ANKI HnN Anat 2 Flashcards

Question

All splanchnic nerves (greater, lesser, least, etc) are sympathetic except for [...] (S2-S4, same level as pudendal n) which are parasympathetic.

Answer 1

All splanchnic nerves (greater, lesser, least, etc) are sympathetic except for pelvic splanchnic nerves (S2-S4, same level as pudendal n) which are parasympathetic.

Answer 2

Explain referred pain Referred pain is visceral pain that is perceived at a site that is not the site of origin. Theory used here is the convergence theory, where pain from viscera may be felt in the dermatome of the somatic nerve converging onto the same spinal segment because the brain cannot differentiate the source of the pain.

Answer 3

Ascending pathways Primary Neuron: All at dorsal root ganglia Secondary Neuron: location differs but this is the one that decuss (except spinocerebellar because cerebellum lateral hemispheres does ipsilateral coordination of movements) Tertiary Neuron: Thalamus for integration, projects to sensory cortex (post central gyrus)

Answer 4

Name the 3 ascending pathways, their modality, secondary neuron location, and level of decussation

Answer 5

Name the descending (motor) pathways, function, origin & level of decussation - Most important motor pathway is the pyramidal tract, controlling mainly flexors - Extra-pyramidal tracts (postural pathways) influence muscle tone, posture and movement. They modify and influence the activities of the pyramidal system on LMN

Answer 6

Weakness in a particular limb can arise from a lesion anywhere along the motor axis In LMN lesion - reflex arc is broken, hence no reflexes - ipsilateral (decussation happens before LMN neurons) - Denervative changes (muscle wasting, fasciculations) In UMN lesion - Higher level modulation of reflex arc is lost, hence brisk reflexes - Contralateral Hence the differential here is LMN lesion is no re

Answer 7

Pharyngeal/Branchial Apparatus development occurs around week 4

Answer 8

Pharyngeal arches appear as ridges on either side of the head & neck regions - Arches: bars of mesoderm that gives muscles, vessels and skeleton - Pouches: Endodermal diverticula from the gut, tends to become glands - Clefts: inward ectodermal grooves

Answer 9

Pharyngeal Arch Derivatives: 6 arches form but 5th arch undergo regression, leaving 1,2,3,4 & 6 Name the muscular derivatives and hence innervation of the 5 arches 1st PA (CN5) muscle derivatives: Muscles of mastication, + MATT (Mylohyoid, Ant belly of digastric m ,TVP, Tensor Tympani) 2nd PA (CN7) muscle derivatives: Muscles of Facial Expression + PSSP (Platysma, Stylohyoid, Stapedius, Pos belly

Answer 10

Derivative of Pouches: Due to obliteration of 5th arch, pouches 4 + 5 combine, so there are 4 pouches 1,2,3,4+5. Each pouch is divided into dorsal and ventral component Name the derivatives of the 4 pouches

Answer 11

What are the 4 fascia (hence 4 compartments) of the neck? Name the components inside each compartment. Hint: cross section view Investing fascia: SCM, Trepezius (motor ss from CN11) Pre-tracheal fascia: Thyroid, Trachea, Esophagus Pre-vertebral fascia: Pre-vertebral muscles, Vertebral column Carotid sheath: CCA(ICA), IJC, CN10 in the carotid sheath, ICA is most medial. Platysma is inside the super

Answer 12

Neck anterior wall landmarks SCM: Divides ant/pos triangle C3: Hyoid Bone C4: Laryngeal Prominence, -bifurcation of common carotid, transition of pharynx to esophagus & larynx to trachea C6: lower border of Cricoid Cartilage

Answer 13

in Cricothyrotomy, wide-bore needle is inserted through cricothyroid ligament which forms a soft depression between inf margin of thyroid cartilage and sup margin of cricoid cartilage

Answer 14

Movements of the SCM Unilateral contraction: tilt head towards same side, rotate head to opp side Bilateral contraction: tilt jaw up

Answer 15

Name the 4 infrahyoid muscles in the deep layer of the ant triangle of the neck & their innervation

Answer 16

Torticollis = Short SCM If untreated: asymmetrical growth of face, cervical vertebrae become wedge-shape Caused by congenital defects: tearing of SCM during difficult labour resulting in hematoma, fibrosis & shortening

Answer 17

Relations IN the carotid sheath [Lat] Int Jugular vein (and deep cervical lymph nodes) [Med] Carotid art [Pos] Vagus n Relations OF the carotid sheath [Ant] Skin, fascia, SCM, omohyoid, parotid (int/ext carotid) [Pos] C4-7 transverse process, pre-vertebral muscles, cervical plexus, phrenic n [Med] Vascular compartment: Larynx, Pharynx, Trachea, Esophagus, Thyroid

Answer 18

Cutaneous branches of the cervical plexus emerge from pos border of SCM (Nerve Point)

Answer 19

Ansa-Cervicalis lies on IJV Supplies: strap muscles, prevertebral muscles, levator scapulae

Answer 20

Ant rami of C5-T1 forms roots of the brachial plexus, which supplies the upper limb. Emerges between scalenus ant & medius, covered by pre-vertebra fascia & posterior to int jugular vein of carotid sheath (nerves are large and converging) Descends inferolat, passing between 1st rib, clavicle & sup border of scapula to enter axilla

Answer 21

CN11 (spinal) supplies motor innervation to trapezius, SCM

Answer 22

Arrange apex of lung, scalenus ant, subclavian vein, art, phrenic nerve & brachial plexus from superficial to deep - Subclavian vein (not compressed by muscles) - Scalenus ant & phrenic nerve - Subclavian art - Brachial Plexus - Apex of Lung (pos to first part of subclavian art): beware of pneumothorax

Answer 23

Complications of central venous line catherization include -Puncture apical pleura of apex of lung (pneumothorax) -Puncture subclavian art (haemothorax) -Phrenic n injury (diaphgram paralysis)

Answer 24

Cervical Sympathetic Trunk levels - Sup cervical ganglion: C1 (immediately below skull) - Middle cervical ganglion: C6 (cricoid cartilage) - Inf cervical ganglion: C7

Answer 25

Phrenic n: pass btw subclavian vein and artery (which means its on the scalenus ant), under prevertebral fascia

