week 2 Flashcards
what are the functions of the skull?
To protect the brain
Provides attachment for muscle in your face that moves up and down
Supports your eyes and ears all your special sensors have to be in the right positions and also protects
use the skull in chewing and feeding
the upper airway is continous with the skull
What is the drawbacks of the skull
there is only a finite amount of space in the skull and it is not smooth. There are sharp edges which can damage the brain depending on the skull injury.
What is the name of the part of the the skull that is not the mandible?
Cranium
Name the two parts of the cranium
nuerocranium and viscero cranium –> facial part
importance of the carotid canal?
the route in which the inerntal common carotid enters the skull
importance of Ethmoid cribriform plate?
Small holes that allow nerves to go from your nasal cavity to your brain
what does the ethmoid bone contribute to ?
roof and lateral walls of the nasal cavity
what is the most common joint in the skull
sutures
what is the importance of sutures?
they all the growth of the skull
what promotes the growth of sutures?
the growth of the brain
when does ossification takes please?
around the age of 20
what is Craniosynostosis?
premature sutural fusion. This mean that the brain grows abnromally and the shape of the brain is not normal. Different parts growing at different rates
what is the treatment for Craniosynostosis?
The surgical removal of the skulla nd reforming the skull to give it more space
what is the damage of the middle meningeal artery assoicated with?
extradural hemorrhage –> is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull.
wHAT KEY structure does the middle meningeal artery pass through to get to the brain?
foramen spinossum
what is the name of the shape where the sutures meet?
pterion region
Why is the pterion region week?
it is very thin and the sutures arent formed properly. The Middle meningeal artery runs medially to this
what are the two processes of the ramus?
coronoid process that attatches the big muscles needed for chewing
condylar process which forms the arituculation with the cranium
what is the movement of the temporal mandibular joint when it is contracted?
rotation and then a anterior sliding
what problem can you have if your sinuses get blocked such as frontal sinus?
you can have issues with pressure changes
what is the first cranial nerve and what are you testing it for?
olfactor nerve and it is the nerve for smell
what are you testing 2nd cranial nerve for ?
Visual acuity
Visual fields
Pupils and responses
what normal inspections of the eye do you do?
Pupillary size. Are they equal?
Exophthalmos – protruding eyeball
Ptosis – drooping of an eyelid
which cranial nerve is the optic nerve?
2nd cranial nerve
how do you test for visual aquity?
you ask the patient to read a book or something. They will use glases if they usually need to. You use smellen chart to see if they have redcued aquity?
describe how visual field is tested?
you waggle you fingers laterally to the middle and the patient should say when they see it. They should cover one eye up and use the other. Should be done from each of the 4 corners and done for both eyes
Using a torch not opthalmoscope you shine a light into a eye and wait for to constrict then return to normal then you shine the light again on the same eye and should see the other eye constricting too. Done to both eyes. What is this testing for and what cranial neve is it?
This is testint pupils and responses to light and it is cranial 2. –> optic nerve
what should be the response when testing for pupils and responses to accomadation?
the pupils shoudl contrict as you more your index finger closer to the eye
how is Fundoscopy performed?
it is performed using opthalmoscope
what are nerves 3,4 and 6 and what are they tested for?
3rd –> occularmotor 4th –> trochlear and 6th-abducens
it is testing the movement of the eye.
With your finger make a H shape and assess the movement of one of the eyes. The other should be covered.
what nerve is trigeminal? Is it sensory or motor?
It is cranial nerve 5 and it is both.
what is the sensory testing for trigeminal?
5th nerve sensation –> using cotton touch there forehead, cheak and neck on both sides and ask the patient to tell you when they feel it
corneal reflex–> from side touch the corneal with whisp of cotton they should blink. –> if they have nerve lesion as them if they can feel it
what is the motor testing for trigeminal?
jaw clenching is done to test the masseter muscle –> bilateral muscle contraction
jaw jerk–> patient open there mouth place your finger on there chin and using tendon hammer tap your finger –> your mouch should jerk closeed –> massater has contracted
the 7th cranial nerve what is it and how do you test for it?
it is the facial nerve that controls the face –> test of it by asking them to raise there eye brows, smile and squeeze there eyes tight. While you observe for symettery
the 8th nerve –> Vestibulocochlear what are the 3 tests you do for them?
firstly ask if they can hear you easily
second is the webers test: place a tuning fork in the middle of the forhead and ask them from what direction can they hear from ( should be from the middle). This is testing bone conducation.
final test is the rinees test: place tunning fork next to ear and then mastoid process and should ask where is louder. Should be on the ear
which two cranial nerves are testing together?
cranial nerve 9 and 10. Glossopharyngeal nerve and vagus nerve
how do you test for cranial nerves 9 and 10.
