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MRCS B > Anatomy - Head and Neck > Flashcards

Anatomy - Head and Neck Flashcards

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1
Q

Cubital fossa borders

A

Med - pronator teres
Lat - brachioradialis
Superior - epicondyles
Roof - bicipital aponeurosis, fascia, subcut fat, skin
Floor - brachialis and supinator

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2
Q

What age do cranial sutures ossify?

A

18-24 months

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3
Q

Bones forming the pterion

A

Temporal
Parietal
Frontal
Sphenoidal

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4
Q

Where does the middle meningeal artery enter the skull?

A

Foramen spinosum

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5
Q

Zygomatic arch # neuromuscular damage

A

Infraorbital nerve -> ipsilateral paraesthesia of cheek/ nose /lip

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6
Q

Boundaries of middle cranial fossa

A

Ant - lesser wing of sphenoid (post margin), anterior schismatic groove, anterior crinoid process

Posterior - crest of petrous temporal bone + dorm sellae

Lateral - squamous temporal bone + greater wing of sphenoid

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7
Q

Which artery lies at the posterior part of the clivus of the skull

A

Basillar artery (forms at junction between pons and medulla, clivus sits ant. to foramen magnum)

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8
Q

Lobe of brain in middle cranial fossa

A

Temporal

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9
Q

Where does the pituitary gland lie?

A

Sella turcica of the sphenoid bone

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10
Q

Contents of foramen magnum

A

Medulla oblongata

Vertebral arteries
Ant + post spinal arteries

Nerve roots of spinal accessory nerves
Sympathetic plexus around vertebral artery

Meninges
Tectorial membrane
Apical ligament of dens

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11
Q

Optic canal contents

A

Optic nerve
Ophthalmic artery
Symp nerves

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12
Q

Jugular foramen contents

A

CNs 9, 10, 11 (glossopharngeal, vagus, spinal accessory)
Internal jugular vein

Also: inf petrosal sinus, post meningeal artery, sigmoid sinus

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13
Q

Branches of internal carotid artery

A

Neck: none

Ophthalmic (after emerging from cav sinus)

Intracranial/ circle of willis: Middle cerebral, anterior cerebral, PComm, Ant choroidal

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14
Q

Function of cavernous sinuses

A

Each lies laterally to sella turcica (pituitary gland)

Drain venous blood from superficial middle cerebral, inf + sup ophthalmic veins, and sphenoparietal sinuses

Drain (along side inter cavernous sinuses) into sup + inf petrosal sinuses

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15
Q

Contents of cavernous sinus

A

Venous blood (from middle cerebral/ ophthalmic veins)

Nerves: CN 3,4, 6, 5 V1/V2

Internal carotid artery + surrounding symp plexus)

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16
Q

Cavernous sinus thrombosis

a) causes

b) symptoms

A

a) Infections of areas drained by facial/ ophthalmic veins

b)
Painful eye swelling,
Loss of vision,
CN 3-6 palsies

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17
Q

Cranial nerves - which skull fossa

A

Anterior fossa:
1 olfactory - cribriform plate of ethmoid bone

Middle fossa:
2 optic - optic canal
3/4/6 - superior orbital fissure
5: v1 - sup orbital fissure
v2 - rotundum
v3 - ovale

Posterior fossa:
7/8 - int acoustic meatus
9/10/11 - jugular foramen
12 - hypoglossal canal

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18
Q

Difference between right and left vertebral arteries

A

Left usually larger

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19
Q

4 parts of the vertebral arteries

A

1st: from subclavian infront of C7 + symp trunk
2nd: C2-6 transverse foramina
3rd: infant of C1 transverse foramina
4th: through dura -> anterior to medulla oblongata to become basilar