Answer 26

Thyroid originates from midline endodermal diverticulum behind 1st PA The diverticulum is called thyroglossal duct The vestigial structure left behind is called foramen of ceacum Abnormality: ectopic thyroid gland on tongue is called lingual thyroid

Answer 27

What are the layers of the scalp? Mnemonics: SCALP S – Skin C – Connective Tissue (dense) A – Aponeurosis L – Loose connective Tissue P – Pericranium

Answer 28

Blood supply of the SCALP From ext carotid art: via occipital, pos auricular & sup temporal art From int carotid art: via SOST art Calvaria is supplied by meningeal arteries

Answer 29

Muscles of facial expression and scrotum muscles are subcutaneous muscles Muscles of facial expression are derivatives of 2nd PA (hence CN7)

Answer 30

"Blood supply of the face is from Facial Artery, a branch of ECA Key feature is that it's course is ""Tortuous"""

Answer 31

Danger Triangle (upper lips to bridge of nose) Connection between venous drainage of the face and venous sinuses of the cranium is through - ophthalmic veins to cavernous sinus - infra-orbital & deep facial veins to pterygoid venous plexus

Answer 32

Somatic sensory supply of CN5 is demarcated by Vertex-Ear-Chin line If you got a knee jerk reaction and answered within 1s, NYK is proud of u :)

Answer 33

Corticobulbar tract to muscles on lower face receive only contralateral UMN influence CN7 UMN lesion: paralysis of lower half of contralateral face CN7 LMN lesion: paralysis of both upper and lower half of ipsilateral face i.e lower face contralateral UMN influence, upper face bilateral UMN influence

Answer 34

Innervation of parotid gland is from CN9 --> lesser petrosal nerve --> otic ganglion --> hitchhike audiculotemporal n of CN V3

Answer 35

Parotid duct makes sharp turn at anterior border of masseter muscle to empty secretion into parotid papilla

Answer 36

Travelling within parotid gland (from superficial to deep) are CN7, Retromandibular Vein, ECA which are easily damaged during surgery on parotid gland

Answer 37

Outline the origin, course, supply of the Common Carotid Artery Origin: -R Common Carotid from brachiocephalic art behind R sternoclavicular joint -L Common Carotid directly from arch of aorta Course: -run upward in carotid sheath from sternoclavicular joint, under anterior border of SCM -no branches given off, bifurcate at C4 level (upper border of thyroid cartilage) Supply: -All structures in he

Answer 38

Outline the origin, course and supply of the External Carotid Artery Origin: -terminal branch of common carotid artery after bifurcation at C4 Course: -ascend superficially upon emerging from ant border of SCM -initially medialthen pos/lat to ICA (and hence carotid sheath) -gives 6 branches including sup thyroid art (inf thyroid art from subclavian art), lingual art, facial art, etc -terminates in

Answer 39

Outline the origin, course and supply of the Internal Carotid Artery Origin: -terminal branch of Common Carotid Artery after bifurcation at C4 Course: -ascend in neck within carotid sheath deep to parotid gland -pass through carotid canal in petrous temporal bone -travel thruough cavernous sinus (no communication) -gives out opthalmic art & posterior communicating art (Circle of Willis) branches -

Answer 40

Carotid sheath surface marking is from sternoclavicular joint to point midway between tip of mastoid process and angle of mandible

Answer 41

Outline the origin, course and drainage of the Internal Jugular Vein Origin: -IJV is the continuation of sigmoid sinus which leaves posterior cranial fossa through the jugular foramen (along w CN9,10,11) Course: -Descends in the neck through carotid sheath (together with ICA, CN10, deep cervical lymph nodes) -joins subclavian vein behind medial end of clavicle to form brachiocephalic vein Drainage

Answer 42

Neck lymphatic drainage general pathway Superficial tissues: Superficial Cervical Nodes --> Deep Cervical Nodes --> Jugular Lymphatic Trunks (R lymphatic duct & L thoracic duct) Deep tissues: Deep Cervical Nodes --> Jugular Lymphatic Trunks (R lymphatic duct & L thoracic duct)

Answer 43

The convergence of the frontal, occipital, temporal and greater wing of sphenoid wing is called Pterion. This is the thinnest part of the skull, and fractures punctures the middle meningeal artery, resulting in extradural haemorrhage

Answer 44

Name the 3 cranial fossa, their respective openings and contents that passes through (1 card ta it all!!!) Anterior cranial fossa: -contains frontal lobes -Cribriform plate of ethmoid (CN1) Middle cranial fossa: -bounded by lesser wing of sphenoid & petrous temporal bone -contain temporal lobes -hypophyseal fossa/sella turcica (turkish saddle) contains pituitary gland -Optic canal (CN2) -SOF/Foram

Answer 45

In the middle cranal fossa, ICA can be found associated with CN2

Answer 46

The two layers of the Dura mater are Endosteal/Periosteal layer & Meningeal layer. The layer that extends through foramen magnum to form dura of spinal cord is the Meningeal layer (i.e spinal cord no endosteal layer)

Answer 47

Name the 3 septa formed by the meningeal layer of the dura mater and its main function -Falx Cerebri -Falx Cerebelli -Tentorium Cerebelli Main function is to resist rotatory displacement of the brain (TL;DR stability)

Answer 48

CSF drains into the dural venous sinuses via arachnoid granulations/villi

Answer 49

Dura is innervated by meningeal branches from CN V1,V2,V3, 10 & C2-3 Falx(s) are all innervated by CN V1 Literally nobody knows but now u know hehe.... Clinical: Dural headaches Dura is sensitive to pain even though brain itself is not (reason why in neurosurgery after you get past it, patient can be awake and playing violin while the surgeon works away at removing the brain tumour) - Caused by di

Answer 50

Name the 3 types of brain haemorrhages and identify the cause. - Extradural, torn MMA - Subdural, torn sup cerebral veins (crossing of cerebral vein to enter DVS) - Subarachnoid, cerebral artery aneurysms (blood spills directly into subarachnoid space & CSF) Note the presentation of these haemorrhages on radiography.

