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Anatomy Flashcards

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1
Q

Branches of the maxillary artery

A

DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics Anonymous

Deep auricular
Anterior tympanic
Middle meningeal
Inferior alveolar
Accessory meningeal
Masseteric
Pterygoid
Deep temporal
Buccinator
Sphenopalatine
Descending palatine
Infraorbital
Posterior superior alveolar
Middle superior alveolar
Pharyngeal
Anterior superior alveolar
Artery of the pterygoid canal
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2
Q

Branches of the external carotid

A

Some Asians Like Fucking, Others Prefer SM

Superior thyroid
Ascending pharyngeal
Lingual
Facial
Occipital
Posterior auricular
Superficial temporal
Maxillary
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3
Q

Layers of the scalp

A 
Skin
Connective tissue
Aponeurosis (Galea Aponeurotica) 
Loose areolar connective tissue
Pericranium
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4
Q

What arteries contribute to Kiesselbach’s plexus?

A

FOMM

Facial (superior labial branch)
Ophthalmic (ant ethmoidal branch)
Maxillary (greater palatine branch)
Maxillary (sphenopalatine branch)

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5
Q

What drains to each nasal turbinate meatus?

A

PS-FAMM-N

Superior meatus:

  • Posterior ethmoidal air sacks
  • Sphenoidal sinus

Middle meatus:

  • Frontal sinus
  • Anterior ethmoidal air sacks
  • Middle ethmoidal air sacks
  • Maxillary sinus

Inferior meatus:
-Nasolacrimal duct

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6
Q

Three muscles off of styloid process & their innervations

A

Stylopharyngeus (glossopharyngeal n.)
Stylohyoid (facial n.)
Styloglossus (hypoglossal n.)

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7
Q

Which CN’s contain parasympathetics?

A

3, 7, 9, 10

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8
Q

Which laryngeal muscles are aBductors & aDductors?

A

Abductor: PCA (oPen)
Adductor: LCA (cLose)

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9
Q

Which laryngeal muscles affect pitch?

A

Cricothyroid - raises pitch

Thyroarytenoid - lowers pitch

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10
Q

How is the auricle attached to the skull?

A

Anterior, posterior, superior ligaments
Anterior, posterior, superior auricular muscles
Skin
EAC cartilage

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11
Q

What proportion of the EAC is bony vs. cartilaginous?

A

2/3 bony
1/3 cartilagenous

Opposite of eustachian tube

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12
Q

Cutaneous innervation of the auricle

A

Anterosuperior: Auriculotemporal n. (V3)
Posterosuperior: Lesser occipital n. (cervical plexus)
Inferior: Great auricular n. (cervical plexus)

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13
Q

What borders the pars flaccida?

A

Anterior & posterior malleolar folds (tympanic striae)

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14
Q

Where is there no fibrous annulus to the TM?

A

Notch of Rivinus (where pars flaccida connects directly to temporal bone)

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15
Q

What bony plate separates squamous & petrous air cells?

A

Koerner’s (Petrosquamous) septum

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16
Q

Borders of the facial recess

A

Superior: Short process of incus
Medial: Facial nerve
Lateral: Chorda tympani

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17
Q

What surface marking on the temporal bone shows where the tegmen is?

A

Temporal line

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18
Q

What are the major parts of the temporal bone

A

Petrous
Mastoid
Squamous
Tympanic

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19
Q

What suture lines are found in the EAC?

A

Tympanomastoid fissure
(posterior)

Tympanosquamous fissure
(anterosuperior)

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20
Q

What is the landmark used to gain access to the mastoid antrum?
What defines the borders?

A

Macewen’s triangle (mastoid fossa)

Anterior: Spine of Henle
Superior: Temporal line
Posterior: A line connecting the two

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21
Q

Landmark on superior temporal bone for superior semicircular canal

A

Arcuate eminence

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22
Q

Superior temporal bone: contains internal carotid

A

Foramen lacerum

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23
Q

What does the facial hiatus contain?

A

Greater superficial petrosal n.

