Back, Head, & Neck Flashcards

Question

simple cubdoidal

Answer 1

duct work, salivary or pancreas

Answer 2

guts, intestinal tract stomach down, long and stretched out polarity of cells

Answer 3

keratinized (skin) and non-keratinized (esophagus)

Answer 4

rounds and flattened out bladder and ureter

Answer 5

goblet cells making mucus in airways secretary w/ cilia

Answer 6

specialized ducts ductus deferens

Answer 7

distend and contract over time rather rapidly setup of it

Answer 8

built up by actin and myosin sarcomere w/ different organizations

Answer 9

ask cell, fiber, extracellular matrix and background (ground substance) different connective tissue w/ different relationship

Answer 10

loose packing of fibers of both elastic and collagenous (areolar, adipose, and reticular tissue. allowing inflammatory cells run through found in joint capsule for strength and support

Answer 11

regularly lined up collagen lined up in tendon

Answer 12

make collagen

Answer 13

nonvascular w/ chrondocytes building it found in lacuna found in articular (joint) nonvascularized and have perichondrium allowing for vascularization w/ collagen. elastic cartilage- elastic fibers fibrocartilage- lots of strands of cartilage w/ lacuna and chrondocytes lined up in rows w/ collagen reinforcing making it flexible but strong

Answer 14

mineralized calcium and potassium w/ osteocyte running through canaliculi keeping bone vascular and heal faster source for vessels and such is periosteum (compared to chondrocyte and lacuna)

Answer 15

multiplicative layer. metabolically active layer

Answer 16

skin cells fill with keratin to waterproof skin

Answer 17

volcano cone shaped and outcropping

Answer 18

loose connective layer of papillary layer w/ vasculatur

Answer 19

collagen below papillary layer and hair located in it

Answer 20

superficial fascia, major vascular layer in fat

Answer 21

skin ligaments prominent ones of suspensory ligaments of breast

Answer 22

superficial affecting mostly the epidermis not hitting the dermis causing pink, light red, or tender affecting free nerve endings

Answer 23

red, weeping painful, in nerve endings into the vascularity and dermis layer very painful

Answer 24

pale slightly moist less red, no sensation through hypodermic, dermis, superficial fascia, adipose tissue or down to muscle appearing pearly white or charred, parchmentlike, translucent (vein show through) no sensation, w/ eschar

Answer 25

feel cutting across the grain because of arranged patterns of cleavage lines of skin

Answer 26

based on moisture and positioning, pressure causes a loss of vascularity to an area epidermis from dermis, try to not have sustained pressure on capillary end of artery. prolonged skin pressure longer than 32 can lead to initial changes as involving more of skin and ulceration and deep tissue

Answer 27

integumentary evaluation lethal skin cancers. begins w/ melanocytes at basal layer dropping down to papillary layer first affecting lymphatic so by the time it gets to the epidermis and horny layer it is equal on either side of basal

Answer 28

sticking up back part of vertebra

Answer 29

stick out anchoring limbs and musculature anchoring and moving it around

Answer 30

hold traverse process

Answer 31

spinal cord runs through this space

Answer 32

massive in lumbar vertebra smaller as you go up dependent on load

Answer 33

fibrocartilage big strands of cartilage offering flexibility w/ planes of motion delineated by articular facets

Answer 34

depending on place facets have directional w/ lumbar have flexion, extension, and lateral bending w/ no rotation facets are lateral in thoracic making it was to rotate but given spinous processes can't flex or extend cervical facets are in horizontal plane to turn head w/ most done at atlas and axis.

Answer 35

structurally annulus fibrosis or layers of febrile cartilage surrounding the nucleus pulpsosus (spinal column overgrowth of earlier notochord). w/ pumping activity, weight bearing, and causing drying of nucleus pulpous causing easy herniation or slipped disc. articular facets and synovial joints but most come from IV disc

Answer 36

keeping spine lined up,

Answer 37

ALL (wide) surrounding IV disc, cover over vertebral bodies resisting against hyperextension.

Answer 38

holding spinous process together

Answer 39

between cervical muscles expansion into nucle ligament w/ elastic fiber (helpful for prey to constantly look up and down)

Answer 40

connect vertebral arch connecting laminae. yellow elastic fiber.

Answer 41

spinous process sticks out, nuchal groove and ligament

Answer 42

should be able to feel spinous processes despite high BMI

Answer 43

paired come out of vertebral foramina, cervical spinal nerves start on top side of atlas w/ 8 nerves instead of seven the rest are corresponding to the number of vertebrate

Answer 44

Spinal cord ends L1-L2because the bones and connective tissue grows faster than spinal tissue leading to the stretching of the lumbar spinal nerves