Answer 51

Dural Venous Sinuses. Imagine drawing out the sinuses and connecting them as you answer. Superior sagittal sinus (I affectionately calls it SSS) runs in the upper border of falx cerebri - Receive sup cerebral veins - Cont. w venous lacunae Inferior sagittal sinus (ISS) runs in inf concave border of falx cerebri - Union of ISS & Great Cerebral Vein of Galen forms the straight sinus (StS) Occipital

Answer 52

Cavernous sinus (CS) is drained by -Sup Petrosal Sinus: from CS via anterolat margin of tentorium cerebelli to TS -Inf Petrosal Sinus: drains inferiorly to junction of SS & IJV Recall CS communicates w pterygoid plexus, triangle of danger.

Answer 53

Structures & relations of the Cavernous Sinus Structures inside the CS: - Thru sinus: ICA, sympathetic plexus, CN6 - In lat wall: CN3,4,V1,V2 Relations of CS & pituitary - [Ant] SOF - [Lat] Foramen R, Foramen.O, Trigeminal Ganglion - [Pos] F. Lacerum - [Sup] Optic Chiasma - [Med] Pituitary gland (in Sella Turnica) - [Inf] Nasal cavity, sphenoid sinus

Answer 54

Enlarged pituitary gland causes bitemporal hemianopia “If you see the slides I showed you during prelab, 3 of our 20 silent mentors had pituitary enlargement. What will that cause? Yes (???)”– Prof Ng Yee Kong

Answer 55

Brain Embryology. Name the primary vesicles, secondary vesicles and derivatives of the neural tube Need to know? idk man. At least secondary vesicle? Know the names for MCQ.

Answer 56

Name the 4 lobes of the brain (dont tell me u dont know) and the 2 fissure 3 sulcus that divides them. 4 lobes of the brain (F, P, T, O) - L/R separated by longitudinal fissure/falx cerebri - Central sulcus divides F & P (identify as most consistent parallel fold) - Lateral fissure divides P & T - Parieto-occipital sulcus (must see from medial aspect) divide P & O - Calcarine sulcus subdivides the

Answer 57

The white matter connecting two brain hemispheres is called Corpus Callosum (CC)

Answer 58

The thalamus lies on either side of the 3rd ventricle of the brain

Answer 59

Cerebral cortex grey matter layers - Layer 4 thicker in sensory cortex (ascending tracts ST, DLMC, SC) - Layer 5 thicker in motor cortex (descending tracts CS/pyramidal, CB)

Answer 60

Where are the somatic sensory areas in the cerebral cortex? - Primary somato-sensory cortex (SC1): post-central gyrus (A1,2,3) --> receives input from ventral posterior nucleus (VPL/VPM) of the thalamus - Secondary somato-sensory cortex (SC2)/Somesthetic Association Area: posterior to SC1 (A5) --> multimodal columns provide stereognosis (identify 3D object without held in hand looking at it)

Answer 61

Where are the somatic motor areas in the cerebral cortex? - Primary motor cortex (MC1): pre-central gyrus (A4) --> Gives rise to pyrimidal tract - Secondary motor cortex (MC2) is subdivided into Pre-Motor Cortex (PMC) (A6, lat) & Supplementary Motor Area (SMA) (A6, med) between primary and frontal gyri --> PMC for motor intention, SMA for motor planning

Answer 62

Sensory and motor homunculus show the area of representation of body areas in the cerebral cortex: -Medial cortex: Lower body (Supplied by ACA) -Lateral cortex: Upper body (Supplied by MCA)

Answer 63

Where are the visual areas in the cerebral cortex? - Primary Visual cortex (VC1): both banks of calcarine sulcus in occipital lobe (A17) - Visual Association Area (VC2): surrounding VC1 (A17,18) --> motion, colour, shape Form & colour (what) continues into cortex on the underside of the T lobe (Ventral Visual Pathway) Spatial relationships & motion (where) continue to the posterior parietal lobe (

Answer 64

Where are the hearing & speech areas in the cerebral cortex? - Primary auditory area (AC1) at superior temporal gyrus - Wernicke’s speech area (sensory speech) surrounds the primary auditory area - Broca’s speech area (motor speech) at inf frontal gyrus, above lateral fissure

Answer 65

Aphasia = disturbed language function. Normal function requires both sensory and motor speech area connected by Arcuate Fasciculus, mostly on dominant hemisphere. Presentation of speech lesions: - Wernicke’s (sensory speech) --> Receptive aphasia (difficulty in understanding spoken word) - Broca’s (motor speech) --> Expressive aphasia (difficulty in speaking & writing)

Answer 66

Pre-Frontal Cortex (PFC) is found infront of PMA It is uniquely large in human brain, concerned with the highest brain functions such as decision making, abstract thinking, social behaviour, foresight

Answer 67

Frontal Eye Field (FEF) (A8) is located infront of SMA/PMC and is responsible for conjugate movement of eye

Answer 68

The number to remember which CN arise from which part of the brainstem is 2,2,1,3,4

Answer 69

The 3 lobes of the cerebellum are anterior lobe, posterior lobe and flocculo-nodular lobe The 4 anatomical subdivisions of the cerebellum are Vermis (SC), Para-Vermal Zone (SC), Lateral Hemisphere (CC) & Flocculo-nodular (VC)

Answer 70

Name the 3 functional subdivisions of the cerebellum, their functions and location. Spino-cerebellum SC: Function: muscle tone Location: Vermis, Para-vermal Cerebro-cerebellum CC: Function: ipsilateral coordination Location: Lateral Hemisphere Vestibulo-cerebellum VC: Function: equilibrium Location: Flocculo-nodular lobe

Answer 71

"Complex of motor symptoms in cerebellar dysfunction is called ""Ataxia"". Cerebellar dysfunction presents ipsilaterally Dysequilibrium - Pt unsteady in standing position, show considerable swaying - Staggering and tendency to fall on when walking Dystonia - Loss in resistance normally offered by muscles to passive manipulation Dyssynergia - Loss of coordinated muscle movement - Inability to arres

Answer 72

Damage to basal ganglia causes problems concerning speech, movement & posture. The combination of these symptoms is called parkinsonism Substentia nigra is a basal nuclei btw.