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24
Q

How is the IAC divided?

A

Divided by falciform crest (horizontal) & Bill’s bar (vertical, top half only)

UL: Facial n. & NI
UR: Superior vestibular
LR: Inferior vestibular
LL: Cochlear

“7up, coke down”

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25
What are the embryologic precursors to the ossicles?
First branchial arch: Malleus head/neck, incus body & short process Second branchial arch: Malleus manubrium, incus long & lenticular processes, stapes cruses
26
Innervation of tensor tympani & stapedius
Tensor tympani = V3 | Stapedius = VII
27
Where does the tensor tympani come out from?
Cochleariform process
28
Where does the stapedius come out from?
Pyramidal eminence
29
What attaches the stapes footplate to the bony margins of the oval window?
Annular ligament
30
Embryologic precursor to the stapes footplate & annular ligament
Otic capsule
31
Embryologic precursor to the eustachian tube
Ventral 1st branchial arch
32
What parts of eustachian tube are bony vs. cartilaginous?
Posterior 1/3 is bony | Anterior 2/3 is cartilaginous
33
What muscle opens the eustachian tube?
Tensor veli palatini (CNV3)
34
Middle ear space divisions
Epitympanum Mesotympanum Hypotympanum
35
What is the lateral bony wall of epitympanic recess?
Scutum
36
What is the promontory?
Basal turn of the cochlea - forms the medial wall of the middle ear
37
What CN is Jacobson's n. from? | What does it supply?
CNIX Functions: 1) Sensory to the EAC 2) Jacobson's --> Lesser petrosal --> otic ganglion --> auriculotemporal --> parotid parasympathetics
38
What CN is Arnold's n. from? | What does it supply?
CNX Sensory fibers to EAC. Responsible for otoscope-cough reflex and referred otalgia in laryngeal pathology
39
Ridge of bone between round window niche and pyramidal eminence
Subiculum
40
Date of developmental arrest & associated inner ear deformities
Weeks 3-7: "Missionary coitus actually helps monogamy" 3) Michel aplasia 4) Common cavity 5) Aplasia (of cochlea) 6) Hypoplasia (of cochlea) 7) Mondini aplasia 8th week - normal development
41
What two spaces does the periotic duct (cochlear aqueduct) connect?
Subarachnoid space and scala tympani
42
What two spaces does the endolymphatic duct (vestibular aqueduct) connect?
Vestibule to endolymphatic sac (abuts posterior fossa dura)
43
Electrolyte compositions of perilymph & endolymph
Perilymph: Na+ > K+ Similar to ECF & CSF Endolymph: K+ > Na+ Similar to ICF
44
How are perilymph & endolymph formed?
CSF filtered to perilymph Perilymph filtered to endolymph
45
What is the ampulla?
Pear-shaped expansion at one end of each of the SCC Contains the Cupula
46
What is the cupula?
Gelatinous layer within each ampulla of the SCC's. Seals the SCC to detect pressure (cupula contains hair cells).
47
What is the crista ampullaris?
Sensory element of the SCCs - contains hair cells extending into the cupula
48
Which otolithic organ senses which type of acceleration?
Utricle - horizontal linear | Saccule - vertical linear
49
Which vestibular nerves carry information from which organs?
Inferior vestibular n. - Posterior SCC - Saccule Superior vestibular n. - Superior SCC - Horizontal SCC - Utricle
50
What fluid is contained in the Scala Vestibuli?
Perilymph
51
What fluid is contained in the Scala Media?
Endolymph
52
What fluid is contained in the Scala Tympani?
Perilymph
53
What membrane separates the scala media and scala vestibuli?
Reissner's membrane
54
What membrane separates the scala media and scala tympani?
Basilar membrane
55
What is the area advantage of the middle ear?
17:1
56
What is the lever advantage of the middle ear?
1.3:1
57
What is the total mechanical advantage of the middle ear?
22:1 ~30 dB gain
58
What are the neurovascular structures contained within the cavernous sinus?