Answer 45

``` dura mater (tough mother) attenuates closer to spinal nerves arachnoid (webby w/ subarachnoid space having CSF flowing through pia (dear) mater is close to the spinal cord found to the denticulate ligaments holding it side to side forming it. ```

Answer 46

myelanted tracts running up and down the spinal cord

Answer 47

rootlet>roots>nerves>branch into dorsal or ventral rami dorsal horn>dorsal roots>rami

Answer 48

goes through vertebral foramen go off find section of skin or muscle (dermatome or myotome)

Answer 49

cell bodies of motor live in ventral or anterior horn axons run through ventral root go through spinal nerve running out ventral (most of body wall or limbs) or dorsal ramus innervation (deep back)

Answer 50

free endings or structured ending go through mixed spinal nerves traveling through ventral rams or dorsal ramus creating cell bodies off to side forming dorsal root ganglion going into nerve tracts or interneuron.

Answer 51

not in spinal cord, cranial nerves or sacral region of spinal cord S2, 3, 4 keeps things off the floor. short postganglionic neurons mean that they are closer to their target

Answer 52

come out T1-L2, thoraciclumbar outflow, come out of lateral or intermediate horn. two autonomic nerves hand off of sympathetic chain on either side of vertebral bodies or splanch nerve to ganglion in aorta. postganglionic nerves long to get whole body stimulated

Answer 53

thorax and abdominal nerves

Answer 54

go off to target neuron

Answer 55

white rami myelantate postganglionic unmyelinated

Answer 56

sensory neurons from viscera are going similar to motor having visceral referred pain because they share so many pathways w/ short postganglionic feeding back to few vertebrate.

Answer 57

conus medlars tapers to end forming horses tail w/ stretched out ventral and dorsal roots of sacral nerves using Illiac crest L4 tap into there forming caudal equine roots out of the way. useful for collecting cerebral spinal fluid to find meningitis

Answer 58

gets you chance local anesthetic numbing nerves as nerve roots pass through. epidural space fat filled w/ no into cerebrospinal fluids causing infection so need to flood w/ anesthesia for no pain allowing monitoring.

Answer 59

vertebral bodies form around notochord. the last to fuse is the first to mess up because not deadly w/ last step most apparent and common not formal closure causing interaction w/ them. most commonly tuft of hair.

Answer 60

flexing bend in thoracic region

Answer 61

curvature in flexion of lumbar

Answer 62

lateral curvature causing respiratory compromise idiopathic (unknown origin)

Answer 63

osteoclasts lead to breakdown in bones causing severe curvature of spine in thoracic addition to injury

Answer 64

atlas taking hit

Answer 65

hangman caused by MVA, knot to the side to break though lateral of bone

Answer 66

vertebral canal expansive depending on direction of fracture dented

Answer 67

fracture pattern in lumbar region get a lot of use. superior inferior articular process leading to limbs in pedicle in depth thought pars articulates, thoracic or cervical deadly not as impactful in lumbar.

Answer 68

fracture pattern in lumbar region get a lot of use. therefore feel for steph off

Answer 69

Keratinized stratified squamous epithelium, upper most layer of skin w/ stratum corneum and basalum, avascular noushed by dermis supplied by afferent nerve endings. from ectoderm

Answer 70

Dense layer of interlacing collagen and elastic fibers lower, connective tissue layer with vasculature, provide skin tone and strength deep layer contains hair follicles, arrestor muscles erect hair compressing sebaceous gland secreting onto skin. mesoderm

Answer 71

loose connective tissue underneath dermis contains deepest parts of sweat glands, blood and lymphatic vessels, and cutaneous nerves. Most fat storage. allows skin to glide over eachother

Answer 72

tougher dense organized connective tissue surrounding muscle (epimysium), devoid of fat envelops most of body deep to skin and subcutaneous tissue. W/ skin ligaments connecting and holding onto them. attaches to deep superficial fascia

Answer 73

)layers of fibrile cartilage, stiffening causing herniated disc) connected to the vertebral bodies above and below. fibrocartilage ring holding in cushioning nucleus pulposus, can weaken with age to allow contents to herniate ("slipped disc"). Concentric lamellar of collagen fibers. / s a ring consisting of concentric lamellae of fibrocartilage forming the circumference of the IV disc. The anuli insert into the smooth, rounded. epiphysial rims on the articular surfaces of the vertebral bodies

Answer 74

: broad COVERS VERTEBRAL BODY, RESISTING AGAINST HYPEREXTENSION, WIDE. a long ligament on the anterior (ventral) surface of the vertebral bodies that helps to prevent hyperextension damage, e.g., in "whiplash" injury. / a strong, broad fibrous band that covers and connects the anterolateral a spects of the vertebral bodies and IV discs

Answer 75

two superior and two inferior arise from junctions of pedicles and laminae bearing articular surfacesuperior and inferior processes that allow articulation (at the facet surface) of adjacent vertebrae. Osteophytes from the processes may lead to spinal nerve impingement. / hese joints slope inferiorly in the cervical spine (facilitate lexion and extension), are more vertically oriented in the thoracic region (limit lexion and extension but allow for rotation), and are interlocking in the lumbar spine (they do allow lexion and extension, but not to the degree present in the cervical spine)

Answer 76

nodding and no joints, respectively. Neither have intervertebral discs, and both contain membranes and ligaments to limit the extent of those movements. / occipital=>The main movement is ﬂexion, with a little lateral ﬂ exion (sideways tilting of the head) and some rotation. These joints also permit sideways tilting of the head. The atlanto-occipital joints are synovial joints of the condyloid type and have thin, loose joint capsules, axial => There are three atlanto-axial articulations: two (right and left) lateral atlanto-axial joints between the lateral masses of C1 and the superior f acets of C2 (Fig. 4.12C) and one median atlanto-axial joint between the dens of C2 and the anterior arch and transverse ligament of the atlas (Fig. 4.12A,B). The median atlanto-axial joint is a pivot joint, whereas the lateral atlanto-axial joints are plane-type synovial joints. Movement at all three atlantoaxial joints permits the head to be turned from side to side, as occurs when rotating the head to indicate disapproval (the “no” movement).

Answer 77

C1 with two articular surfaces for occipital condyles and "yes" motion.

Answer 78

C2 with its projection to allow swivel "no" motion / point on altas sticks up that allows to move head back and forward

Answer 79

smooth ring external to anulus fibrosus, can be the site for osteophytes, e.g., with osteoarthritis ring of smooth bone around rim of vetebra derived from anular epiphysis

Answer 80

four articular processes are in opposition w/ corresponding process of vertebrae superiot and inferor forimging small synovial joints between vertebrae (Gr: “together projection”) / allow for gliding and sliding movements. Slope inferiorly in the cervical spine

Answer 81

projection of posterior occipital bone, landmark for posterior neck muscles

Answer 82

between spinous processes HOLDS . smaller connective tissue bands running between the spinous processes of adjacent vertebrae

Answer 83

With weight bearing an important function here, the intervertebral discs take on special consideration. They consist of an an(n)ulus fibrosus )layers of fibrile cartilage, stiffening causing herniated disc) connected to the vertebral bodies above and below, and a central nucleus pulposus within(gel in middle overgrowth of notochord when dries get herniated) . The discs allow movement between vertebral bodies, but they may degenerate with age. tough cushioning between discs, thickest in the mobile cervical and lumbar regions, made of anulus fibrosis and nucleus pulposus. w/ cartilage offer flexibility and delineated by facets.

Answer 84

superior and inferior vertebral notches of adjacent vertebrae combine to form gap between vertebral notches of adjacent pedicles, where spinal nerves exit and accompanying vessels containing the spinal ganglia / the opening formed by the vertebral notches that is traversed by spinal nerve roots and associated vessels.

Answer 85

two broad, flat plates of bone, unite in the mdiline and meet the pedicles. the "roof" over the vertebral canal; cut into for a laminectomy / paired portions of the vertebral arch that connect the transverse processes to the spinous process.

Answer 86

("yellow ligaments") are connective tissue bands that connect adjacent laminae. elastic, connecting laminae

Answer 87

median ligament of neck with lots of fibroelastic tissue; superior to supraspinous ligament; can ossify with cervical spondylosis

Answer 88

within(gel in middle overgrowth of notochord when dries get herniated) . gooey internal contents of intervertebral disc, adult remnants of notochord. Central nuclear zone of collagen and hydrated proteoglycans. Acts as shock absorber compressing when load bearing and relaxing when removed. / usually herniates in a posterolateral direction, where it can impinge on the nerve roots passing through the intervertebral foramen. A disc herniating at the L4-L5 level usually impinges on the L5 roots, and herniation at the L5-S1 level involves the S1 roots.

Answer 89

part of skull that contains foramen magnum; projections that allow “yes” motion / permit nodding of the head, such as the neck ﬂ exion and extension that occurs when indicating approval (the “yes” movement). The main movement is ﬂ exion, with a little lateral ﬂ exion (sideways tilting of the head) and some rotation. These joints also permit sideways tilting of the head.

Answer 90

short, stout processes join vertebral arch to body. project posteriorly to meet laminae. the "stalk" supporting the arch from the body / The pedicles project posteriorly to meet two broad, flat plates of bone, called laminae / paired portions of the vertebral arch that attach the transverse processes to the body.

Answer 91

narrow, lining the “floor” of the vertebral canal, BISECTS DISC. a long ligament on the posterior (dorsal) surface of the vertebral bodies (i.e., within the "floor" of the vertebral canal) that helps to prevent hyperflexion damage, e.g., in "whiplash" injury.

Answer 92

off of C1, instead of a spinous process

Answer 93