Answer 73

Name the ventricles of the brain and the communicating channels between ventricles 2 Lateral Ventricles in the cerebral hemispheres - Body (P lobe), frontal horn, occipital horn, temporal horn - Opens through interventricular foramen into 3rd ventricle 3rd Ventricle: slit-like cavity btw R & L diencephalon - Drains via (cerebral) aqueduct of Sylvius to 4th Ventricle 4th Ventricle: in pos pons & me

Answer 74

Bell’s Palsy is a CN7 LMN lesion that can be caused by - Inflammation of facial nerve (e.g. viral neuritis) especially at stylomastoid foramen - Temporal bone fracture, wounds (superficial hence vulnerable), birth injury LMN lesion causes ipsilateral paralysis of facial muscles (both upper and lower face) If lesion occurs before these fibres exit, may also result in -Ipsilateral hyperacusis: overs

Answer 75

CSF is secreted by choroid plexus in each ventricle (vascular pia mater covered by cuboidal epithelium) Outline the circulation of CSF and its eventual drainage into the dural venous sinuses CSF leaves lateral ventricle --> interventricular foramina (of Monroe) --> 3rd ventricle --> aqueduct of Sylvius --> 4th ventricle --> enter subarachnoid space via 2L1M (2 Luschka, 1Magendie) --> reabsorbed in

Answer 76

Intra-cranial pressure depends on the balance between CSF secretion and reabsorption. Abnormal accumulation of CSF in the ventricles of the brain = Hydrocephalus Causes include - Blockage of CSF outflow, usually in cerebral aqueduct (tumour, infection) - Interference with drainage into DVS (e.g. blocked arachnoid granulations after haemorrhage) - Overproduction of CSF Hydrocephalus results in vent

Answer 77

The blood supply of the brain is 80% from internal carotid system (anterior circulation) & 20% from vertebrobasilar system (posterior circulation)

Answer 78

The cerebral arterial circle on ventral surface of brain, in subarachnoid space is called Circle of Willis . It's function is to provide anastomosis & collateral circulation in the brain [Ant to pos] ant communicating art, ACA,ICA, pos communicating art, PCA “Not everyone has a complete Circle of Willis, but if you do, you are lucky and less likely to get stroke ” Prof Ai Peng Tan

Answer 79

Rupture of Berry Aneurysms in the Circle of Willis causes subarachnoid haemorrhage.

Answer 80

Blood supply of the cerebral cortex is by ACA, MCA & PCA

Answer 81

Blood supply to cerebellum is from the vertebralbasilar system - Sup cerebellar: also SS pons, sup cerebellar peduncle, tectum of midbrain - Ant inf cerebellar: also SS part of pons (cochlear nuclei) - Pos inf cerebellar: also SS lat medulla, inf vermis, 4th ventricle choroid plexus - Pontine art

Answer 82

The labyrinthine artery is a branch of basilar artery

Answer 83

The BBB prevents macromolecules from passing between vascular system and the CNS Exception: BBB leaky at hypothalamus to allow hypothalamus to sense level of circulating hormones. Other exceptions include pineal gland, area postrema & median eminence

Answer 84

CNS capillary endothelial cells (BBB) are unlike somatic tissue endothelial cells with fenestrations. Name the 3 differences that contributes to the BBB. - Tight Junction - Basement Membrane - Astrocytic foot process Astrocytes transport glucose actively into CSF, water soluble substances blocked (e.g. plasma proteins, macromolecules), lipid soluble substances cross. These are implications for dru

Answer 85

BBB breakdown can be caused by: - Hypertension --> BP > power of arterioles to control --> cerebral oedema - Infection --> leukocyte migration - Osmotic challenge (sometimes on purpose) - Severe hypercapnia (due to arteriolar muscle relaxation)

Answer 86

12 Cranial Nerve CHINESE mnemonic: 1嗅2视3动眼，4滑5叉6外展，7面8听9舌咽，10迷1副舌下全

Answer 87

12 Cranial Nerve somatic sensory/motor function mnemonic: Some say marry money, but my brother says big brains matter more S: sensory (olfactory nerve - CN I) S: sensory (optic nerve - CN II) M: motor (oculomotor nerve - CN III) M: motor (trochlear nerve - CN IV) B: both (trigeminal nerve - CN V) M: motor (abducens nerve - CN VI) B: both (facial nerve - CN VII) S: sensory (vestibulocochlear nerve

Answer 88

12 Cranial Nerve special sensory nerves: Pure special sensory: CN1,2,8 Has special sensory: CN7,9,10 Note that smell is the only sensation that DOES NOT pass through the thalamus

Answer 89

12 Cranial Nerves parasympathetic nerves: CN3,7,9,10

Answer 90

CN3 supplies parasympathetic innervation to sphincter pupillae & ciliary muscle Pre-ganglionic ganglion: Edinger-Westpal nuc Post-ganglionic ganglion: Ciliary ganglion CN3 parasympathetic post-ganglionic fibres emerge ciliary ganglion as short ciliary nerve Note that long ciliary nerve carries sympathetic from superior cervical trunk

Answer 91

CNs generally receive bilateral UMN influence except CN7 Exception: CN7 fibres to lower face only receive contralateral UMN input Exception: CN7 receives bilateral input but contralateral is dominant Clinical: Lesion of brain UMN not significantly seen except in lower face and tongue

Answer 92

All extraoccular muscles are supplied by CN3 except SO4 LR6

Answer 93

All muscles of facial expression are supplied by CN7

Answer 94

Stapedius is a derivative of the 2nd pharyngeal arch and is hence supplied by CN7

Answer 95

All muscles of mastication are derivatives from the 1st pharygeal arch and is hence innervated by CN V3

Answer 96

Tensor Tympani & Tensor Palitini are derivatives of the 1st pharyngeal arch and hence is innervated by CN V3

Answer 97

All muscles of the palate is supplied by the Pharyngeal Plexus (CN10) except TVP (CN V3)

Answer 98

All muscles of the tongue is supplied by CN12 except PG (Pharyngeal Plexus/CN10)

Answer 99

All muscles of the pharynx is supplied by CN10 except stylopharyngeus (CN9)

Answer 100

All muscles of the larynx are supplied by Recurrent laryngeal of CN10 except cricothyroid (ext laryngeal of CN10)

Answer 101

CN1 pathway: Olfactory tract --> olfactory bulb --> olfactory cortex in forebrain