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20
Q

Branches of subclavian artery

A

VIT C D

1st:
Vertebral
Internal thoracic/ mammary
Thyrocervical trunk

2nd:
Costocervical trunk

3rd: Dorsal scapular

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21
Q

Describe course of vertebral artery

A

1 - arises from 1st part subclavian artery

2 - anterior to C7/ symptoms trunk

3 - through TP foramina of C6-C1

4 -travels back/ transverse across post arch atlas (C1) to enter foramen magnum

5 - join to form basillar

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22
Q

Branches of basilar artery

A

Posterior cerebral
Superior cerebellar
Pontine
Anterior Inferior cerebellar

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23
Q

Symptoms of vertebral artery dissection

A

Posterior head pain
Cerebellar - ataxia/ coordination
Visual cortex - contralateral visual field loss
Lateral medullary syndrome - difficulty swallowing/ speaking

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24
Q

Common sites for cerebral artery aneurysms

A

85% in anterior circulation (5% post)

-30-35% between ACA + Acomm
-30-35% at division of ICA + PComm
-20% MCA bifurcation
-5% basilar bifurcation

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25
Presentation and mx of basilar tip aneurysm
Sudden rupture most common - SAH SOL - bitemporal hemianopia Mx: coiling (IR) or clipping (surgical)
26
Boundaries of anterior triangle of the neck
Sup - lower border of mandible Post - SCM Anterior - midline of neck
27
What are the subdivisions of the anterior triangle of the neck? and what divides them?
Submandibular/ digastric triangle Submental Carotid triangle Muscular triangle Sup belly omohyoid Ant + post digastric
28
Contents of carotid triangle
Carotid sheath (common carotid + bifurcation, vagus, Int jugular vein) +Branches of external carotid - sup thyroid, asc pharyngeal, lingual, facial Ansa cervicalis (C1-3 nerves supplying infrahyoid muscles)
29
Contents of submandibular/ digastric triangle
Submandibular gland Submandibular lymph nodes Facial artery/ vein Hypoglossal nerve (CN 12)
30
Contents of muscular triangle of neck
Strap muscles External jugular vein
31
Nerve supply to digastric (ant + post)
Ant - mylohyoid nerve Post - facial nerve
32
Boundaries of posterior triangle of neck
Ant - SCM Post - traps Inf - clavicle middle 1/3 Apex - occipital bone Roof - skin, superficial and deep investing fascia
33
Contents of posterior neck triangle
Nerves: Accessory (CN 11) Phrenic nerve Trunks of brachial plexus Branches of cervical plexus - supraclavicular, great auricular, lesser occipital, tv cervical (lie within roof of triangle in fascia) Vessels: EJV (inf part) 3rd part subclavian artery Muscles: Inf omohyoid Scalene Lymph: occipital/ supraclavicular
34
Where does the external carotid artery originate and terminate
Origin: From common carotid at C4 Terminate: inside parotid as maxillary/ sup temoporal branches
35
Branches of external carotid artery
Superior thyroid Ascending pharyngeal Lingual Facial (tonsillar + labial) Occipital Posterior auricular Maxillary (inf alveolar + middle meningeal) Superficial temporal
36
Contents of submental triangle
Submental lymph nodes Submental artery + vein Anterior jugular vein
37
38
39
What is the carotid body and carotid sinus?
Body - chemoreceptors for pH change Sinus - baroreceptors for BP
40
Where is the carotid body located?
Dilation at base of ICA at common carotid bifurcation / superior border of thyroid cartilage
41
Blood supply to the thyroid
Sup thyroid artery (from ECA) Inferior thyroid artery (from thyrocervical trunk < subclavian) * also parathyroids +/- thyroid ima (brachiocephalic/ aorta)
42
Venous drainage of thyroid
Sup + middle thyroid veins -> IJV Inferior thyroid vein -> brachiocephalic veins