CN: III, IV, VI, V2, V3 | ICA
59
Nerves supplying sensation to the V2 distribution
Infraorbital n. | Zygomaticotemporal n.
60
Nerves supplying sensation to the V3 distribution
Mental n. Buccal n. Auriculotemporal n.
61
What is contained in the posterior triangle?
Accessory nerve cutaneous branches of the cervical plexus external jugular vein transverse cervical and suprascapular vessels subclavian vein (occasionally) and artery posterior (inferior) belly of the omohyoid roots and trunks of the brachial plexus.
62
What triangles are formed by the posterior belly of the omohyoid?
Occipital and subclavian triangles
63
What triangles comprise the anterior triangle?
Submental triangle Digastric triangle Carotid triangle Muscular triangle Divided by the anterior and posterior digastric and the anterior omohyoid
64
What muscles insert onto the body of the hyoid?
geniohyoid mylohyoid omohyoid sternohyoid muscles.
65
What inserts onto the greater cornua of the hyoid?
``` middle constrictor hyoglossus digastric (anterior and posterior) bellies stylohyoid thyrohyoid muscles. ```
66
What attaches to the lesser cornua of the hyoid?
Stylohyoid ligament
67
What comes off of the styloid process?
Stylohyoid Styloglossus Stylopharyngeus Stylohyoid ligament Stylomandibular ligament
68
What comes off of the brainstem from under the pons?
CNVI CNVII CNVIII AICA
69
Which cranial nerves come out of the brainstem anteriorly?
CNII CNIII CNVI CNXII
70
What are the 5 spaces within the infrahyoid neck?
``` Visceral space Carotid sheath Retropharyngeal space Posterior cervical space Periverterbal space ```
71
What is the retropharyngeal space continuous with vertically?
The suprahyoid space superiorly | The middle mediastinum inferiorly
72
Contents of the visceral neck space
``` Larynx/Trachea Hypopharynx/Esophagus Thyroid/Parathyroid Pre/Paratracheal LN's Superior & Recurrent Laryngeal nerves Embryologic remnants ```
73
What is the pathophysiology of Eagle's Syndrome?
Elongated styloid process puts pressure on glossopharyngeal n. causing pain and dysphagia. Can also compress great vessels. Tx: styloidectomy.
74
What runs through the inferior tympanic canaliculus?
Jacobson's n. (Tympanic branch of IX) Inferior tympanic artery It is located between inferior carotid canal opening and jugular foramen
75
What runs through the mastoid canaliculus?
Arnold's n. (auricular branch of X) It is found in the lateral aspect of the jugular fossa
76
What two recesses straddle the mastoid portion of the facial n?
``` Facial recess (lateral) Sinus tympani (medial) ```
77
What are the ligaments of the malleus?
Anterior Lateral Superior
78
What is the ligament of the incus?
Posterior incudal
79
What branches of the facial nerve are given off in the temporal bone?
Greater superficial petrosal n. (Becomes vidian) N. to stapedius Chorda tympani
80
What does the cochlear aqueduct connect?
Perilymphatic space and subarachnoid space
81
Where is a pars tense cholesteatoma found?
AKA Sinus cholesteatoma Found in the sinus tympani and FN recess
82
Where do sinus cholesteatomas erode the ossicles?
Medial incus | Manubrium of malleus
83
What runs through foramen ovale?
CNV3 Lesser petrosal n. Accessory meningeal artery
84
What runs through foramen spinosum?
Middle meningeal artery | Meningeal branch of CNV3
85
What opening connects the middle cranial fossa & the pterygopalatine fossa?
Foramen rotundum
86
What opening connects the middle cranial fossa & the infratemporal fossa?
Foramen ovale
87
What are the CT findings for persistent stapedial artery?
Absent ipsilateral foramen spinosum | Soft tissue prominence with enlargement of tympanic segment of facial nerve
88
What does the vidian canal transmit?
``` Vidian nerve (GSPN+DPN) Vidian artery ```
89