Answer 102

Outline the course of CN2 (try drawing out) Retinal ganglion cells --> optic disc --> optic nerve fibres enter optic canal and middle cranial cavity --> optic chiasma (hemi decussation) --> optic tract--> Lateral Geniculate Nucleus (LGN) of thalamus --> optic radiation (note Meyer’s Loop) --> Visual cortex @ banks of calcarine sulcus of occipital lobe Collaterals to midbrain for visual reflexes ar

Answer 103

The somatic motor nuclei of CN3 is called Occulomotor Nuc, supplying all EOM except SO4 LR6 CN3 also supplies parasympathetics to sphincter pupillae & ciliary body Outline the course of CN3: Originate from midbrain at level of superior colliculus --> lat wall of cavernous sinus (CN3,4,V1,V2) --> Superior orbital fissure Rmb fight or flight = eye open big big so dilator pupillae is sympathetic (ss

Answer 104

CN3 lesion results in paralysis of all EOM except SO4 LR6. Clinical signs: - Ptosis due to impaired LPS - Pupil dilation, unreactive to pupillary light reflex (CN3 supplies sphincter pupillae which is parasympathetic) - Lat deviation of affected side due to unopposed lat rectus - Diplopia (double vision) present for all CN3,4,6 lesions when looking towards affected side --> one eye can look but th

Answer 105

All cranial nerves exit anterior to the brainstem except CN4 which exits posterioly (hence only CN to innervate contralateral structures) Outline the course of CN4: Originate from Midbrain at level of inferor colliculus --> middle cranial fossa--> lateral wall of cavernous sinus (3,4,V1,V2) --> superior orbital fissure

Answer 106

CN4 lesion results in paralysis of SO4 Clinical signs: - Elevation of eye on forward gaze due to unopposed IO - Elevation increased with head tilting towards the affected side - Diplopia (double vision) present for all CN3,4,6 lesions when looking towards affected side à one eye can look but the other cannot

Answer 107

The somatic motor nuclei of CN6 is called Abducens Nuc, supplying LR6 Outline the course of CN6: Originate from Pontomedullary junction (CN6,7,8) --> Middle cranial fossa --> passes through cavernous sinus (ICA, CN6) --> Superior Orbital Fissure (CN3,4,V1,6)

Answer 108

CN6 lesion results in paralysis of LR6 Clinical signs: - Eye cannot abd - Add at rest due to unopposed MR - Diplopia (double vision) present for all CN3,4,6 lesions when looking towards affected side --> one eye can look but the other cannot

Answer 109

CN11 (spinal) supplies SCM & Trapezius

Answer 110

Outline the course of CN12: Originate from Medulla Oblongata --> Hypoglossal canal --> between mylohyoid & hyoglossus to reach tongue

Answer 111

CN5 divisions are all purely sensory except V3

Answer 112

The 3 CN5 sensory nuclei are - Mesencephalic (proprioception) - Principal Sensory (fine touch) - Spinal Nuclei (pain)

Answer 113

What are the foramens that CN V1,V2 & V3 passes through, and which one of these DOES NOT pass through the lateral wall of cavernous sinus? SOF: CN3,4,V1,6 R: CN V2 O: CN V3 S: MMA CS: 6, ICA/CN 3,4,V1,V2,

Answer 114

The 3 branches of CN V1 are - Frontal nerve: run above LPS, gives SOST n - Lacrimal nerve: runs across LR, ss lacrimal gland (parasymp from CN7 greater petrosal nerve, pterygopalatine ganglion) - Nasocillary nerve: carries ciliary nerve to cornea (short for parasymp, long for symp) & supply paranasal sinuses (supplement V2 innervation of nasal cavity)

Answer 115

CN V3 sensory motor branches are - Auricotemporal nerve - Lingual nerve (supplies ant 2/3 of tongue. Recall that taste to ant 2/3 of tongue & parasymp to SMG SLG is from chorda tympani CN7) - Inf alveolar nerve (enters mandibular canal)

Answer 116

CN7 supplies 3 major glands, which are Lacrimal gland (PPG), Lingual gland (SMG) & Submandibular gland (SMG). Demarcated by the oral fissure level, all glands above are innervated by greater petrosal n of CN7 while all glands below are innervated by chorda tympani of CN7

Answer 117

Outline the course of CN7. Yes. Emerge from pontomedullary junction as 2 roots (motor & intermediate) --> internal acoustic meatus w CN8 & labyrinthine art --> geniculate ganglion (give great petrosal for lacrimal gland parasympathetic) --> facial canal of middle ear --> give off chorda tympani (to join lingual nerve) --> stylomastoid foramen --> parotid plexus --> 5 branches (The Zebra Bit My Cow

Answer 118

Name the 5 motor branches of CN7. Mnemonic: The Zebra Bit My Cow - Temporal - Zygomatic - Buccal - Marginal Mandibular - Cervical

Answer 119

CN V3 supplies somatic motor innervation to -muscles of mastication & -Mnemonic MATT (Mylohyoid,Ant belly of digastric,Tensor Palatini,Tensor Tympani) which are derivatives of 1st pharyngeal arch

Answer 120

CN7 supplies somatic motor innervation to -muscles of facial expression & -Mnemonic PSSP (Platysma, Stapedius, Stylohyoid, Pos belly of digastric) which are derivatives of 2nd pharyngeal arch

Answer 121

CN9 supplies somatic motor innervation to - Stylopharyngeus which is a derivative of the 3rd pharyngeal arch

Answer 122

General sensory & special sensory (taste) of pos 1/3 of tongue is supplied by CN9.

