Attaches to the sclera of the eye, posterior to the lateral rectus

78
Q

actions of inferior oblique muscle

A

Elevates, abducts and laterally rotates the eyeball.

79
Q

inenervation of the inferior oblique muscle

A

oculomotor nerve (CN III)

80
Q

3 eye characteristics of horners syndrome

A

horners syndrome - damamge to sympathetic trunk in the neck

Partial ptosis (drooping of the upper eyelid) – Due to denervation of the superior tarsal muscle.

Miosis (pupillary constriction) – Due to denervation of the dilator pupillae muscle.

Anhidrosis (absence of sweating) on the ipsilateral side of the face – Due to denervation of the sweat glands.

81
Q

give some possible pathologies horners syndrome can represent

A

Horner’s syndrome can represent serious pathology, such as a tumour of the apex of the lung (Pancoast tumour), aortic aneurysm or thryoid carcinoma.

82
Q

is the optic nerve purely sensory?

A

yep

83
Q

where do the axons of the optic nerve originate?

A

in the retinal cells

84
Q

describe the path of the optic nerve

A

The two nerves partially decussate to form the optic chiasma, where the optic tracts continue posteriorly to the lateral geniculate body inferior to the thalamus.

85
Q

what surrounds the optiv nerve

A

As an outgrowth of the brain, the optic nerve is surrounded by pia, arachnoid, and dura up to the point where it pierces the sclera

86
Q

is there a subarachnoid space surrounding the optic nerve

A

a small but definite one

87
Q

describe the effect on an increase in intracranial pressure on the optic nerve - and how this can be seen

A

any increase in intracranial pressure is transmitted around the nerve via the cerebrospinal fluid, leading to the appearance of papilloedema, i.e. swelling of the optic nerve disc.

88
Q

describe the path of the oculomotor nerve

A

After exiting the midbrain, the oculomotor nerve pierces the roof of the cavernous sinus and runs in its lateral wall.

Emerging from the sinus, it divides into superior and inferior divisions, which pass into the orbit through the superior orbital fissure and the tendinous ring.

89
Q

what do the superior and inferior divisions of the oculomotor nerve supply

A

The superior division supplies levator palpebrae superioris and superior rectus.

The inferior division supplies the inferior rectus, medial rectus and inferior oblique muscles, and also carries parasympathetic axons for the ciliary muscle and sphincter pupillae.

90
Q

describe how the oculomotor nerve innervates the ciliary and sphincter pupillae muscles.

A

Preganglionic parasympathetic fibres leave the inferior division to reach the ciliary ganglion.

Postsynaptic postganglionic axons leave the ganglion via 10-12 short ciliary nerves. These run forwards in the eyeball to reach the ciliary and sphincter pupillae muscles.

91
Q

describe the location of the ciliary ganglion

A

between the lateral surface of the optic nerve and the lateral rectus muscle.

92
Q

describe the path of the trochlear nerve

A

arises from tochlear nucleus of the brain

emerges from the posterior aspect of the midbrain

It runs anteriorly and inferiorly within the subarachnoid space before piercing the dura mater adjacent to the posterior clinoid process of the sphenoid bone.

The nerve then moves along the lateral wall of the cavernous sinus (along with the oculomotor nerve, the abducens nerve, the ophthalmic and maxillary branches of the trigeminal nerve and the internal carotid artery) before entering the orbit of the eye via the superior orbital fissure.

93
Q

whats the smallest cranial nerve by number of axons

A

trochlear nerve

94
Q

does the trochlear nerve have purely somatic function

A

yep

95
Q

does the trohlear nerve innervate the contralateral side?

A

yep.

As the fibres from the trochlear nucleus cross in the midbrain before they exit, the trochlear neurones innervate the contralateral superior oblique.

96
Q

how does trochlear nerve palsy present?

A

head tilt away from the affected side.

patients have difficulty looking downwards “verticle diplopia”

97
Q

abducens nerve: somatic motor or sensory function

A

purely somatic motor function

98
Q

abducens nerve innervates what muscle

A
99
Q

path of the abducens nerve (CN VI)

A

arises from the abducens nucleus in the pons of the brainstem.

exits the brainstem at the junction of the pons and the medulla.

It then enters the subarachnoid space and pierces the dura mater to travel in an area known as Dorello’s canal.

At the tip of petrous temporal bone, the abducens nerve leaves Dorello’s canal and enters the cavernous sinus (a dural venous sinus).

It travels through the cavernous sinus (lying just lateral to the internal carotid artery)

enters the bony orbit via the superior orbital fissure.

100
Q

whats diplopia?