Where do foramen rotundum & vidian canal lie on coronal CT?
``` Rotundum = superolateral Vidian = inferomedial ```
90
What is the foramen of Vesalius?
Variant anatomic foramen located between rotundum and ovale. Transmits emissary vein.
91
What is the palatovaginal canal?
Found just medial to vidian canal. Variant foramen what connects pterygopalatine fossa to pharyngeal roof. Contains the pterygovaginal artery & pharyngeal nerve.
92
What does the jugular spur divide?
Separates the Pars nervosa from the Pars vascularis in the jugular foramen.
93
What is contained in the Pars nervosa of the jugular foramen?
Pars nervosa contains CNIX and inferior petrosal sinus.
94
What is contained in the Pars vascularis of the jugular foramen?
Internal jugular vein CNX CNXI Posterior meningeal artery
95
Which jugular foramen is larger?
R > L in 2/3 of cases
96
What defines a high riding jugular bulb?
Dome reaches higher than IAC. If sigmoid plate is dehisced, considered dehiscent jugular bulb.
97
When do salivary glands present as pseudomasses?
1) Accessory parotid tissue (overlies masseter) | 2) Mylohyoid defect (sublingual tissue/fat/vessels can protrude)
98
What can cause reetropharyngeal edema?
Jugular thrombosis SVC syndrome Retropharyngeal adenitis Don't mistake for retropharyngeal abscess
99
What lies within the carotid sheath?
Carotid IJ CNIX, X, XI, XII Deep cervical LN's
100
Masses of the parapharyngeal space
Prestyloid: Salivary gland tumors (pleomorphic adenoma most common) Poststyloid: Neural tumors (schwannoma, paraganglioma, neurofibroma)
101
What arises from the 5th/6th ethmoturbinal?
Supreme turbinate
102
What arises from the 1st ethmoturbinal?
Agger Nasi (ascending) & Uncinate process (descending)
103
What arises from the 2nd ethmoturbinal?
Ethmoid bulla
104
What arises from the 3rd ethmoturbinal?
Middle turbinate
105
What arises from the 4th ethmoturbinal?
Superior turbinate
106
What separates the parotid gland from the submandibular gland?
Stylomandibular ligament
107
What are the histology cell types of the salivary glands?
Parotid: serous Submandibular: mixed Minor salivary glands: mucinous
108
What are the components to a salivary duct?
``` AISE: Acini cells Intercalated duct Striated duct Excretory duct ```
109
Innervation of the parotid
``` CNIX Jacobson's LSPN Otic ganglion Auriculotemporal (V3) Parotid ```
110
Innervation of the sublingual/submamdibular glands
``` Nervus intermedius Chorda tympani Lingual nerve Submandibular ganglion Glands ```
111
Saliva production rate
1-1.5 pints per day
112
CSF production rate
20cc/hr
113
What are the subsites of the supraglottis?
Epiglottis AE folds Arytenoids False cords
114
What innervates the strap muscles?
C1-C3
115
What controls the pitch of voice?
Cricothyroid
116
What are the vocal fold ADductors?
LCA Thyroarytenoid/Vocalis Cricothyroid Interarytenoid
117
What is the sensory innervation of the larynx?
Superior to vocal fold: Internal superior laryngeal n. | Inferior to vocal fold: RLN
118
What cartilage can be mistaken for a foreign body?
Triticeous cartilage Normal variant that can calcify and be mistaken for a foreign body.
119
What are the types of cartilage found in the larynx?
Hyaline: Thyroid, cricoid, arytenoid Fibroelastic: Epiglottis, corniculate, cuneiform
120
Layers of the vocal fold
Squamous epithelium Lamina propria (superficial, intermediate, deep) Thyroarytenoid/Vocalis muscles
121
Where is Reinke's space?
It is within the superficial lamina propria of the vocal fold
122
What does the vocal fold cover consist of?
Squamous epithelium & superficial lamina propria
123
What does the vocal ligament consist of?
Intermediate and deep lamina propria
124
What nerve carries negative pressure sensors?
Superior laryngeal n. Responsible for reflex ABduction with inspiration