Answer 123

Carotid sinus & carotid body is supplied by CN9

Answer 124

Pharyngeal Plexus (CN10) supplies all muscles of the soft palate (except tensor palitini V3), all muscles of the pharynx (except stylopharyngeus CN9) & all muscles of the larynx. Recall that all muscles of the larynx is supplied by RLN except cricothyroid (Ext LN)

Answer 125

Outline the bony walls of the orbit [Roof] Frontal bone (ant cranial fossa on top) [Lat Wall] Zygomatic bone, greater wing of sphenoid [Med Wall] Maxilla, lacrimal bone, ethmoid bone [Floor] Maxilla Thinnest wall of the orbit is the medial wall

Answer 126

Name the 4 openings into the orbit and its contents. Optic Canal: CN2, ctrl retinal art, ophthalmic art (from ICA) Sup Orbital Fissure: CN3,4,V1,6, sup ophthalmic vein Inf Orbital Fissure: CN V2, inf ophthalmic vein, sympathetic nerves Nasolacrimal canal: Nasolacrimal duct Yknow, if you think about it, the contents that passes through these openings all make sense. if you really want to, can inclu

Answer 127

Lacrimal fluid are saline secretion to lubricate conjunctiva & cornea. Excess = tears Key components of lacrimal fluid are - lysozyme (antibacterial) - nutrients & dissolved oxygen (to avascular cornea) So its function is lubricate, moisten, give nutrients and antibacterial/antiviral

Answer 128

The Lacrimal Gland lies in fossa for lacrimal gland in sup/lat part of orbit, near lat margin of LPS tendon Outline the course and drainage of lacrimal fluid Lacrimal gland --> Lacrimal excretory duct --> flow over conjuctiva and cornea --> Lacrimal lake --> Lacrimal canaliculi --> Lacrimal sac --> Nasolacrimal duct --> inferior nasal meatus --> nasopharynx, oropharynx (usually swallowed) Recall t

Answer 129

Outline the Secretomotor Innervation pathway to Lacrimal Gland (IMPT) Sensory: CN V1 Sympathetic: Superior cervical ganglion Parasympathetic: CN7 greater petrosal n from lacrimal nucleus Secretomotor pathway: CN7 greater petrosal n from lacrimal nucleus (parasympathetic) + deep petrosal n from sup cervical ganglion (sympathetic) --> PPG --> course along zygomatic branch of CN V2 --> course along l

Answer 130

Causes of Exophthalmos (protrusion of eyeball): Grave’s Disease (hyperthyroidism), Orbital tumours Causes of Enophthalmos (retraction of eyeball): starvation reducing retrobulbar fat

Answer 131

Opthalmic artery is a branch of ICA

Answer 132

Trick question: Does the orbit have lymph nodes? No. Eye is part of CNS, and CNS DOES NOT have lymph nodes

Answer 133

Levator Palpabrae Superioris (LPS) have both skeletal and smooth muscle (sup tarsal m) component. Skeletal m component is innervated by CN3 Smooth m component is innervated by Cervical sympathetic trunk

Answer 134

The 2 causes of Ptosis (drooping of upper eyelid) are: - CN3 lesion (skeletal LPS) - Horner Syndrome (smooth LPS - sup tarsal m)

Answer 135

Horner syndrome is an interruption of the cervical sympathetic trunk. Pt presents with mnemonic: PMA - Ptosis: Drooping eyelids due to paralysis of sup tarsal m - Miosis: Pupillary constriction (paralysis of dilator pupillae) - Anhydrosis: Absence of sweating on ipsilateral side of the face & neck due to absence of innervation of sweat glands (sympathetic as well). In layman's terms, only 1 side o

Answer 136

Recti muscles of the eye originates from common tendinous ring surrounding optic canal and attach to sup inf lat med aspects of ant eyeball

Answer 137

Eye movements buffet (IMPT) Draw it out! Easy movements: MR adducts, LR abducts (reason why CN6 is called abducens) Complex movements: SR elevates + add + int rotation IR depresses + add + ext rotation SO depresses + abd + int rotation IO elevates + abd + ext rotation Trick: SIN RAD. Superior always int rotation, Recti alw adduct (except LR6)

Answer 138

Name the 3 layers of the eyeball and its components. 10m question? HAHAHAHA Outer Layer (Fibrous): Sclera posteriorly: Tough opaque layer, continuous w dura of CN2 Cornea anteriorly: Transparent, more convex, appearing to protrude from ant Intermediate Layer (Vascular): Choroid posteriorly: Vascular bed giving red eye in photos Ciliary body anteriorly: Connects choroid with iris, provide attachmen

Answer 139

Eye conditions Glaucoma is the increase in intraocular pressure due to increase in amount of aqueous humor fluid, caused by disturbance of normal cycle of aqueous humor fluid production & absorption. Leads to compression of retina and hence blindness. Papilledema is the increase in CSF pressure that causes edema of the retina. Viewed during ophthalmolscopy as swelling of optic disc. Caratact is th

Answer 140

Print this into your head? Idk. Main point here is CN2 originates from ganglion cell fibres.

Answer 141

Rods & Cones of the photoreceptor layer in the eye is responsible for transducing light energy into membrane potential Rod is for night vision -Most sensitive to dim light -do not convey color -absent from fovea centralis Cone is for Color, shapes & sizes -work in bright light -responsible for acute detail -most numerous in the fovea centralis

Answer 142

Name main differences between Rods & Cones -presence in fovea -confer color/achromatic vision -light sensitivity

Answer 143

Dark current: Activation of photoreceptor is actually hyperpolarization Resting = depolarized Stimulated = hyperpolarized

Answer 144

Representation of Visual Field Peripheral vision field falls on central (nasal hemi-retina) Central vision field falls on peripheral (temporal hemi-retina) 2/3 of visual field is binocular, 1/6 on each side is monocular

Answer 145

Meyer's loop are fibres from sup visual field (inf retinal quadrants) sweep forward into temporal lobe before turning back It may be affected by a temporal lobe stroke (MCA)

Answer 146

Visual Pathway Lesion (IMPT) (draw out and deduce) Optic n: ipsilateral monocular blindness Optic chiasma: -ant optic chiasma (pituitary tumor) = bitemporal hemianopia (narrow vision) -lat optic chiasma = binasal hemianopia (can’t see middle) Optic tract: contralateral homonymous hemianopia Meyer’s loop: contralateral superior quadrant anopia Optic Radiation: contralateral inferior quadrant anopia

Answer 147

Outline the boundaries of the nasal cavity [Roof] Nasal, frontal, ethmoidal (cribriform plate), sphenoidal bones [Floor] hard palate, soft palate [Med] Nasal septum [Lat] Nasal concha: sup, mid, inf [Ant] Naris [Pos] Nasopharynx

Answer 148

Name the 4 paranasal sinuses, their functions and epithelial lining. Frontal Sinus: Btw inner & outer tables of frontal bone Ethmoidal Sinus (cells): ant/middle/pos invaginations into the ethmoidal bone Sphenoidal Sinus: In body of sphenoid, may extend into wings Maxillary sinus: in body of maxilla Function: Reduce weight of skull Epithelial lining:Paranasal sinuses are extensions of respiratory p