43
Lymph drainage of thyroid
Prelaryngeal Pretracheal/ paratracheal Deep cervical Brachiocephalic
44
vertebral level of thyroid
c4
45
Why does the thyroid move with swallowing
It is within the pre tracheal fascia which is pulled up when the digastric muscle pulls the hyoid bone/ thyroid cartilage
46
Nerves commonly injured during thyroidectomy
external laryngeal nerve (close to sup thyroid artery) recurrent laryngeal nerve (inf thyroid artery) Cervical sympathetic chain
47
What is the only type of thyroid cancer to spread via lymph
Papillary
48
Medullary carcinoma of thyroid cell origin
parafollicular c cells (secrete calcitonin)
49
Embryological origin of parathyroid glands
superior - 4th branchial arch inferior - 3rd arch (with thymus)
50
Muscles of the larynx nerve supply
All (except cricothyroid) - recurrent laryngeal nerve Cricothyroid - external laryngeal (from superior laryngeal)
51
Muscles of pharynx nerve supply
Pharyngeal plexus - Pharyngeal branches of vagus Except for stylopharyngeus - glossopharyngeal nerve
52
Sensation of larynx supply
Above VC - internal branch of superior laryngeal nerve Below VC - recurrent laryngeal
53
Sensation of pharynx supply
glossopharyngeal nerve (CN9)
54
Muscles responsible for opening / closing vocal cords
opening - posterior cricoarytenoid closing - lateral cricoarytenoid
55
Muscles responsible for tensing/ relaxing vocal cords
tensing - cricothyroid relaxing - thyroarytenoid
56
What does the recurrent laryngeal nerve supply
Motor - all larynx except cricothyroid Sensory - larynx supply below vocal cords
57
Sx of unilateral RLN injury
Dysphagia Hoarsness/ diplophonia
58
Sx of bilateral RLN injury
Partial - adducted cords = resp compromise Full - add + abd = aphonia, unable to speak/ cough
59
Sx of SLN injury
Larynx sensation + cricothyroid m. affected Pitch abnormalities Can't sing
60
What nerve pierces through thyrohyoid membrane
internal laryngeal branch of superior laryngeal
61
Layers of the scalp
Skin Connective tissue Aponeurosis (of occipitofrontalis) Loose connective tissue (temporalis muscle laterally) Periosteum
62
What age does the mastoid bone develop?
2yrs
63
Fusion of skull sutures at birth is called?
Craniosynostosis
64
What are diploid and emissary veins of the skull
Diploid - Drain diploid space (trabecular skull bone) -> dural venous sinuses Emissary - drain aponeurosis
65
What vessel may tear to form subdural haematoma?
Cerebral vein + bridging veins
66
What type of joint is the TMJ?
Bilateral modified synovial hinge joint
67
Muscles responsible for TMJ protrusion
Lateral (+medial) pterygoids
68
Muscles responsible for TMJ retraction
Temporalis + masseter (+geniohyoid/ digastric)
69
Contents of foramen lacerum
none - covered by cartilage ICA passes across
70
Contents of foramen ovale
Otic ganglion (lies on top) V3 branch of CN5 Accessory meningeal artery Lesser petrosal nerve Emissary veins
71
Contents of foramen rotundum
CN V2 maxillary nerve
71
Contents of foramen spinosum
Middle meningeal artery Meningeal branch of CNV3
72
Contents of carotid canal
ICA
73
Contents of superior orbital fissure
CN3/4/6/V1 Superior ophthalmic vein
74
Contents of optic canal
CN 2 Ophthalmic artery
75
Contents of internal acoustic meatus
CN 7/8 Labyrinthine artery + vein
76
Contents of hypoglossal canal
CN12
77
Contents of jugular foramen
IJV CN 9/10/11
78
Contents of foramen magnum
Brainstem (medulla) Spinal root of CN11 Vertebral arteries Other: Tectorial membranes Apical ligament of dens Ant + post spinal arteries
79
Causes of lytic skull lesions
Multiple myeloma Paget's disease Mets Osteomyelitis Haemangioma Sarcoidosis
80
What muscles attach to the styloid process?
Stylohyoid (larynx) Stylopharyngeus (pharynx) Styloglossus (tongue)
81
Where do the cavernous sinuses lie