125
Where can pressure be applied to break laryngospasm?
Larson's notch (behind angle of mandible)
126
Direction of normal vocal fold vibration
Inferior to superior (can't see) | Medial to lateral (can see)
127
What are the fundamental frequencies of speech?
Males 128 Hz | Females 256 Hz
128
When is laryngoscopy indicated in the hoarse patient?
>3mo of hoarseness | Significant risk factors or warning signs
129
Most common cause of aphonia (no contact of vocal folds)?
Psychogenic Bilateral ABductor spasmodic dysphonia is rare
130
What is normal vocal jitter?
Variation in vocal pitch | 0.4%
131
What is normal vocal shimmer?
Variation in vocal amplitude | 0.5 dB
132
What are the perceptual testing scales for voice?
GRBAS | CAPE-V
133
Most common cause of a non-recurrent RLN
Right-sided | Caused by a retroesophageal right subclavian artery
134
Which pharyngeal cleft has an adult correlate?
1st branchial cleft forms the EAC, all others involute
135
What muscles are derived from the 1st branchial arch?
``` Muscles of mastication Mylohyoid Anterior belly of Digastric Tensor tympani Tensor veli palatini ```
136
What artery is derived from the 1st branchial arch?
Maxillary
137
What nerve is derived from the 1st branchial arch?
CNV3
138
What muscles are derived from the 2nd branchial arch?
Muslces of facial expression Stapedius Stylohyoid Posterior belly of digastric
139
What branchial arches are the Hillocks of His derived from?
2nd branchial arch = HoH 1-3 | 3rd branchial arch = HoH 4-6
140
What nerve is derived from the 2nd branchial arch?
CNVII
141
What artery is derived from the 2nd branchial arch?
Stapedial
142
What is derived from the 2nd branchial pouch?
Tonsillar fossae
143
What muscles are derived from the 3rd branchial arch?
Stylopharyngeus | Superior and middle constrictors
144
What bone is derived from the 3rd branchial arch?
Hyoid
145
What nerve is derived from the 3rd branchial arch?
CNIX
146
What artery is derived from the 3rd branchial arch?
Carotid
147
What is derived from the 3rd branchial pouch?
Inferior parathyroid gland and Thymus
148
What is derived from the 4th branchial arch?
Muscles of soft palate (except tensor veli palatini), Muscles of the pharynx (except stylopharyngeus) Cricothyroid Inferior pharyngeal constrictor Thyroid & cuneiform cartilage
149
What nerve is derived from the 4th branchial arch?
SLN
150
What artery is derived from the 4th branchial arch?
Aorta (left) | Subclavian (right)
151
What is derived from the 4th branchial pouch?
Superior parathyroids | C-cells of thyroid
152
What muscles are derived from the 6th branchial arch?
``` Laryngeal cartilages (Cricoid, arytenoid, corniculate) Intrinsic muscles of larynx (except cricothyroid) Upper muscles of esophagus ```
153
What nerve is derived from the 6th branchial arch?
RLN
154
What is the external continuation of the anterior ethmoid nerve called?
External nasal nerve Exits nasal cavity between the nasal bones and lateral nasal cartilage.
155
What does the anterior ethmoidal nerve divide into?
Septal branch | External nasal nerve
156
What nerves supply posterior nose sensation?
Posterior superior lateral nasal nerves Posterior superior medial nasal nerves Nasopalatine nerve All come from sphenopalatine foramen Nasopalatine runs on septum to incisive foramen
157
What supplies sympathetic and parasympathetic innervation to the nose?
Greater superficial petrosal nerve (pterygopalatine ganglion)
158
Where do lymphatics of the nasal cavity drain to?
Anterior to SM nodes | Posterior to RP then upper deep cervical nodes
159
All muscles of the soft palate are innervated by X except for which muscle?
Tensor veli palatini (V3)
160
Where does the mental nerve exit?
Second bicuspid

ENT (10 decks)

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