A

double vision

101
Q

the ophthalmic nerve is a branch of what>

A

its V1 branch of the trigeminal nerve (CN V)

102
Q

describe the path of the ophthalic nerve

A

arises from the trigeminal ganglion

travels laterally to the cavernous sinus

gives off the recurrent tentorial branch .

picks up postganglionic sympathetic fibres from the internal carotid plexus.

exits the cranium via the superior orbital fissure, where it divides into 3 main branches

103
Q

3 main branches of the ophthalmic nerve

A

frontal nerve

lacrimal nerve

nasociliary nerve

104
Q

The ophthalmic division of trigeminal nerve provides sensory innervation to the following structures:

A

Forehead and scalp

Frontal, ethmoid and sphenoid sinuses

Upper eyelid and its conjunctiva

Cornea

Dorsum of the nose

Lacrimal gland

Parts of the meninges and tentorium cerebelli (recurrent tentorial branch)

105
Q

do you know which part of the skull the ophthalmic nerve gives cutaneous innervation to

A

cutaneous innervation to the face and scalp by the three branches of the trigeminal nerve have sharp borders and little overlap

106
Q

outline the corneal reflex

A

ophthalmic nerve acts as the afferent limb

107
Q

what artery primarily supplies the eye?

A

ophthalmic artery - arising as a branch of the internal carotid artery immediatly distal to the cavernous sinus

108
Q

give the branches of the ophthalmic artery

A

After entering the orbit, ophthalmic artery gives the central artery of the retina and branches to the extraocular muscles.

It ascends on the lateral surface of the optic nerve and gives the lacrimal artery

109
Q

what does the central artery of the retina supply

A

internal surface of the retina

occulsion of this artery. = blindness

110
Q

whats special about the lacrimal artery

A

Not infrequently it is given off before the artery enters the orbit.

It accompanies the lacrimal nerve along the upper border of the lateral rectus and supplies the lacrimal gland.

has a recurrent meningeal branch that anastomoses with the anterior branch of the middle meningeal artery, creating an anastomosis between the internal and external carotid arteries.

111
Q

describe the superior ophthalmic vein

and the inferior ophthalmic vein

A

leaves the orbit through the superior orbital fissure to enter the cavernous sinus

The inferior ophthalmic vein may join the superior vein, pass separately through the superior orbital fissure to join the cavernous sinus, or pass through the inferior orbital fissure to join with the pterygoid venous plexus in the infratemporal fossa.

112
Q

what are the medial and lateral canthi

A

The eyelids are two movable folds which protect the eye. When they are open, the angles of junction of the upper and lower lids are known as the medial and lateral canthi.

113
Q

whats the palpebral fissure.

A

The opening between the eyelids is the palpebral fissure.

114
Q

what are the tarsal plates

A

The tarsal plates are laminae of condensed connective tissue in each lid.

115
Q

what does the superior tarsal plate receive

A

the main insertion of levator palpebrae superioris

116
Q

describe the

tarsal or Meibomian glands

A

Modified sebaceous glands, along rims of eye lid - produce meibum - an oily secretion to make the lid margins waterproof when closed and prevents evaporation of the eye’s tear film.

There are about 25 such glands on the upper eyelid, and 20 on the lower eyelid

117
Q

what do lacrimal glands do

A

secrete lacrimal fluid onto the surfaces of the conjunctiva and cornea of the eye

118
Q

describe the location fo the lacrimal gland

A

anteriorly in the superolateral aspect of the orbit, within the lacrimal fossa – a depression in the orbital plate of the frontal bone.

anatomical relations=:

Superior – zygomatic process of frontal bone

Anterior – orbital septum

Posterior – orbital fat

Inferolateral – lateral rectus muscle

119
Q

where do the lacrimal glands open?

A

Closing the lids creates a conjunctival sac, with the lines of reflection known as the superior and inferior conjunctival fornices

The ducts (12-14) open into the lateral part of the superior conjunctival fornix.

120
Q

The lacrimal fluid produced by the gland is secreted into excretory ducts, which empty into the ,……

A

The lacrimal fluid produced by the gland is secreted into excretory ducts, which empty into the superior conjunctival fornix.

121
Q

describe the lacrimal apparatus

A

responsible for the drainage of lacrimal fluid from the orbit.

After secretion, lacrimal fluid circulates across the eye, and accumulates in the lacrimal lake – located in the medial canthus of the eye. From here, it drains into the lacrimal sac via a series of canals.

The lacrimal sac is the dilated end of the nasolacrimal duct, and is located in a groove formed by the lacrimal bone and frontal process of the maxilla. Lacrimal fluid drains down the nasolacrimal duct and empties into the inferior meatus of the nasal cavity.

122
Q
A
123
Q

done

A

yay

HNA-MVST1B (3 decks)

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