Each side of the sella turcica laterally
82
Where do cavernous sinuses drain blood from/ to?
From: Superior ophthalmic** Facial vein ** Emissary veins Sphenoparietal sinuses To: Sup + infpetrosal sinuses Intercavernous sinues IJV
83
What is the 'danger area of the face' and its clinical significance
Corners of mouth -> bridge of nose -> between eyes Areas drained into the cavernous sinus (facial and sup ophthalmic veins). Infection can lead to cavernous sinus thrombosis
84
Signs of cavernous sinus thrombosis
Painful eye swelling CN palsies - 3/4/5/6 - horners/ ophthalmoplegia/ facial numbness (V1/2) Gradual loss of vision
85
Contents of cavernous sinus
O TOM CAt Lateral wall (top to bottom) Occulomotor nerve (3) Trochlear nerve (4) Ophthalmic nerve (V1) Maxillary nerve (V2) Contents (med - lat): Carotid artery (+symp plexus) Abducens nerve (6)
86
What venous brain sinuses drain into the confluence of sinuses And then where does the confluence drain to
Occipital (< Sup sag Straight (< great cerebral vein + inf sag) Drains to - transverse sinus (> sigmoid > IJV)
87
What venous brain sinuses drain into the sigmoid sinus Where does the sigmoid sinus drain
Superior and inferior petrosal Transverse (< confluence) Drains to IJV
88
Major vein draining the brain parenchyma
Great cerebral vein
89
Describe the location go the striaght venous sinus
At the junction of tentorium and falx cerebelli
90
What is the arterial supply to the temporalis muscle and its overlying skin
Muscle - deep temporal arteries (Maxillary
91
Describe the intracranial course of facial nerve
Origin - between pons + medulla Through internal acoustic meatus -> facial canal (petrous temporal bone) Exits skull through stylomastoid foramen Branches in parotid gland
92
What 4 cranial nerves have p'symp fibres What are their ganglion where they synapse?
3 Occulomotor - ciliary 7 Facial - pterygopalatine/ submandibular 9 Glossopharyngeal - otic 10 Vagus
93
Horner's vs 3rd CN palsy?
Horner's = sympathetic chain disruption/ T1 level - pupil constriction (unopposed psymp) - partial ptosis (loss of LPS smooth muscle part from symp) - anhydrosis 3rd CN palsy -eye down + out - complete ptosis(loss of CN3 striated muscle + symp smooth muscle parts of LPS) - pupil dilatation (p'symp fibres run along CN3 to sphincter papillae and ciliary muscles)
94
What do the 4 p'symp ganglion of the head and neck innervate
Ciliary (3) - orbit (sphincter pupillae + ciliary muscle) - for dilation + lens accommodation Pterygopalatine (7) - hay fever aka lacrimal/ nasal/ palatine gland Submandibular (7) - sublingual + submandibular gland for saliva Otic (9) - parotid gland for saliva
95
Structures passing through parotid gland
Facial nerve Auriculotemporal nerve (from V3) ECA Retromandibular vein Deep parotid lymph nodes
96
Blood supply to parotid (A+V) + lymph
Arterial - ECA branches Venous - retromandibular vein Lymph - deep + sup parotid > deep cervical
97
Nerve innervation of parotid gland
Sensory - greater auricular Sympathetic - superior cervical ganglion P'Symp - otic ganglion
98
What is Frey syndrome?
Damage of p'symp fibres from auriculotemporal nerve Causes excessive gustatory sweating in response salivary stimuli
99
Typeof secretions of parotid/ submandibular ducts
Parotid - serous Submandibular - mixed
100
Where do the salivary glands open (location + duct name)
Parotid - Stenson's duct, upper 2nd molar tooth Submandibular - Wharton's duct, either side of frenulum Sublingual - floor of mouth
101
What areas are drained by the pre-auricular lymph nodes?
Upper 1/2 face Temporal region Ear/ EAM Gums
102
What nerves are at risk during submandibular gland surgery?
Hypoglossal nerve (runs below) - causes tongue deviation to affected side Marginal mandibular branch of facial Lingual nerve (branch of V3, runs below)