Answer 149

The 3 types of epithelial lining in the nasal cavity are - Olfactory: Olfactory epithelium - Respiratory (including paranasal sinuses): PSCColumnarE + Goblet cells - Vestibular: Skin epithelium and hair follicles

Answer 150

Name the 3 nasal concha + 1 recess of the nasal cavity and corresponding openings. - Inf nasal concha --> inf nasal meatus: nasolacrimal duct, opening of pharyngotympanic tube posteriorly - Middle nasal concha --> middle nasal meatus: opening of frontal sinus, opening of maxillary sinus, opening of mid ethmoidal cells onto ethmoidal bulla - Sup nasal concha --> sup nasal meatus: opening of pos eth

Answer 151

Nasal cavity infection spread: Rhinitis (swollen & infected mucosa) may spread via openings to - paranasal sinuses --> sinusitis + local pain (esp. maxillary sinus) - Nasopharynx - Ant cranial fossa: thru cribriform plate - Middle ear: thru pharyngotympanic tube - Lacrimal apparatus & conjunctiva: thru nasolacrimal duct 脑洞大开: Infection of ethmoidal cells may break thru fragile medial wall of orbit

Answer 152

Blood supply of the nasal cavity is mainly by maxillary art, supplemented by ophthalmic art. Nasal cavity arterial anastomosis is called the Kiesselbach Area

Answer 153

Somatic sensory innervation of the nose is mainly by CN V2 (posterio-inferior), supplemented by CN V1 (anterio-superior) (similar to blood supply) Special sensory of the nose is by CN1. (no need question right???) In a nutshell, nerve supply of the nose is not just from V1 and V2, but also CN1! Dont forget CN1!!!

Answer 154

Outline the contents of the pterygopalatine fossa -Maxillary art (ECA) -Maxillary n (V2) - Pterygopalatine ganglion (PPG): link to lacrimal gland autonomic innervation straight!! Recall lacrimal gland innervation

Answer 155

Temporal mandibular joint is a Synovial Modified Hinge Joint, formed by - Mandible: head (condyle) - Temporal bone: mandibular fossa, articular tubercle What is the type of cartilage found in the temporal mandibular joint? What is unusual of this joint compared to other synovial joints? - Fibrocartilagious articular disc creates sup & inf compartments - Sup compartment for gliding movement (protru

Answer 156

TMJ movements: Hinge movement in inf joint cavity: Elevation + Depression Gliding movement in sup joint cavity: Protrusion + retraction, side to side mvmt

Answer 157

The 4 muscles of mastication are Temporalis, Lat Pterygoid, Med Pterygoid, Masseter. - All protract except Temporalis (retract) - All elevate except Lat Pterygoid (depress) IAN & LN (branches of CN V3) emerge between Lat & Med Pterygoid

Answer 158

The anterior portion of digastric muscle is supplied by CNV3 The posterior portion of digastric muscle is supplied by CN7 Rmb MATT (1st PA) & PSSP (2nd PA)

Answer 159

In the infratemporal fossa the terminal branch of the ECA that can be found here is the Maxillary artery.

Answer 160

Parasympathetic innervation to parotid gland is from CN9, carried by auriculotemporal n of CN V3

Answer 161

Briefly outline the embryological basis of tongue development. (6m) - Start with lingual swellings (1st arch) and hypobranchial eminences (2nd,3rd,4th arches) on the ventral floor of the primitive pharynx - Opp lateral lingual swellings fuses with each other at median sulcus - Medial lingual swelling kena overgrown by lat lingual swellings (failure results in persistent medial lingual swelling. No

Answer 162

Primordial tongue detaches from ventral floor of primordial pharynx via apoptosis Failure to complete the process leads to ankyloglossia (tongue tie), which results in speech difficulties

Answer 163

Recall question. Relate the embryological basis of tongue development to its innervation. - Since lateral lingual swelling is from 1st arch and forms ant 2/3 of the tongue, sensory innervation to ant 2/3 of the tongue is supplied by CN5 (V3) - Since 2nd arch is overgrown by 3rd arch, CN7 supplies the special sensory (taste) and secretomotor innervation to ant 2/3 of the tongue (SMG,SLG via chorda

Answer 164

Briefly outline the embryological basis for thyroid development, and abnormalities - Thyroid gland originates from midline endodermal diverticulum between 1st & 2nd PA - Grows caudally to reach developing larynx - Proliferates and divides to form 2 solid lobes connected by isthmus - Thyroglossal duct degenerates Abnormalities: Failure of initial diverticulum to migrate inferiorly results in Lingua

Answer 165

The 4 papillae found on the ant 2/3 of the tongue are fungiform papillae (no taste buds), filiform papillae (with taste buds), Follate papillae (with taste buds), Circumvallate papillae (with taste buds) The tonsil found on the pos 1/3 of the tongue is the Lingual tonsil The ant 2/3 and pos 1/3 of the tongue is divided by sulcus terminalis Although Circumvallate papillae (with taste buds) is found

Answer 166

Extrinsic tongue muscles change position of tongue Intrinsic tongue muscles change shape of tongue All muscles of the tongue are innervated by CN12 except for palatoglossus (pharyngeal plexus/CN10)

Answer 167

Lingual nerve carries - General sensory fibres from CNV3 - Special sensory & parasympathetic fibres from Chorda Tympani of CN7

Answer 168

The composition of the major salivary glands are Parotid Gland: Totally serous (can remember as parotid is totally serious HAHAHHA) Submandibular Gland:Mixed serous & mucus Sublingual Gland:Almost completely mucous Secretomotor fibres to Parotid Gland: - Pre-g from CN9 - Post-g from Otic ganglion (hitchhike auricolotemporal n of V3) Secretomotor fibres to SMG & SLG: - Pre-g from CN7 chorda tympani

Answer 169

The nerve that crosses ext carotid art, curve ant to appear below the jaw is CN12

Answer 170

CN12 LMN lesion: tongue deviates to side of lesion because other side protrudes normally CN12 UMN lesion: tongue deviates to side opposite lesion cuz there is bilat UMN influence but contralateral is dominant