one median projects posteriorly (and usually inferiorly) from vertebral arch at junction of laminae dorsal projection, those of C7 and T1particularly palpable

Answer 94

the ridge on the occipital bone that includes the inion, superior limit of neck / marking the superior limit of the neck, extends laterally from each side of this protuberance

Answer 95

dorsal to spinous processes that merges into a large nuchal ligament in the cervical region . tough connective tissue band running from the dorsal "peak" of one spinous process to another to help hold vertebrae together

Answer 96

synovial joints involving articularcartilage surfaces interacting with each other within synovial fluid (full of glycosaminoglycans, particularly hyaluronicacid) secreted by fibroblasts in the synovial membrane, all surrounded by a joint capsule of dense connective tissue. the spine will include a pivot joint between the first and second cervical vertebrae (C1 and C2; atlas and axis), and multiple plane joints between articular facets among vertebrae.

Answer 97

hole in transverse process of a cervical vertebra, space for vertebral artery / covered with thick muscles and may or may not be palpable.

Answer 98

project posterolaterally from junctions of pedicles and laminae. sticks out sideways for muscle attachment; "divides" hypaxial and epaxial muscle groups

Answer 99

on C3-C7; hooked-shaped and on the top sides to prevent slippage and limit lateral flexion / lies posterior to the superior mesenteric vessels

Answer 100

note overall differences; Sacral and thoracic are fetal curvatures (kyphosis), lumbar and cervical (lordosis)secondary cervical (C1-7) with foramina transversaria (contain vertebral aa.) and bifid spinous process flexion, swivel; thoracic (T1-12) have costal facets and inferior-pointing spinous processes thoracic rotation and overlapping processes suggest no extension; lumbar (L1-5) are large and weight-bearing, flexion, extension, and lateral bending no rotation large spinous and transverse processes anchor ligaments for muscle attachment , large vertebral bodies to support weight . placement of superior and inferior facets from the articular processes in a sagittal plane that allows more for ; sacral (S1-5) are fused into the curved sacrum; and the coccyx (Co1-4) is the fused remnant of caudal vertebrae (as well as painful to land on, being one cause of coccygodynia/coccydynia)

Answer 101

the "tunnel" made by the vertebral foramina strewn together, for the spinal cord, meninges (protective membranes), fat, spinal nerve roots, and vessels / which contains the spinal cord, meninges (protective membranes), fat, spinal nerve roots, and vessels /

Answer 102

vertebral arch and posterior surface of vertebral body form walls of the hole made by the vertebral arch / the opening formed by the vertebral notches that is traversed by spinal nerve roots and associated vessels. / a foramen formed from the vertebral arch and body that contains the spinal cord and its meningeal coverings

Answer 103

large block of epaxial muscle—major spine extensor and a lateral flexor. Note that epaxial mm. names refer more to patterns of attachment than to individual muscles, e.g., longissimus thoracis, cervicis, capitis. Erector spinae mm. refers to the following three components; iliocostalis most lateral, attached to ribs, longissimus attached to transverse processes, spinalis thin and most medial, attached to spinous processes. / The erector spinae muscles (sacrospinalis) lie in a “groove” on each side of the vertebral column between the spinous processes and the angles of the ribs (Fig. 4.22). The massive erector spinae, the chief extensor of the vertebral column, divides into three muscle columns: / layer of muscles is the largest group of the intrinsic back muscles and is important for maintaining posture, extending the spine, and laterally bending the spine. hese muscles are divided into three major groups, as follows

Answer 104

deepest back muscles, dorsal rami of spinal nerves, either between spinous process to extend or transverse processes to flex, respectively.

Answer 105

inferior back, makes up posterior axillary wall, thoracodorsal n., antagonistic to pectoralis muscles, useful for butterfly swimmers / fan shaped, passes from trunk of humerus and acts directly o the glenohumeral (shoulder) joint and indirectly on the pectoral girdle. Raises the trunk t the arm, which occurs when limb is fixed and body moves, chinups or climbing tree

Answer 106

elevate ribs

Answer 107

elevates ribs and so assists inspiration. The serratus posterior muscles are thin and are more layer landmarks to encourage careful dissection this first week than acting as active contributors to respiration.

Answer 108

extend head/neck, or if singly, can rotate to one side. Palpable; also may be better seen as part of posterior triangle of neck.

Answer 109

extend, rotate cervical spine. / lies deep to the trapezius and semispinalis capitis muscles / muscle group in occipital region made of rectus capitis posterior major, minor, obliquus capitis inferrior and superior. The boundaries and contents are: Superomedially, rectus capitis posterior major • Superolaterally, obliquus capitis superior • Inferolaterally, obliquus capitis inferior • Floor, posterior atlanto-occipital membrane and posterior arch of C1 • Roof, semispinalis capitis • Contents, vertebral artery and suboccipital nerve (C1)

Answer 110

deep to semispinalis capitis, includes a number of muscles innervated by C1 (suboccipital n.); these include rectus capitis posterior major and minor m., and obliquus capitis superior and inferior m.; listed here as an objective as they may be involved in whiplash, or be trigger points to be addressed by massage therapy. Presumably, these small muscles are offering proprioceptive information regarding head and neck movements.

Answer 111

fascia surrounding deep muscle, especially in lumbar region, blends in with other fascia, e.g., that of quadratus lumborum m. / extensive fascial complex that has anterior, middle, and posterior layers with muscles enclosed between them. It is thin and transparent where it covers thoracic parts of the deep muscles but is thick and strong in the lumbar region

Answer 112

small, epaxial m. that contribute to an overall postural effect, even though small individually. These are in the order of superficial to deep and longer to shorter, e.g., rotatores run from the transverse process of one vertebra to the spinous process of the adjacent superior vertebra. Multifidus helps to stabilize the lumbar spine, so can be implicated in low back pain (LBP).

Answer 113

large multifunction scapular muscle, remnant of gill-raising m. to explain its CN XI motor innervation

Answer 114

A survey of the blood supply and drainage of the spine and spinal cord can address other possible sources of back pain. The spinal cord is supplied by one anterior and two posterior spinal arteries off of the vertebral arteries. These are supported by many radicular arteries off of the aorta, in particular the great radicular artery (of Adamkiewicz). Extensive venous plexuses drain both inside and outside the vertebral canal. major supplies to the spine, originally off of the vertebral arteries, but supplemented extensively with segmental medullary arteries / Posterior and anterior roots of the spinal nerves and their coverings are supplied by posterior and anterior radicular arteries, which run along the nerve roots. These vessels do not reach the posterior or anterior spinal arteries. Segmental medullary arteries occur irregularly in the place of radicular arteries; they are larger vessels that supply blood to the spinal arteries.

Answer 115

will form plexuses, with the internal venous plexus in the epidural space / run the length of the cord and drain into segmental (medullary) radicular veins

Answer 116

a thinner middle meningeal layer, so named because of the trabeculations extending through the subarachnoid space / the fine, weblike avascular membrane directly beneath the dural surface.

Answer 117

The typical target for lumbar puncture is L3-L4, L4-L5; the cauda equina is located in that region, as the spinal cord terminates in the L1 range, so less risk of spinal cord damage. Given the nerve roots of the cauda equina in the CSF, they can “float away” as the needle is advanced. "horse's tail" of dorsal and ventral roots reaching out to intervertebral foramina of lumbar and sacral nerves—a result of the continued growth of the vertebral column compared to that of the CNS. Hence, L3-4 and L4-5 make a useful site for lumbar puncture (spinal tap). / bundle of spinal nerve roots running inferior to the spinal cord through the lumbar cistern (subarachnoid space).

Answer 118

somewhat vestigial, contains CSF, contiguous with ventricles; cervical central canal may be enlarged with syringomyelia

Answer 119

terminal portion of spinal cord, at about L1-2 in adults.

Answer 120

pegs of pia mater that help to hold the spinal cord into position in the vertebral canal. / run longitudinally along each side of the spinal cord. These ligaments consist of a fibrous sheet of pia mater extending midway between the posterior and the anterior nerve roots. Between 20 and 22 of these processes, shaped much like sharks’ teeth, attach to the internal surface of the arachnoid-lined dural sac. The superior processes (uppermost part) of the right and left denticulate ligament attach to the cranial dura mater immediately superior to the foramen magnum. The inferior process extends from the conus medullaris passing between the T12 and the L1 nerve roots.

Answer 121

autonomic components. include the (myelinated) white ramus communicans leading to the sympathetic trunk and the (unmyelinated) gray ramus communicans leading from it. after the mixed spinal nerve is formed at the point of the intervertebral foramen, it splits into a small. dorsal and larger ventral ramus to supply the deep back and the rest of the body wall and limbs, respectively. vertebral facet joints are innervated via branches of dorsal rami of spinal nerves that supply the synovial linings of capsules. Nociceptors are pain receptors that are often free nerve endings, and depending on the nociceptor, can be triggered by mechanical, thermal, chemical, or polymodal means

Answer 122

ROOTLET>ROOT>NERVES FORMING RAMUS. home to the nerve cell bodies of sensory (affeerent neurons w/ cell bodies in dorsal root ganglion

Answer 123

the outermost, tough connective tissue meningeal covering that will thin out as spinal nerves reach out peripherally / richly innervated by sensory nerve ﬁbers

Answer 124

that part of dura mater inferior to the conus medullaris, so a target for lumbar puncture (spinal tap).