103
Motor supply to tongue
All - hypoglossal *except palatoglossus = vagus
104
Tongue sensory supply (general and taste)
Ant 2/3: Sensory: lingual (V3) Taste: Facial via chorda tympani Post 1/3: Both - glossopharyngeal (+gag reflex) Root of tongue = vagus both
105
What are the 4 extrinsic muscles of the tongue?
Palatoglossus (CN10) Styloglossus (CN12) Genioglossus (CN12) Hyoglossus (CN12)
106
Muscle responsible for tongue retraction?
Styloglossus
107
What forms the roof of the middle ear
tegmen tympani (thin layer of petrous temporal bone)
108
Damage to which nerve causes hyperacusis?
Facial nerve - supplies stapedius via nerve to stapedius (normally dampens sound vibrations)
109
Intracranial branches of facial nerve+ functions
1) Greater petrosal - psymp via pterygopalatine ganglion to nasal/ lacrimal/ palatine glands 2) Nerve to stapedius muscle 3) Chorda tympani (runs with lingual to tongue) - p'symp via submandibular ganglion to SM/sublingual glands - taste to ant 2/3 tongue
110
How do middle ear infections cross into skull
Erosion of tegmen tympani bone Spread to mastoid air cells - > mastoiditis
111
What area is located in the post and pre-central gyrus
Pre - primary motor cortex (area 4) Post - primary somatosensory cortex (areas 1-3)
112
How to identify central sulcus of brain
extends onto medial side
113
What area of the body is represented by the medial and lateral aspects of the motor area in the brain
Medial - Lower limb Lateral - face+ upper limb
114
What cells does meningioma arise from
Arachnoid cap cells (of arachnoid villi)
115
What is an Arnold Chiari malformation?
Downward displacement of cerebellar tonsils through foramen magnum -> blockage of CSF outflow (non-communicating hydrocephalus)
116
communicating vs non-communicating hydrocephalus
Communicating - CSF flow normal but can't be reabsorbed into venous circulation - infection/ thrombus/ haemorrhage Non-communicating - blockage of CSF flow (obstructing)
117
Ddx of ring enhancing lesion on brain MRI
MAGIC DR Meningioma Abscess Glioblastoma Infarct Contusion Demyelination (MS) Radiation necrosis/ resolving haematoma
118
What is the most aggressive form of glioma?
Glioblastoma multiforme -from astrocytes - most common 1y brain tumour in adults
119
CSF pathway
Choroid plexus (3rd v) Lat v > IV foramen of munroe) >3rd v >cerebral aqueduct >4th v >foramen of Lushka/ Magendie > subarachnoid space >sup sag sinus
120
Branches of ICA (circle of willis)
ACA MCA Pcomm Ant choroid Ophthalmic
121
Branches of basilar artery (circle of willis)
Bottom to top: Ant inf cerebellar (AIC) Labyrinthine Pontine Superior cerebellar PCA
122
Branches of vertebral artery
Post spinal Ant spinal Post inferior cerebellar (PIC)
123
What is subclavian steal syndrome
Blockage of subclavian after vertebral artery. Reversal of blood flow + collaterals to UL from vertebral. Increased supply to UL (e.g. lifting heavy overhead) steals blood from brain-> syncope
124
What area of the brain is supplied by posterior circulation (vertebral/basilar arteries)
Occipital cortex Brainstem Cerebellum Thalamus
125
Signs of MCA infarct?
Hemiplegia in lower 1/2 face and limbs contralaterally Aphasia if in dominant hemisphere
126
Where do vertebral arteries join to form basilar
Lower border of pons
127
Why may pts be asymptomatic with an ICA occlusion
Due to circle of willis providing blood bilaterally
128
129
How to test superior and inferior oblique vs anatomical action
Superior: Test - in and down Action - out and down Inferior: Test - in and up Action - out and up
130
How to test superior and inferior rectus vs anatomical action
Superior: Test - up and out Action - up and in Inferior: Test - down and out Action - down and in
131

MRCS B (10 decks)

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