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GIR Test 3 > B5.052 Skull, Scalp, Cranial Fossa, Nose and Paranasal Sinuses > Flashcards

B5.052 Skull, Scalp, Cranial Fossa, Nose and Paranasal Sinuses Flashcards

1
Q

skull functions

A

protects brain
exclusive site of 4/5 sense: sight, olfaction, taste, hearing
openings of both respiratory and digestive tracts

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2
Q

what is the diploic space

A

space in between the inner and outer table of cortical bone

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3
Q

causes of widening of the diploic space

A 
sickle cell anemia
thalassemia
iron deficiency anemia
renal osteodystrophy
hyperparathyroidism
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4
Q

what is Paget’s disease?

A

causes an increased head size, thickening of skull bones, particularly frontal bone
headaches and hearing loss caused by impinging upon nerves exiting the skull

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5
Q

epidemiology of Paget’s disease

A

1-2% of Caucasians over 55
uncommon in people under 40
tends to occur in families (having a relative with Pagets makes you 7-10x more likely to develop it)

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6
Q

cause of Paget’s disease

A

unknown

potentially a slow acting virus

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7
Q

diagnosis of Paget’s disease

A

skull x-ray

mild elevation of serum alk phos

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8
Q

why is alk phos elevated in Pagets

A

produced by osteoblastic cells as they try to rebuild bone

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9
Q

treatment for Paget’s

A

bisphosphonates (induce apoptosis of osteoclasts)

calcitonin

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10
Q

common types of skull fractures

A

linear 69%
depression 11%
basilar 4%

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11
Q

result of depression fractures

A

inner table of bone often more extensively fractured than outer table
often cause extradural or epidural hemorrhage

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12
Q

describe the structure of a newborn’s skull

A

bones of a newborn’s calvaria are joined by dense connective tissue fibrous joints called sutures
softness of bones and looseness of sutures allow compression (molding) through the birth canal and rapid brain growth
small face, only unilamellar bone, no diploe, glabella, superciliary arches, or mastoid processes
styloid process has not fused to temporal bone yet

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13
Q

what is a fontanelle

A

sites of fibrous sutures where several bones meet

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14
Q

anterior fontanelle

A

future site of bregma (front part of hear)
junction of coronal and sagittal sutures
closes at 18-24 months

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15
Q

posterior fontanelle

A

future site of lamba
junction of sagittal and lamdoid sutures
closes at 9 months

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16
Q

premature suture/fontanelle closure

A

more concerning than a late closure

potential to limit CNS growth

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17
Q

what is craniosynostosis

A

premature closure of the sutures leads to deformities of the head which inhibit proper brain development

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18
Q

epidemiology of craniosynostosis

A

1 in 2000 births (75% males, 25% females)

part of a syndrome in 15-40% of patients, but usually isolated

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19
Q

risk factors and treatment of craniosynostosis

A

environmental factors can increase risk

surgical treatment generally required between 6-12 months or brain growth may be impaired

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20
Q

petrous part of temporal bone

A

wedge between sphenoid and occipital bones and encloses internal ear
dural sinuses sit on top

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21
Q

sella turcica

A

superior surface of body of sphenoid bone

forms hypophyseal fossa for the pituitary gland

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22
Q

sphenoid bone

A

body contains pituitary
lesser wing helps form the posterior edge of anterior cranial fossa
greater wing helps for floor of anterior edge of middle cranial fossa

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23
Q

palate expander

A

used to expand cartilaginous suture line (generally turns from cartilage to bone during puberty) between maxilla and palatine bones
only work if midline suture is cartilaginous