Answer 125

space between the bony vertebral canal and the meninges covering the spinal cord; useful for epidural anesthesia, e.g., access through sacral hiatus (the "epidural" of labor and delivery)

Answer 126

gray from neuron cell bodies, ventral horn with lower motor neurons, ventral horn associated with sensory tracts, and lateral horn, present from T1-L2, the location of the cell bodies of the sympathetic preganglionic neurons. (intermediate) horn in the thoracic and lumbar regions where preganglionic (presynaptic) neuron cell bodies originate for the sympathetic nervous system. fuse to form the spinal nerve (that will exit out of an intervertebral foramen between vertebrae). The spinal nerve will then split into a dorsal ramus (“branch”) to the intrinsic (deep) back muscles/overlying skin and a ventral ramus to the rest of the body.

Answer 127

most internal meningeal layer, better seen on brain as a sheet, delicate and transparent covering the spinal cord

Answer 128

major component of CNS, 31 pairs of spinal nerves

Answer 129

between arachnoid and pia mater, site of CSF (cerebrospinal fluid). / Wispy threads of connective tissue extend from this layer to the underlying pia mater and span the subarachnoid space, which is illed with CSF.

Answer 130

motor nerve from the posterior rami of C1 to the muscles of the suboccipital triangle

Answer 131

connective tissue that connects conus medullaris; may be the basis of tethered cord syndrome / attaches to coccyx

Answer 132

refers to the motor and sensory, respectively, to the mixed spinal nerves

Answer 133

Vertebral arteries go through transverse foramen into medulla from cervical spine Spinour process of vertebra- bifold chunk attaching to unchallenged ligament . visible in the suboccipital triangle before entering the foramen magnum / a branch of the subclavian artery. in the lower anterior neck, passes through the transverse foramen of the atlas and loops medially to enter the foramen magnum of the skull to supply the brainstem

Answer 134

surrounding gray mater region for spinal tracts. posterior funiculus, dominated by the dorsal columns (carries discriminatory senses); lateral funiculus, with corticospinal tract (major motor tract) and spinocerebellar tracts (unconscious proprioception), with anterolateral region dominated by spinothalamic tract (pain and temperature); anterior funiculus, dominated by “extrapyramidal” reticulospinal and vestibulospinal tracts that affect posture.

Answer 135

The paranasal sinuses are air-filled spaces in facial bones. They are lined by respiratory epithelium (pseudostratified, ciliated, epithelium). Palpable sinuses include the frontal and maxillary sinuses. Sinuses- hollow things out and not so heavy and as resonating center. Maxillary sinus goes upward causing it to yuck up and fill up before draining (piriform aperatures); open up into nasal cavities, sinuses, found within many bones, frontal, maxillary, etc. may be better appreciated on x-ray (or on after-dinner commercials for various remedies!)

Answer 136

junction of coronal/sagittal sutures; used in skull measurement; adult remnant of anterior sagittal suture

Answer 137

cranial vault or brain case vs. the facial skeleton vs. the skullcap (calotte) / Most calvarial bones are united by fibrous interlocking sutures; however, during childhood, some bones (sphenoid and occipital) are united by hyaline cartilage (synchondroses).

Answer 138

between frontal and parietal b.

Answer 139

of ear and external acoustic meatus/canal. Auricle with elastic cartilage, and the canal lined with glands that produce cerumen (earwax) that ends in the tympanic membrane. Outer ear funneling sounds, middle ear bones magnify sounds, eustachian or pharyngeal tympanic or auditory tube to rain middle ear from around bone ossicles. Inner ear w/ auditory aspects of cochlea nad semicircular canal of vestibule to help w/ balancing. Much of this is facial nerve (stapedius saying high to faces). external ear canal, often with cerumen (wax) buildup. / leads to the tympanic membrane (eardrum)

Answer 140

in about 10% of population, there's a remnant of a frontal suture / front of skull into eye holes

Answer 141

behind superciliary arches within frontal bone; continue to enlarge through puberty and adolescence. If fractured, risk of CSF leakage. / sensory innervation from CN V1 (supraorbital nerve) / between the outer and inner tables of the frontal bone, posterior to the superciliary arches and the root of the nose. Each sinus drains through a frontonasal duct into the ethmoidal infundibulum, which opens into the semilunar hiatus of the middle meatus (Fig. 7.66). The frontal sinuses are innervated by branches of the supra-orbital nerves (CN V1).

Answer 142

U-shaped attachment for many neck muscles, can be fractured in (manual) strangulation. Body main part with horns projecting from it.

Answer 143

junction of lamboid/sagittal sutures; used in skull measurement; adult remnant of posterior fontanel

Answer 144

between occipital and parietal b. / unites the occipital bone with the right and left parietal and temporal bones

Answer 145

horizontal body, two rami, angle the posterior body/ramus meeting spot, the head as the surface involved in TMJ (temporomandibular joint), coronoid process anterior to that, for mastication muscle attachment / U-shaped bone forming the lower jaw

Answer 146

single bone; can be dislocated at TMJ. / Lower jaw bone that contains 16 mandibular teeth

Answer 147

Le Fort type I fracture horizontal through maxillae / Paired bones that form part of the cheek and contain 16 maxillary teeth

Answer 148

in mandible, site of mental n. (branch of CN V3) / side of lower jaw

Answer 149

the septum is predominantly perpendicular plate of ethmoid and vomer; think of deviated or perforated septum. The nasal bones make up the bridge of the nose, and several nasal cartilages support the nose shape, septum, etc. / dividing the nasal cavity into right and left parts

Answer 150

contains foramen magnum / The cranial base is formed posteriorly by the occipital bone, which articulates with the sphenoid anteriorly. The parts of the occipital bone encircle the large foramen magnum.

Answer 151

unpaired, midline, much of bony nasal septum

Answer 152

parietal b. parietal (L. wall)

Answer 153

lateral temporal region where frontal, parietal, temporal, sphenoid meet. Thin part of skull, with middle meningeal artery deep to it, hence risk of epidural hematoma with trauma. / anterior part of the temporal fossa, superior to the midpoint of the zygomatic arch, is the pterion (G. pteron, wing). It is usually indicated by a roughly H-shaped formation of sutures that unite the frontal, parietal, sphenoid (greater wing), and temporal bones.

Answer 154

between parietal bones / unites the right and left parietal bones

Answer 155

in sphenoid bone, most posterior of sinuses. Drains down into pharynx. One of four paired paranasal sinuses / sensory innervation from CN V2 (orbital branches); the blood supply is from the pharyngeal arteries (from the maxillary artery); the sphenoid sinus drains into the sphenoethmoidal recess above the superior concha.

Answer 156

pathway for CN VII, vulnerable point for Bell's palsy within the facial canal that opens into this foramen / lies between the mastoid and styloid processes.

Answer 157

bony ridge deep to eyebrows, may lead to skin laceration if struck hard

Answer 158

the turbinates (covered by respiratory pseudostratified epithelia in situ); useful for humdification, especially large inferior conchae. Superior and middle conchae off of the ethmoid b., while the inferior conchae are separate bones. Superior conchae protect the olfactory bulb, middle conchae cover over the sinus openings.

Answer 159

(L. alveolus-little bowl, basin), sockets for teeth, also constitute the supporting bone for the maxillary teeth

Answer 160

temporal bone made of several different bones that fuse; mastoid air sacs develop postnatally

Answer 161

modified hinge synovial joint w/ squamous part of temporal bone; typically, anterior dislocation, e.g., in yawning position. with opening and closing the mouth. Delay in its movement can lead to TMJ clicking with jaw movement.The mandibular heads can dislocate anteriorly. Pain radiates to the ears and temporal regions because of branches of CN V. Disc can help to account for TMJ gliding motion. / articulation between the condylar process of the mandible and the squamous portion of the temporal bone (mandibular fossa) (Figs. 8.28 and 8.29 and Table 8.9). he TMJ is a modiﬁed hinge-type synovial joint. Unlike most synovial joints, the TMJ surfaces are covered with ﬁbrous cartilage rather than hyaline cartilage and the joint cavity is divided by a ﬁbrocartilaginous articular disc.

Answer 162

most superior part of skull, near center of sagittal suture

Answer 163

consists of temporal bone/zygomatic bone

Answer 164

makes up orbital wall, anterior part of zygomatic arch; cheek prominence

Answer 165

elevate rib cage and laterally flex neck. accessory muscles of respiration similar to scalenus medius, except that origin is on the anterior aspect of the transverse processes as vs. the posterior of the cervical transverse processes seen in scalenus medius.

Answer 166

compresses cheek, e.g., trumpet playing or chewing. / smiling, keep cheek taut and prevents it from folding and being injured during chewing, sucking, whistling blowing as well

Answer 167

pulls thyroid cart. forward, thereby lengthening vocal cords. Rest of laryngeal m. from recurrent laryngeal n.

Answer 168

elevate hyoid, depress mandible. / feature two bellies in series, sharing a common intermediate tendon.

Answer 169

pull skin posteriorly and wrinkle posterior neck, move scalp backward.

Answer 170

protrudes tongue through mout / The extrinsic muscles of the tongue (genioglossus, hyoglossus, styloglossus, and palatoglossus) originate from bony formations outside the tongue and attach to it. /supplied by CN XII

Answer 171

together, protrude mandible, separately, side-to-side movement of jaw. / passes posteriorly. Its superior head attaches to the joint capsule and disc of the TMJ, and the inferior head attaches primarily to the pterygoid fovea at the condylar process of the mandible.

Answer 172

elevates upper lip

Answer 173

elevate scapula

Answer 174

flexes/rotates cervical spine. May be damaged during whiplash-type injuries.

Answer 175

elevates mandible

Answer 176

together, elevate mandible, separately, protrude side of jaw, can work to create grinding motion. / lies on the medial aspect of the ramus of the mandible. Its two heads embrace the inferior head of the lateral pterygoid and then unite