You ask the patient to say ahh and the uvula should protude forward if to the side they have a lesion.
also should test for gag reflex
is cranial 9 and 10 involved in sensation or movement?
glossophrayngeal nerve (9) is sensation to the posterior 1/3rd of the tongue and motor for swallowing vagus nerve (10) is involved in both movement of the larynx and pharynx and sensation to the epiglottis and palate.
what supply is the 11th accessory nerve?
is motor supply to the sternocleidomastoid muscle and trapezius
how do you test the accessory nerve?
Ask the patient to shrug their shoulders against resistance. Any weakness will be detectable.
which cranial nerve is Hypoglossal nervea and how do you assess it?
Cranial nerve 12 –> tongue. Inspect the tongue for normal size, fasciculate. –> lesion wil cause wasting and fasciculate.
Also ask patient to stick there tongue out. If there is a lesion it will go to one side. Also ask to push tongue against cheak and see the strength
What is the condition where the pupil reacts normally to acccomodation, but not to light
Argyll Robertson pupil.
Said to be characteristic of neurosyphilis, but may occur in diabetes. The pupil is usually small to begin with.
The lesion is thought to be near the acqueduct
who was Argyll Robertson?
Scottish ophthalmologist and eye surgeon
if the 3rd nerve occularmotor is damage what will the eye look like?
unilateral complete ptosis
the eye faces down and laterally
fixed and dilated pupil
if the 4th trochlear nerve is damage what happens to the eye?
squint maximal on looking down and away from the side of the lesion
what happens to the eye when the 6th cranial nerve Abducens is damage?
the eye cannot be abducted beyond the midline i.e. squint maximal on looking to the side of the lesion
What is trigeminal neuralgia?
Episodes of intense pain that occur abruptly and last for a few seconds, occurring several times a day. It commonly starts in the mandibular division and then spreads to affect the other divisions. It is often brought on by a specific trigger e.g. shaving.
It is very disabling and may be treated medically + surgically.
what is bells palsy?
This is a unilateral lower motor neurone 7th nerve lesion.
It is thought to be of viral aetiology, that causes swelling of the nerve. This leads to compression as the nerve passes through the petrous temporal bone.
It results in weakness of the facial muscles
How do you tell the difference between an upper and a lower motor neurone facial nerve lesion?
in both lesions weakness of the facial muscle is the characterstic. However in upper the frontials muscles are spaired and therefore patient has normal eyebrow furrowing and can close the upper lid e.g. blink. However in lower all functions are impriared
Does the facial nerve have a sensory function?
yes Via the chorda tympani which carries taste fibres from the anterior two-thirds of the tongue. This geniculate ganglion (taste) lies within the petrous temporal bone and lesions here may damage taste sensation
what is the chorda tympani?
branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain.
If there is a lesion of the 12th nerve, does the tongue point to the affected or the unaffected side?
Points to the affected side –> Simply because these muscles are weaker and so the normal (stronger) muscles push the tongue sideways.
who Sir Charles Bell?
Scottish anatomist, surgeon, and physiologist
what is the suture between the temporal and parietal bone?
squamos suture
what suture is between the parietal bones?
sagital suture
what suture is between the frontal and parietal bone?
coronal suture
what suture is between the occipital and parietal bone?
lamboid suture
what is the suture between the mastoid part of the temporal bone and the occipital?
occipitamastoid suture
name the 4 fotanelle?
anterior, posterior, mastoid and sphenoid fotanelle
what is the name of the joint formed between the condylar and the cranium?
It is a joint between the condylar and temporal bone and is called the temporomandibular joint.
in which direction does the mandible dislocate?
anteriorly
what is the action of the temporomandibular joint?
anterior and posterior sliding action
what are the two main parts of the mandible?
the ramus and body of the mandible
what is the different parts of the zygomatic bone?
the zygomatic bone, arc and process
what part of the skull does the ethmoidal plates contribute too?
the lateral, medial walls and roof of the nasal cavity?
what does the maxilla contribute too?
the hard palate and roof of the mouth
what are the 3 foremans found in the sphenoid bone?
foramen ovale, retundum and spinosum
which bone is the formane magnum from?
occipital bne
which bone is the carotid canal from?
temporal bone
what are the 4 sinuses in the skull
frontal, maxilla, ethmoidal and sphenoid sinus
which sinus does the posterior gland sit superiorly too?
the spheniod sinus
by which route is a pituitary tumour normally removes
through the nasal cavity –> transphenoidal route
what is a blow out fracture of the orbit?
ball hits the eye –> increase pressure on the eye –> cause increase intraorbital pressure which blows out the small delicate bone beneath the eye ball
what are the 3 le fort fractures?
1) the maxilla seperating
2) the maxilla and nasal area seperating
3) the whole of the viscerocranium seperating
what keeps the arachnoid mater tightly adhered to the meningeal layer of dura matar?
the pressure of the underlying CSF