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24
Q

what are le Fort fractures

A

common patterns of facial fractures

most people survive unless CNS is affected

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25
le fort I
separates maxillary teeth from rest of face
26
le fort II
separates upper teeth and nose from the rest of the face
27
le fort III
fracture through upper portion of the orbits, separating the face from the rest of the skull
28
5 layers of scalp
1. skin 2. connective tissue 3. aponeurosis 4. loose connective tissue 5. periostium
29
connective tissue of scalp
highly vascular with blood vessels attached to the aponeurosis below
30
aponeurosis of scalp
dense connective tissue
31
loose connective tissue of scalp
layer upon which aponeurosis glides
32
periosteum of scalp
dense connective tissue attached to the bone with Sharpey's fibers
33
what is the functional scalp
three outer layers of the scalp skin connective tissue aponeurosis
34
discuss the structure of the functional scalp
dense connective tissue aponeurosis is continuous with the dense connective tissue surrounding the occipitalis posteriorly and the frontalis anteriorly both muscles are derived from the second branchial arch and are supplied by cranial nerve VII
35
occipitalis muscle origin
superior nuchal line
36
scalping
can occur when hair is caught in machinery 3 outer layers (hair, skin, connective tissue, and epicranial aponeurosis) are pulled away as a unit and skull with periosteal connective tissue layer is left exposed scalp can be reattached if bleeding is controlled
37
why might a patient die from scalping?
if knocked unconscious arteries serving the scalp run in the connective tissue layer on top of the epicranial aponeurosis, tend to limit smooth muscle from contracting, allowing continued blood loss
38
"danger zone" of scalp
loose connective tissue | infection may easily spread within this zone and may also spread intracranially via emissary veins
39
what are emissary veins
connect the outside of the skull with the dural intracranial sinuses normal blood flow from inside outward, but no valves so sometimes reverse
40
lacerations through epicranial aponeurosis
tend to gap widely due to pulling of the frontalis and occipitalis muscles tend to bleed profusely due to lack of arterial contraction direct pressure can usually stop it
41
surgical flaps on scalp
central region of forehead works well because it contains supratrochlear nerve, artery, and vein can be used to reconstruct a nose
42
function of the CSF
mechanical and protective support for the brain brain "weight" is 90% less in water than in air ion sink for brain excitability
43
volume of CSF
total: 125-150 mL | 75 mL surround the brain, 75 mL surrounds the spinal cord
44
description of CSF
clear fluid pink- bleed suspected cloudy- bacterial or viral infection pressure = 70-180 mm
45
describe the production and movement of the CSF
60% is produced in the choroid plexuses within the lateral 3rd and 4th ventricles passes the interventricular foramina into the 3rd ventricle down the cerebral aqueduct of the fourth ventricle out either the median aperture or the two lateral apertures
46
subarachnoid cisterns
large subarachnoid space
47
cerebellomedullary cistern
large subarachnoid space at the base of the skull
48
absorption of CSF
absorbed back into venous blood through arachnoid villi along the superior sagittal sinus some absorbed along the length of the spinal cord
49
what is a spinal tap leak
sometimes after a spinal tap has been performed, CSF continues to leak at the site under pathological conditions which increase intracranial pressure above the tentorium cerebelli (subdural hematoma) or decrease in pressure below tentorium cerebelli (CSF leak from spinal canal) the brain may herniate through the tentorial incisure
50
what is an extracranial hematoma
goose egg | typically above galea, rarely below
51
what is the pterion
junction of 4 bones: greater wing of sphenoid, frontal, parietal, and temporal bones forms an H like structure
52
what is special about the pterin
skull is particularly thin frontal branch of the middle meningeal artery runs along the inner surface causes an epidural hematoma if ruptured
53
epidural hemorrhage
bleeding from a torn meningeal vessel may lead to an extradural accumulation of blood that can rapidly compress the brain, progressing to herniation or death if not evacuated
54
what can cause an epidural hemorrhage
depression fracture of the skull
55
extradural/epidural space
"potential" space superficial to dura matter
56
subdural space
"potential" space between the dura and then fluid impermeable (membranous) layer of arachnoid
57
subarachnoid space
real space filled with CSF
58
how much CSF produced daily
500 ml
59
list the layers of the meningeal coverings and spaces
``` skull epidural potential space dura matter subdural potential space arachnoid matter subarachnoid space pia matter brain ```
60
subdural hemorrhage
acute or chronic classifications depends on the pressure of the vessel torn most often in elderly people, cerebral veins are torn as the enter the superior sagittal sinus following head trauma
61
cerebral vein tearing
blood leakage may be slow
62
cerebral artery tearing
blood may spread quickly and over a large area (hemisphere) compressing the brain
63
most frequent cause of subdural hemorrhage
tearing of the bridging veins between rain surface and dural sinus can occur as the result of a relatively minor trauma
64
those at greatest risk of subdural hemorrhage
``` children (thinner veins) aged adults (longer bridging veins) ```