Answer 177

flexes neck lateally, elevates 1st rib in forced inspiration.

Answer 178

elevates floor of mouth

Answer 179

depresses hyoid / has two bellies united by an intermediate tendon that is connected to the clavicle by a fascial sling

Answer 180

closes eyelids. Important in preventing dry eye with blinking, and so concern of corneal ulcer with Bell('s) palsy.controlled by facial nerve (CN VII), is going to be the important muscle for blinking to help spread tears. Tarsal glands help oil eye or mygobiun glands. Fat filled and infiltrated w/ immune cells

Answer 181

compresses and protrudes (purses) lips. If Bell's palsy, then lots of drooling.

Answer 182

depresses lower lip, tightens neck skin (human remnant of subcutaneous muscle that "quivers" flies away in cows). / arises in subcutaneous tissue covering the superior parts of the d eltoid and pectoralis major muscles and sweeps s uperomedially over the clavicle to the inferior border of the mandible. It is a broad thin sheet of muscle.

Answer 183

flexes neck laterally, elevates second rib if necessary as acessory respiratory mm (other scalenes assist with forced inspiration as well).

Answer 184

retracts angle (think of risor sardonicus in tetanus).

Answer 185

extend head/neck, or if singly, can rotate to one side. Palpable; also may be better seen as part of posterior triangle of neck.

Answer 186

The sternocleidomastoid muscle is innervated by CN XI, the spinal accessory nerve. It turns the head to the opposite side (hence a great muscle to test for malingerers who complain of hemiparalysis). congenital thickening / attaches inferiorly to the sternum and clavicle and superiorly to the mastoid process of the temporal bone of the cranium / flexion

Answer 187

lowers hyoid / covers the lateral lobe of the thyroid gland, attaching to the oblique line of the lamina of the thyroid cartilage immediately superior to the gland, limiting superior expansion of an enlarged thyroid gland

Answer 188

lowers larynx / wider than the sternohyoid, under which it lies. The sternothyroid covers the lateral lobe of the thyroid gland, attaching to the oblique line of the lamina of the thyroid cartilage immediately superior to the gland, limiting superior expansion of an enlarged thyroid gland.

Answer 189

elevates and retracts hyoid

Answer 190

small m. deep to clavicle, helps to anchor it and to protect subclavian vessels / lies almost horizontally when the arm is in the anatomical position (Fig. 6.14D). This small, round muscle is located inferior to the clavicle and affords some protection to the subclavian vessels and the superior trunk of the brachial plexus if the clavicle fractures.

Answer 191

CN V (trigeminal); elevates mandible / arises from the bony floor overlying the temporalis fascia, which form the roof of the temporal fossa / broad proximal attachment to the floor of the temporal fossa and is attached distally to the tip and medial surface of the coronoid process and anterior border of the ramus of the mandible (Fig. 7.41 A,B; Table 7.8). It elevates the mandible (closes the lower jaw); its posterior fibers retrude (retract) the protruded mandible.

Answer 192

raises larynx

Answer 193

the other big CN XI muscle, don't shrug it off. / provides a direct attachment of the pectoral girdle to the trunk. This large triangular muscle covers the posterior aspect of the neck and the superior half of the trunk (Fig. 6.16A; Table 6.2). The trapezius attaches the pectoral girdle to the cranium and vertebral column and assists in suspending the upper limb. The fibers of the trapezius are divided into three parts that have different actions at the scapulothoracic joint between the scapula and the thoracic wall:

Answer 194

elevates corner of mouth (smile!)

Answer 195

50) into subclavian or external jugular veins; may be a site for accidental placement of a central venous catheter. / The AJV typically arises near the hyoid bone from the confluence of superficial submandibular veins. At the root of the neck, the vein turns laterally, posterior to the SCM, and opens into the termination of the EJV or into the subclavian vein. Superior to the manubrium, the right and left AJVs commonly unite across the midline to form the jugular venous arch in the suprasternal space.

Answer 196

continuation of subclavian artery, with boundaries from lateral edge of 1st rib to distal margin of teres major muscle. / begins at the lateral border of the 1st rib as the continuation of the subclavian artery and ends at the inferior border of the teres major / The first part of the axillary artery is located b etween the lateral border of the 1st rib and the medial border of the pectoralis minor; it is enclosed in the axillary sheath and has one branch: the superior thoracic artery. • The second part of the axillary artery lies posterior to the pectoralis minor and has two branches: the thoraco-acromial artery and lateral thoracic artery, which pass medial and lateral to the muscle, respectively. • The third part of the axillary artery extends from the lateral border of the pectoralis minor to the inferior border of the teres major and has three branches. The subscapular artery is the largest branch of the axillary artery. Opposite the origin of this artery, the anterior circumflex humeral artery and posterior circumflex humeral artery arise.

Answer 197

the carotid sinus is a dilation near the proximal internal carotid a. that acts as a major baroreceptor, while the body is a small brownish/pinkish chemoreceptor in the same area. Both innvervated by CN IX (CN X covers aortic arch bodies, stemming from branchial arch development). major peripheral chemoreceptor that senses blood pH and partial pressures of carbon dioxide (pCO2) and oxygen (pO2)

Answer 198

off of aortic arch on L, brachiocephalic a. on R / arises posterior to the manubrium, slightly posterior and to the left of the brachiocephalic trunk. It ascends anterior to the left subclavian artery and at first anterior to the trachea and then to its left. It enters the neck by passing posterior to the left sternoclavicular joint.

Answer 199

blood supply to face & larynx and visceral neck / artery gives rise to eight major branches to the neck, face, and occipital region and terminates as the supericial temporal artery

Answer 200

drains most of the face and scalp on that side; crosses SCM in superficial fascia before joining subclavian v.

Answer 201

chief artery of face, arising from external carotid. Facial wounds bleed freely, heal quickly. Facial v. major drainage of face, drains into internal jugular. Has no valves, so concern if infection or thrombi of facial v get into cavernous sinus off of the dura mater (don't squeeze those boils!).

Answer 202

major blood supply to brain via circle of Willis / each give rise to an ophthalmic artery, a posterior communicating artery, a middle cerebral artery, and an anterior cerebral artery. Table 8.3 summarizes the brain regions supplied by these vessels and their major branches.

Answer 203

main drainage from dural sinuses

Answer 204

large terminal branch of external carotid a.; middle meningeal a. branches off of it. / the larger of the two terminal branches of the external carotid artery, is the major artery to the deep face. It arises posterior to the neck of the mandible, courses anteriorly deep to the neck of the mandibular condyle, and then passes superficial or deep to the lateral pterygoid (Figs. 7.43 and 7.44A). The artery passes medially from the infratemporal fossa through the pterygomaxillary fissure to enter the pterygopalatine fossa (Fig. 7.40B). The maxillary artery is thus divided into three parts by its relation to the lateral pterygoid muscle

Answer 205

artery coming out of interscalene triangle, vein anterior to scalenus anterior

Answer 206

superior branch of external carotid a., begins within parotid gland, supplies scalp, the site of temporal arteritis (giant cell arteritis), the vein accompanies. / is the smaller terminal branch of the external carotid artery; the other branch is the maxillary artery. The superficial temporal artery emerges on the face between the temporomandibular joint (TMJ) and the auricle and ends in the scalp by dividing into frontal and parietal branches

Answer 207

large branch off of external carotid artery / the most inferior of the three anterior branches of the external carotid artery, runs a ntero-inferiorly deep to the infrahyoid muscles to reach the thyroid gland. In addition to supplying this gland, it gives off branches to the infrahyoid muscles and the SCM and gives rise to the superior laryngeal artery, supplying the larynx.

Answer 208

derived from the second and third pharyngeal arches, respectively

Answer 209

SCM, mandible, neck midline are boundaries. Carotid sheath of carotid artery, jugular vein, and vagus nerve in here, as well as hyoid muscles and thryoid/parathyroid glands.

Answer 210

paired, attachment for vocal cords / three-sided pyramidal cartilages that articulate with lateral parts of the superior border of the cricoid cartilage lamina. Each cartilage has an apex superiorly, a vocal process anteriorly, and a large muscular process that projects laterally from its base (Fig. 8.15B). The apex of each arytenoid cartilage bears the corniculate cartilage and attaches to the ary-epiglottic fold. The vocal process provides the posterior attachment for the vocal ligament (see Figs. 8.17 and 8.18A), and the muscular process serves as a lever to which the posterior and lateral crico-arytenoid muscles are attached. / moves the vocal folds medially (adduction) by the action of the lateral cricoarytenoid muscle and the transverse and oblique arytenoid muscles - lateral movements widens the rima glottidis producing lower tones

Answer 211

the external ear, contains elastic cartilage for its springiness, with helix as its prominent rim, and tragus as fleshy, triangular structure anterior to ear canal (may have hair on it)

Answer 212

connective tissue that covers carotid a., internal jugular v., and CN X in neck / tubular fascial investment that e xtends from the cranial base to the root of the neck. This sheath blends anteriorly with the investing and pretracheal layers of fascia and posteriorly with the prevertebral layer of deep cervical fascia. The carotid sheath contains the (Fig. 8.2B,C) • Common and internal carotid arteries • Internal jugular vein (IJV) • Vagus nerve (CN X) • Deep cervical lymph nodes (some) • Carotid sinus nerve • Sympathetic nerve fibers (carotid periarterial plexuses)

Answer 213

collarbone, most frequently broken in the body