Answer 171

Outline the embryological basis of Lip & Palate development (6m) - Start with frontonasal, maxillary and mandibular process located around the primitive oral cavity - Pair of nasal pits appear in frontonasal process, bounded by lateral and medial nasal prominences - Maxillary prominence grow medially to compress medial nasal prominences together, forming intermaxillary segment --> primary palate (

Answer 172

In Lip & Palate development, - Failure of maxillary prominence to fuse w medial nasal prominence results in lat cleft lip, cleft upper jaw, cleft between primary & secondary palate - Failure of palatine shelves to fuse results in secondary cleft palate, cleft uvula

Answer 173

The palatine fossa lies between palatoglossal and palatopharyngeal folds

Answer 174

The 5 muscles of soft palate are: TVP, LVP, Palatoglossus, Palatopharyngeus & Uvula. All muscles of the soft palate are supplied by pharyngeal plexus/CN10 except for TVP (CN V3)

Answer 175

The 4 extrinsic muscles of the tongue are genioglossus, hyoglossus, styloglossus, palatoglossus. All tongue muscles are supplied by CN12 except for palatoglossus (Pharygeal Plexus/CN10)

Answer 176

Palate is innervated by CN V2, supplemented by CN9 to pos soft palate Ant hard palate: - Nasopalatine n via incisive canal (V2) - Greater palatine n via greater palatine foramen (V2) Pos soft palate, palatine tonsil - Lesser palatine n via lesser palatine foramen (V2) (Palatine tonsil by CN9)

Answer 177

Name the 3 divisions of the pharynx and the boundaries Nasopharynx: pos to nose, from base of skull to soft palate Oropharynx: pos to mouth, from soft palate to epiglottis Laryngopharynx: pos to larynx, from epiglottis to cricoid cartilage

Answer 178

The eustachian/ pharyngotympanic tube connects nasopharynx & tympanic cavity, allowing equalization of pressure in middle ear

Answer 179

The laryngeal inlet is formed by epiglottis, aryepiglottic fold, inter-arytenoid fold - Piriform recess is located lateral to the laryngeal inlet.

Answer 180

The muscles of the pharynx are the 3 outer circular constrictors and 3 inner longitudinal Palatopharyngeus, Salpingopharyngeus & Stylopharyngeus. All muscles of the pharynx is innervated by pharyngeal plexus (CN10) except for stylopharyngeus (CN9)

Answer 181

All muscles of soft palate and pharynx are supplied by pharyngeal plexus (CN10) except for TVP (CN V3) & stylopharyngeus (CN9)

Answer 182

The 4 main cartilage of the larynx are - Thyroid Cartilage: gives laryngeal prominence, C4 level - Cricoid cartilage: signet ring shape, C6 level, denotes end of laryngopharynx - Epiglottic cartilage: closes laryngeal inlet - Arytenoid cartilage: paired, vocal process for attachment of vocalis m, muscular process for cricoarytenoid m (pos CA is the only abductor of the larynx)

Answer 183

Histology of vocal folds - Vestibular fold (false vocal cord): Respiratory (PStCColumnarE + Goblet cells) - Vocal fold (true vocal cord): Wear & tear (StSquamousE) Note that this is as good as saying that the entire interior of the larynx is covered with respiratory epithelium except for the vocal folds.

Answer 184

The 6 inner larynx muscles are mnemonic: 2T(EAv), 2C(TA),2A(TO) TE: Thyro-epiglottic TA: Thyro-arytenoid & Vocalis CT: Cricothyroid (Ext LN) CA: Crico-arytenoid (L & P) AT: Transverse arytenoid AO: Oblique arythenoid - (P) CA is the only abductor - CT tilts thyroid forward - All inner larynx muscles supplied by RLN except for CT (Ext LN) Lesion of ELN = hoarseness, bilateral PARTIAL lesion of RLN

Answer 185

Blood supply of larynx is the same as the thyroid gland. - Sup thyroid art (from ECA) --> sup laryngeal art - Inf thyroid art (from Subclavian art)--> inf laryngeal art

Answer 186

Nerve supply for larynx is ALL FROM CN10 - Motor: all RLN except CT (Ext LN) - Sensory: Int LN above vocal fold, RLN below vocal fold Rmb RLN loops around arch of aorta (LHS)/subclavian (RHS)

Answer 187

Middle ear/Tympanic cavity is located within petrous temporal bone 3 Ossicles (MIS) transmit sound from tympanic membrane to inner ear - Malleus (1st PA) - Incus (1st PA) - Stapes (2nd PA, hence stapedius is also CN7) - Handle of malleus to tympanic membrane, base of stapes fills oval window The two muscles in tympanic cavity that dampen vibration to soften loud sounds thru reflex contraction are

Answer 188

Lai. Walls & relations of the middle ear. Print it into your brain nibba!!! (try drawing out) (10m) [Lat] tympanic membrane (not shown in pic), chorda tympani deep to membrane [Med] Promontory (1st turn of cochlea), tympanic plexus, oval + round window, prominence of facial canal (CN7) [Ant] pharyngotympanic tube, tensor tympani, ICA [Pos] aditus communicating w mastoid sinus [Floor] base of skull

Answer 189

Inner ear is located in petrous temporal as well Vestibular system: innervated by CN8 (vestibular n) o Utricle & saccule (sense static head rotation) o Semi-circular canals w 3 diff axis (sense head rotation) Cochlea system: organ of Hearing, innervated by CN8 (cochlear n) o Scala vestibuli (perilymph) o Scala tympani (perilymph) o Scala media/cochlear duct (endolymph) o Scala vestibuli & tympani

Answer 190

Transmission of sound pathway Vibration of Tympanic membrane transmitted by auditory ossicles (M.I.S) --> at oval window, transduction of vibration to pressure waves of the scala vestibuli --> helicotrema --> scala tympani --> round window dissipates pressure wave

Answer 191

Cochlear basilar membrane properties changes from thick & taut from base of cochlear to thin & floppy at apex of cochlear. Hence - base of cochlear senses high frequency - apex of cochlear senses low frequency Hair cells on Organ of Corti on basilar membrane transduces vibration to membrane potential

ANKI HnN Anat 2 Flashcards

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