65
subarachnoid hemorrhage
typically due to rupture of an aneurysm as arteries pass within the subarachnoid space blood in CSF
66
symptoms of subarachnoid hemorrhage
``` severe headache stiff neck loss of consciousness often produced by hypertension and results in paralytic strokes spinal tap = bloody ```
67
principal sites of cerebral aneurysms
90% on anterior half of circle of Willis (from internal carotid arteries) 10% from posterior circulation off of vertebral arteries
68
what are arachnoid granulations
hypertrophy of the arachnoid villi results in arachnoid granulations which may form pits on the inner table of cranial bones along the superior sagittal sinus
69
function of arachnoid villi
site where cerebrospinal fluid returns to venous blood along the superior sagittal sinus
70
2 pairs of arteries that supply brain blood
1. internal carotid arteries | 2. vertebral arteries
71
branches of internal carotid arteries
``` ophthalmic arteries anterior cerebral arteries anterior communicating artery middle cerebral arteries posterior communicating arteries ```
72
ophthalmic arteries
supply eye, orbit, and forehead
73
anterior cerebral arteries
supply frontal lobes
74
anterior communicating artery
between anterior cerebral arteries
75
middle cerebral arteries
supply temporal lobes
76
posterior communicating arteries
join posterior cerebral arteries
77
vertebral arteries
pierce the atlantooccipital membrane and dura matter, enter into the subarachnoid space, pass up through the foramen magnum and unite to form a single basilar artery which runs up along the clivus of the occipital bone
78
branches of vertebral arteries
``` posterior inferior cerebellar arteries anterior inferior cerebellar arteries superior cerebellar arteries posterior cerebral arteries posterior communicating arteries ```
79
posterior cerebral arteries
supplies occipital and temporal lobes
80
3 types of headaches
1. vascular 2. muscular contraction 3. traction and inflammatory types
81
sinusitis
inflammation of one or more of the paranasal sinuses, but usually refers to bacterial infection of the sinuses, secondary viral infections or allergic rhinits
82
acute sinusitis
starts w cold-like symptoms runny, stuffy nose and facial fain may start suddenly and last 2-4 weeks
83
subacute sinus inflammation
4-12 weeks
84
chronic sinusitis
12 weeks or longer
85
function of nasal cilia
extremely important in clearing nose, particularly in posterior 2/3 of nasal cavity
86
basal movement of mucous
posteriorly towards nasopharynx and is most pronounced over middle and inferior conchae
87
what can adversely affect nasal cilia
heat, cold, dryness, and drugs | secondary infections much more likely if cilia don't function
88
deviated nasal septum
occurs in 30% of adults | midline structure of nose frequently deviates to one side or the other
89
severe deviation of nasal septum
may occlude a nasal fossa, preventing adequate drainage of nose and sinuses interferes with flow of air on one side
90
what is anosmia
loss of sense of smell
91
what can cause anosmia
head trauma may result in shearing of the olfactory nerves as they pass through the cribriform plate may be early sign of a degenerative brain disease (Parkinson's or alzheimer's)
92
nasal arteries supplying Keisselbach's area
anterior ethmoid artery sphenopalatine artery greater palatine artery superior labial artery
93
which nasal arteries can be manually compressed
greater palatine artery | superior labial artery
94
epistaxis
nosebleed frequent site is at Kiesselbach's area dry air and nose picking may contribute can be arterial or venous
95
what is Kiesselbach's area and why is it susceptible to nosebleeds
4 names arteries (as discussed above) participate in the formation of a rather superficial anastomotic network on the nasal septum just posterior to the vestibular area
96
what to do for a nosebleed from kiesselbachs plexus
apply pressure on upper lip and hard palate behind incisors cutting off blood from septal branch of the superior labial artery and branches from the greater palatine artery that pass through the incisive formen
97
discuss the anesthetic process from a broken nose
1. topical anesthetic applied to nasal mucosa 2. anesthetic injected at bridge of nose bilaterally to block branches of anterior ethmoidal nerves 3. needle inserted via nasal vestibule to reach infraorbital nerves
98
clinical tidbits about toddler's tendency to stick things up their noses
conchae and meatuses provide excellent sites for lodging of foreign objects and may make them difficult to detect
99
sphenoid sinus pain
referred to top of head
100
ethmoid sinus pain
referred to medial and/or lateral to the eyes
101
frontal and maxillary sinus pain
generally caused by tapping on bone superficial to the sinus
102
frontal sinus location and drainage
``` location= under middle turbinate drainage= infundibulum /frontonasal duct ```
103
anterior ethmoid sinus location and drainage
``` location = under middle turbinate drainage = hiatus semilunaris ```
104
middle ethmoid sinus location and drainage
``` location = under middle turbinate drainage = ostia of ethmoid bulla ```
105
posterior ethmoid sinus location and drainage
``` location= under superior turbinate drainage = ostia of posterior ethmoid air cells ```
106
sphenoid sinus location and drainage
``` location = sphenoethmoidal recess drainage = sphenoid ostium ```
107
maxillary sinus location and drainage
``` location = under middle turbinate drainage = maxillary ostium in hiatus semilunaris ```

GIR Test 3 (19 decks)

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