Answer 214

inferior to thyroid cartilage (most inferior of all the laryngeal cartilages) / forms a complete ring around the airway, the only cartilage of the respiratory tract to do so. It is shaped like a signet ring with its band facing anteriorly. ring-shaped, connecting the thyroid cartilage to the trachea. The posterior (signet) part of the cricoid cartilage is the lamina; the anterior (band) part is the arch. The cricoid cartilage is smaller but thicker and stronger than the thyroid cartilage. The cricoid cartilage is attached to the inferior margin of the thyroid cartilage by the median cricothyroid ligament and to the first tracheal ring by the cricotracheal ligament (Fig. 8.15). Where the larynx is closest to the skin and most accessible, the median cricothyroid ligament may be felt as a soft spot during palpation inferior to the thyroid cartilage.

Answer 215

between thyroid and cricoid cartilages; possible site for emergency airway access

Answer 216

guards the opening into the larynx, marks its upper surface; covers the glottis (laryngeal opening) during swallowing, aided by elevation of the hyoid bone. Epiglottitis: less common, given the use of Hib vaccine against Haemophilus influenzae, but a clinical emergency if present.

Answer 217

continues from lower laryngopharynx / passing from the pharynx to the stomach. / transports food to stomach

Answer 218

inferior to cricoid cartilage

Answer 219

brachial plexus and subclavian artery pass through here.

Answer 220

anteroinferior part of the nasal septum where majority of epistaxis occurs, as multiple arteries meet up here/ rich in capillaries where all 5 arteries suplying the septum anastomose. Often where profuse bleeding from the nose occurs / This area is often where profuse bleeding from the nose occurs. A rich plexus of veins drains deep to the nasal mucosa into the sphenopalatine, facial, and ophthalmic veins.

Answer 221

in males, prominent, so called Adam's apple

Answer 222

from epiglottis to level of lower cricoid cartilage, where it joins up with esophagus / lies posterior to the larynx, extending from the superior border of the epiglottis and the pharyngo-epiglottic folds to the inferior border of the cricoid cartilage, where it narrows and becomes continuous with the esophagus (Fig. 8.22). Posteriorly, the laryngopharynx is related to the bodies of the C4–C6 vertebrae. Its posterior and lateral walls are formed by the middle and inferior pharyngeal constrictor muscles. Internally, the wall is formed by the palatopharyngeus and stylopharyngeus muscles (Fig. 8.22C). The laryngopharynx communicates with the larynx through the laryngeal inlet on its anterior wall (Fig. 8.22A).

Answer 223

voice box for phonation w/ 3 unpaired cartilages

Answer 224

naris (nostril) is the nasal opening, nasal aperature is the opening in the skull, and the alae are the wings/lateral components of the nose

Answer 225

respiratory function; superior to soft palate / lies posterior to the nasal cavity above the soft palate.

Answer 226

enlarged adenoid or pharyngeal tube can block out . Middle ear with tympanic cavity, in which the perception of pressure waves by the eardrum is then amplified by ossicles to the oval window of the inner ear. The middle ear is drained by the Eustachian (auditory, pharyngotympanic) tube to the nasopharynx, as well as communicating with internal aspects of the mastoid process. Inner ear with hearing (cochlea) and balancing (vestibule with semicircular canal) components. laterally positioned in nasopharynx

Answer 227

roof of mouth, separating oral and nasal cavities, posterior soft portion is soft palate, and uvula is a midline muscular structure (check its position with CN X testing); cleft palate developmental concerns / has a digestive function. It is bounded by the soft palate superiorly, the base of the tongue inferiorly, and the palatoglossal and palatopharyngeal arches laterally (Figs. 8.22 and 8.23). It extends from the soft palate to the superior border of the epiglottis. / extends from the soft palate to the superior tip of the epiglottis; it is the region that lies posterior to the oral cavity.

Answer 228

the tonsils we're all familiar with, on either side of oropharynx in between palatoglossal/palatopharyngeal arches; the largest component of Waldeyer’s ring of lymphatic tissue. / are concentrated collections of lymphoid tissue on each side of the oropharynx that lie in the tonsillar sinus.

Answer 229

Embedded posterolaterally are parathyroid glands, with parathyroid hormone that regulate serum calcium levels. supply parathyroid hormone (PTH) to raise blood calcium levels, small and pinkish brown, hard to find / produce parathormone (PTH), which controls the metabolism of phosphorus and calcium in the blood.

Answer 230

(Stensen's duct), turns anterior and in front of masseter, penetrates buccinator to 2nd maxillary molar/ courses medially across the medial border of the masseter muscle and then dives deeply into the buccal fat pad, piercing the buccinator muscle of the cheek and opening in the mouth just lateral to the second maxillary (upper) molar./passes horizontally from the anterior edge of the gland. At the anterior border of the masseter, the duct turns medially, pierces the buccinator, and enters the oral cavity through a small orifice opposite the second maxillary molar tooth. Embedded within the substance of the parotid gland, from superficial to deep, are the parotid plexus of the facial nerve (CN VII) and its branches, the retromandibular vein and the external carotid artery. On the parotid sheath and within the gland are parotid lymph nodes.

Answer 231

Large salivary gland anterior/inferior to auricle. CN VII passes through it (but CN IX innervates it!). The gland swells up in mumps. / is the largest of the three pairs of salivary glands and occupies the retromandibular space between the mandibular ramus and mastoid process (see Figs. 8.15 and 8.17). It is encased within the parotid sheath, a tough extension of the deep cervical fascia / is the largest of three paired salivary glands. It is enclosed within a tough fascial capsule, the parotid sheath, derived from the investing layer of deep cervical fascia. The parotid gland has an irregular shape because the area it occupies, the parotid bed, is anteroinferior to the external acoustic meatus, where it is wedged between the ramus of the mandible and the mastoid process (Fig. 7.21). The inferiorly-directed apex of the parotid gland is posterior to the angle of the mandible, and its base is related to the zygomatic arch

Answer 232

also known as adenoids when enlarged. If swollen, they obstruct the nasopharynx, which leads to mouth breathing ("adenoid facies"). / (commonly called adenoids when enlarged) are concentrations of aggregated lymphoid tissue in the mucous membrane of the roof and posterior wall of the nasopharynx (Fig. 8.22B). / lie in the posterior wall and roof of the nasopharynx; called adenoids when enlarged.

Answer 233

both digestive/respiratory functions; boundaries from oral and nasal cavities to past the cranial base to about C6, with portions of naso-, oro-, and laryngopharynx / is the superior expanded part of the alimentary system posterior to the nasal, oral, and laryngeal cavities (Fig. 8.22A). The pharynx extends from the cranial base to the inferior border of the cricoid cartilage anteriorly and the inferior border of C6 vertebra posteriorly. The pharynx is widest opposite the hyoid and narrowest at its inferior end, where it is continuous with the esophagus. The flat posterior wall of the pharynx lies against the prevertebral layer of deep cervical fascia (Fig. 8.2A). / The pharynx is divided into three parts: • Nasopharynx, posterior to the nose and superior to the soft palate • Oropharynx, posterior to the mouth • Laryngopharynx, posterior to the larynx / a ﬁbromuscular tube, connects the nasal and oral cavities of the head with the larynx and esophagus in the neck (Fig. 8.55). It extends from the base of the skull to the cricoid cartilage, where it is continuous with the esophagus

Answer 234

(infranasal depression), groove in upper lip extending to the nose. May be flattened in FAS (fetal alcohol syndrome). / midline infranasal depression of the upper lip.

Answer 235

CN XI in there.

Answer 236

the space between the true vocal cords, a common spot for that overly large piece of steak to lodge

Answer 237

5 layers of S. C. A. L. P., with the first three fused together: "S"; superficial fascia: "C"; galea aponeurotica: "A"; loose areolar tissue: "L"; pericranium (periosteum): "P". skin: a variable hairline is genetically determined. connective tissue: fat in here helps to cushion blows, and decreases with age. In addition to fat, tough connective tissue in this layer ensures that superficial skin lacerations bleed because the connective tissue does not gap and so keeps vessels open. Not gapping of tissue, loose connective tissue on the inside allows cushion. aponeurosis (epicranial) (galea aponeurotica):the tendon of the bellies of the occipitalis/frontalis muscles. If there is a deep coronal laceration, it will correspondingly gape with the tension of the bellies.loose areolar tissue: allows for scalp movement, but can also be a site for spread of infection.pericranium: periosteum of skull, little regenerative power, so often need head plates with repair. Not as regenerative. Frontal is- aponeurosis tendon because of tension of this and occipital "S"(SCALP) typically (?) with hair; "C" (SCALP, connective tissue) subcutaneous tissue, tough and dense, with vessels, nerves running through it; "A" (SCALP) (epicranial aponeurosis), the aponeurosis between frontalis and occipitalis. When split, deep wounds gape open; "L" (SCALP) what separates the pericranium from the "SCA" layers of the scalp. A danger area for infections to spread, as it is loosely filled to allow frontalis/occipital movement; "P" (SCALP) what covers the bones of the cranial vault. During birth, may have cephalohematomas. Poor osteogenic properties, so need to have "fill ins" for adult defects.

Answer 238

around the posterior edge of mylohyoid muscle (lateral inferior mandible) / appear late in the sixth week of development as endoderm-derived buds lateral to the tongue. hey begin to secrete mixed serous and mucous saliva around the 16th week and continue to grow postnatally.

Answer 239

with the laryngeal prominence (Adam's apple). It is larger in males because of testosterone influence during puberty. when prominent, “Adam’s apple” / cartilage around adams apple area /As males reach puberty, the thyroid cartilage enlarges and the vocal ligaments become longer and thicker, leading to a deeper sound in the voice. he quality of each person’s voice also is inluenced by the shape of the oral and pharyngeal spaces, nose and paranasal sinuses, tongue and lips, and soft palate.

Answer 240

The thyroid gland is found inferior to the larynx, consisting of two lobes laterally connected by an anterior isthmus. It is a large endocrine gland that receives a healthy blood flow from various vessels, e.g., superior thyroid arteries. Thyroid hormone is a major regulator of metabolism, as seen by the upcoming slides of hyper/hypothyroidism. Thyroid closer to eternal notch than cartilage. Reflecting thyroid be able to see the parathyroid behind it used for blood calcium w/ below thyroid be able to find recurrent laryngeal innervating larynx left recurrent laryngeal swoops around aortic arch and up and are the branches of the vagus nerve around the trachea, with isthmus as midline connection between two thyroid lobes/ the thyroid gland lies at the C5-T1 vertebral level, anterior to the trachea, and is a ductless endocrine gland that weighs about 20 grams. /The thyroid gland has two lateral lobes connected by an isthmus that lies anterior to the second to fourth tracheal cartilaginous rings. It is enveloped in the visceral layer of the pretracheal fascia. In about 50% of cases, a pyramidal lobe may extend superiorly from the isthmus, demarcating the embryonic migratory pathway of the thyroid from the base of the tongue (see Clinical Focus 8-49). he thyroid gland secretes thyroxine (T4), triiodothyronine (T3), and calcitonin and performs the following functions: • Increases the metabolic rate of tissues. • Increases the consumption of oxygen. • Increases the heart rate, ventilation, and renal function. • Is required for growth hormone production and is important in CNS growth. • Increases the deposition of calcium and phosphate in bones (via the hormone calcitonin).

Answer 241

muscular organ, with most of what we see as body, and dorsal surface with a variety of papillae, with the filiform the most common, and the frenulum as a midline fold of mucosa. This can be short and restrictive and literally present as tongue-tie (ankyloglossia). Hypoglossal nerve sweeping into tongue different than uvula in 10, both side of tongue pushing out but if one sides weak other side will overpower it strong side overpowers weak side pointing to lesion.

Answer 242

in superior mediastinum, supported by cartilaginous C rings / windpipe

Answer 243

depressions between median and lateral glossoepiglottic folds. Targets for laryngoscope blade during intubation.

Answer 244

A pair of strong connective tissue bands are stretched across the larynx from the thyroid cartilage: the true vocal cords, as visualized with a laryngoscope, e.g., for intubation. The vestibular folds superior to them are sensitive, e.g., cough reflex, as they are innervated from branches of CN X. false vocal cords superior to true vocal cords; help to close larynx during swallowing to prevent food entry / The laryngeal vestibular folds (the rima vestibuli is the space between the vestibular folds) and rima glottidis (space between the vocal folds) close to protect the larynx. / have a primarily protective function but can slightly alter the quality of sound.

Answer 245

true vocal cords / The vocal folds (vocal ligaments covered with mucosa) control phonation as a reed might function in an instrument. Vibrations of the folds produce sounds as air passes through the rima glottidis.

Answer 246

outgrowth from forebrain (hence surrounded by meninges, leading to papilledema in the optic disc with swelling), responsible for sight. note that it is covered by dura and arachnoid, and hence even a bit of subarachnoid space. The optic nerve consists of axons of retinal ganglion cells that are carrying photoreceptor information back to the brain as part of the visual pathway. As a result, where these axons (and blood vessels internal to them) aggregate is a blind spot at the optic disc.

Answer 247

V1 ophthalmic, V2, maxillary, V3, mandibular. Maxillary (and mandibular) susceptible to trigeminal neuralgia (tic douloureux). / Go everywhere in the head / Ophthalmic (CN V1) division: exits the skull via the superior orbital ﬁssure. / Maxillary (CN V2) division: exits the skull via the foramen rotundum. / Mandibular (CN V3) division: exits the skull via the foramen ovale.

Answer 248

emerges from pons/medulla junction. Moves the face, tastes, salivates (sublingual, submandibular glands), cries. One-sided defect in Bell's palsy, since comes out in "tight fit" of stylomastoid foramen and facial canal.

Answer 249

carotid sinus n. component should be visible going to carotid bifurcation, also sensory to posterior tongue and triggers salivation from the parotid gland. CN IX, glossopharyngeal nerve, is sensory for the pharynx and posterior third of the tongue, innervates the parotid gland, and innervates two major sensors at the bifurcation of the common carotid artery to the external carotid artery and internal carotid artery: 9 helps parotid gland salivate, taste in back of tongue. Sweets up front bitters in the back, CCA junction of ECA and ICA pressure sensing for orthostatcs pinkish-brownish beneath connective tissue notch carotid body chemosensor connected to 9, gag reflex. Gag reflex: CN IX sensory and CN X (vagus) motor: if the vagus is weak on one side, the functional side will pull the uvula and the rest of the soft palate over to its side, as seen with the right-sided lesion above

Answer 250

runs in carotid sheath / motor and sensory. 10 is motor component of 9, 10 works on both sides uvula a should be midline if offcenter uvula pulled to strong side.

Answer 251

the spinal component is the part responsible for SCM and trapezius m. / skeletal motor

Answer 252

motor to tongue; see it near mandibular angle and mylohyoid m. damage to the nerve will lead to ipsilateral tongue weakness. CN XII issues are seen in context with malignancy, stroke, etc. Hypoglossal nerve sweeping into tongue different than uvula in 10, both side of tongue pushing out but if one sides weak other side will overpower it strong side overpowers weak side pointing to lesion.

Answer 253

nerve loop of C1-3 on the internal jugular v. that supplies the infrahyoid mm. / The superior root of the ansa cervicalis branches from CN XII to supply the infrahyoid muscles (sternohyoid, sternothyroid, and omohyoid). This branch actually conveys only fibers from the cervical plexus (loop between the anterior rami of C1 and C2) that joined the nerve outside the cranial cavity. Some fibers reach the thyrohyoid muscle.

Answer 254

coming out of interscalene triangle / a major nerve network formed by the anterior rami of the C5–T1 spinal nerves

Answer 255

this and lingual n. are sensory branches of CN V3 ; sensory to the lower teeth. / this nerve passes into the mandibular canal and is sensory to the mandibular teeth and gums via inferior dental and gingival branches and to the chin via the mental branch from the inferior alveolar nerve. a branch of CN V3, is the sensory one feeling the pain from toothache secondary to inflamed pulp, e.g., secondary to cavities (caries).

Answer 256

branch of CN V3; sensory to the anterior tongue.

Answer 257

"C 3,4,5, gotta breathe to stay alive"; see it here closely on top of scalenus anterior. / originate chiefly from the 4th cervical nerve (C4) but receive contributions from the C3 and C5 nerves. The phrenic nerves contain motor, sensory, and sympathetic nerve fibers. These nerves provide the sole motor supply to the diaphragm as well as sensation to its central part. In the thorax, the nerves supply the mediastinal pleura and the pericardium. Receiving variable communicating fibers in the neck and fibers from the cervical sympathetic ganglia or their branches, each phrenic nerve forms on the anterior scalene muscle at the level of the superior border of the thyroid cartilage (Fig. 8.5E). The phrenic nerves lie anterior to the subclavian arteries and posterior to the subclavian veins as they enter the thorax (Fig. 8.5E). The contribution from C5 to the phrenic nerve may derive from an accessory phrenic nerve, frequently a branch of the nerve to the subclavius. If present, the a ccessory phrenic nerve lies lateral to the main nerve and descends posterior and sometimes anterior to the subclavian vein. The accessory phrenic nerve joins the phrenic nerve either in the root of the neck or in the thorax.

Answer 258

are branches of vagus n. to larynx supplying almost all of the intrinsic laryngeal muscles

Answer 259

region between cornea and iris, can be blood-filled in hyphema / chamber between the cornea and the iris

Answer 260

produced by the ciliary body and traveling between the lens and the iris in the posterior chamber through the pupil into the anterior chamber behind the cornea to help nourish structures. The aqueous humor is then drained by the scleral venous sinus (canal of Schlemm). transparent, protein-containing fluid of anterior and posterior chambers / fills the anterior segment of the eyeball, the interior of the eyeball anterior to the lens, suspensory ligament, and ciliary body

Answer 261

deep recess of the palpebral conjunctiva / palpebral conjuctiva: The eyelids are movable folds that are covered externally by thin skin and internally by a transparent mucous membrane

Answer 262

A middle vascular layer called the choroid is continuous anteriorly with the ciliary body, ciliary process, and iris. It provides oxygen and nutrients to the underly- ing retina. in posterior eye. dark reddish-brown layer between the sclera and the retina, forms the largest part of the vascular layer of the eyeball and lines most of the sclera. Engorged with blood in life (it has the highest perfusion rate per gram of tissue of all vascular beds of the body), this layer is responsible for the “red eye” eflection that occurs in flash photography. The choroid at- taches firmly to the pigment layer of the retina, but it can easily be stripped from the sclera. color and vascular supportive to neural retina where perception occurs Photoreceptors to brain. Have axons optic nerve 2 since outgrowths of brain have dura, arachnoid, and cerebral spinal fluid surrounding optic nerve w/ palpelodema.

Answer 263

make aqueous humor then drain into blood supply though sclera venous sinus or canal of schlem. Vascular and muscular extension of choroid anteriorly. contains smooth muscle arranged in a circular fashion like a sphincter. When relaxed, it pulls a set of zonular fibers attached to the elastic lens taut and flattens the lens for viewing objects at some distance from the eye. When focusing on near objects, the sphincter- like ciliary muscle (parasympathetically innervated by CN III) contracts and constricts closer to the lens, relaxing the zonular fibers and allowing the elastic lens to round up for accommodation (near vision).. deep to the sclera-corneal junction, contains ciliary m. for lens tension, and for aqueous humor production. ring-like thickening of the layer posterior to the corneoscleral junction that is muscular as well as vascular. It connects the choroid with the circumference of the iris. The ciliary body provides attachment for the lens. The contraction and relax- ation of the circularly arranged smooth muscle of the ciliary body controls thickness, and therefore the focus, of the lens. Folds on the internal surface of the ciliary body, the ciliary processes, secrete aqueous humor. Aqueous humor fills the anterior segment of the eyeball, the interior of the eye- ball anterior to the lens, suspensory ligament, and ciliary body

Answer 264

will be curved and nourished by tears from the lacrimal gland and aqueous humor in the anterior chamber behind it. major point of light bending to focus on retina need fluid w// no vascularity so have chamber behind it containing aqueous humor Seen through the cornea will be the iris and its central aperature, the pupil. Transparent part of outer layer; very sensitive to pain. clear epithelium, nonvascularized, focusing element, target for LASIK (laser-assisted in situ keratomileusis) or other corrective surgeries. fibrous layer covering the anterior one sixth of the eyeball. The convexity of the cornea is greater than that of the sclera and so it appears to protrude from the eyeball when viewed laterally

Answer 265

angle where cornea and sclera meet; may be disclored as Kayser–Fleischer rings in Wilson disease (copper metabolism issues)

Answer 266

circular, pigmented diaphragm / which literally lies on the anterior surface of the lens, is a thin contractile diaphragm with a central aperture, the pupil, for transmitting light

Answer 267

makes tears via CN VII stimulation, in superiorlateral part of orbit / secrete tears; innervated by the facial nerve postganglionic parasympathetic ﬁbers.The drainage of the lacrimal sac and the nasolacrimal duct is set up in the same facial developmental fusion of processes that lead to the formation of the palate and lips. The lacrimal gland (innervated by CN VII) is in the superior lateral component of the orbit, such that tears drain across the eye via punctate openings in the lacrimal papilla into the sac, and then drained towards the nasal conchae. Neural crest cells form head w/ nasal lacrimal duct and lacrimal gland superior lateral quadrant of CN7 w/ lacrimation from tears. (superior lateral and drain into nasal lacrimal duct), watery solution of cornea but mix in oil within upper lid tarsal plate and lid reinforcement or mybomium glands or add oil to tears if become cycstic or Colossians mybomiumitisncan see that.

Answer 268

small black pit on nasal end of eyelids, on top of papilla; to drain tears / medial end on the summit of a small elevation (the lacrimal punctum)

Answer 269

drainage point for tears, in medial portion of orbit. From here, tears drain to nose. / collect tears and release them into the nasolacrimal duct when one blinks (contraction of the orbicularis oculi muscle).

Answer 270

biconvex, focuses light onto retina. Cataracts, presbyopia seen with age.The curvature of the cornea allows for light refraction, and the lens offers adjustable focus to have light hit upon the photoreceptors of the retina, particularly the high resolution cone cells dominating the macula and its fovea.

Answer 271

blinks eye...?

Answer 272

retinal region for central vision, with fovea containing all cones. Macular degeneration in older individuals. / foevea centralis of the macula is the central focusing area and most sensitive portion of the retina. his region is thin because most of the other layers of the retina are absent. Here the photoreceptor layer consists only of cones, specialized for color vision and acute discrimination.

Answer 273

"blind spot" entrance of CN II to eyeball. Papilledema (swelling) from increased intracranial pressure / "our blind spot" because no cones or rods are present in this region of the retina.

Answer 274

posterior edge of ciliary body; represents end of optic retina / the irregular posterior border of the ciliary body

Answer 275

aqueous-filled region between iris and lens / is between the iris/ pupil anteriorly and the lens and ciliary body posteriorly. Aqueous humor is produced in the posterior chamber by the ciliary processes of the ciliary body. This clear watery solution provides nutrients for the avascular cornea and lens. After passing through the pupil into the anterior chamber, the aqueous humor drains through a trabecular meshwork at the iridocorneal angle into the scleral venous sinus

Answer 276

dark since seeing into pigmented posterior eye, aperture that transmits ligh. The pupillary light reflexes involve a direct pathway to the midbrain, with a direct vs. consensual reflex. Accommodation involves the occipital cortex projecting onto the structures and helping to generate focus. consensual reflex:shining light into one eye (stimulation of CN II) causes other pupil to constrict. This is accomplished via the superior colliculus to connection in the pretectal area of the midbrain, then to the Edinger-Westphal nucleus (parasympathetic portion of CN III). Marcus-Gunn pupil (afferent pupillary defect): direct response less than consensual response; tested by "swinging flashlight.” Seen in unilateral optic nerve damage. Argyll-Robertson pupil small irregular pupils that react to accommodation but not light. Do pupils respond to light, 2 (see), 3 (constrict) and consensual response in midbrain along way when get pupillary constriction bringing it closer getting occipital cortex involved getting pupillary restriction there desperate lesion and activityy. Neurosyphailis- misfiring in CNS, pupils don’t react to light but shrink to accommodation when bring it closer.

Answer 277

inner layer of posterior eye, contains rod and cone photoreceptors. consists of optic (sensitive to visual light rays and has neural-light receptive and pigmented layer-single layer of cells and reinforces light-absorbing property of choroid in reducing scatterin of light in eyee) and nonvisual parts (anterior continuation of pigmented layer and supporting cells extending over ciliary body and posterior surfae of iris to pupillary

Answer 278

visible, covered by bulbar conjunctiva, which will be continuous with palpebral conjunctiva. tough opaque part of the fibrous layer (coat) of the eyeball, covering the posterior five sixths of the eyeball and providing attachment for both the extrin- sic (extra-ocular) and the intrinsic muscles of the eye. The anterior part of the sclera is visible through the transparent bulbar conjunctiva as “the white of the eye” , continuous with cornea; tough, protective. Sclera- whites of eyes. Conjunctiva- w/ blood vessels covering sclera that is vascularized over sclera and underneath eyelid. Bulbar and palpebra conjunctiva over cornea is different that could block too

Answer 279

vascular chamber of eyeball drainage of venous blood and aqueous at angle of iris and cornea into circulation—compromise of drainage may lead to glaucoma goes.

Answer 280

CN III: medial rectus (adduct), superior rectus (elevate), inferior rectus (depress), inferior oblique (depends how hard it's contracting: up and out all the way, otherwise elevate while the eye is adducted). CN IV: superior oblique (depends on how hard it's contracting: down and out, otherwise depress while the eye is adducted). CN VI: lateral rectus (abduct). IO is the primary lateral rotator, and the SO the primary medial rotator, of the eye. SO a secondary function as a depressor, the IO a secondary function as an elevator, and both muscles a secondary function as abductors. SO is depression of the pupil in the adducted posi- tion (e.g., directing the gaze down the page when the gaze of both eyes is directed medially [converged] for reading). IO is elevation of the pupil in the adducted position (e.g., directing the gaze up the page during conver- gence for reading

Answer 281

dense connective tissue that make up internal support of the eyelids in superior and inferior eyelids of both eyes

Answer 282

sebaceous glands that open at eyelid rim, may encyst as a chalazion. secrete oily mixture into tears Within the eyelids are small tarsal (meibomian) glands to help “oil” the edges of the eyelids. lubricating edges of eyelids preventing from sticking together when close forming barrier lacirmal fluid does not cross when overproduced spills over as tears

Answer 283

Chamber (body) located behind lens and is filled w/ transparent gelatinous and does not turn over, dominating the posterior segment of the eye the fluid of the humor caught up in the construct of the body helps to cusion and protect fragile retina during rapid eye movements, transmits light and holds it in place (“Out, vile jelly” for those who remember King Lear).

Answer 284

Vertical planes passing through body parallel to median ex. Through midpoint to clavicle midsagittal or parasagittal

Answer 285

Vertical planes passing through body at right angles to median plane, dividing into front (anterior) and back (posterior) can be equal or unequal

Answer 286

Planes passing through body at right angles to median and frontal planes dividing it into upper (superior) and inferior (lower) parts.

Answer 287

Never to feet and close to median plane

Answer 288

Nearer to head and farther from median plane

Answer 289

Occurring on same side of body

Answer 290

Opposite side of body

Answer 291

Anerior hand (palmar) vs. posterior hand (dorsal)

Answer 292

Inferior foot surface (sole) vs. superior foot surface (dorsal)

Answer 293

Pushing shoulder forward (protrusion- chin)

Answer 294

Pushing shoulder back (retrusion- chin)

Answer 295

Bring something closer in sagittal plane

Answer 296

Bring something away at sagittal plane

Answer 297

Bring something towards the body infrntal plane

Answer 298

Bring something away from the body in the frontal plane

Answer 299

Keep the skin taut, yet allow for creasing w/ movement. Lacerations or surgical incisions parallel tension lines heal well w/ little scarring because minimal disruption of collagen fibers w/ incision across it disrupt more causing gaping wound and keloid scarring

Answer 300

Tissue injuries caused by thermal, electrical, radioactive, or chemical agents. different degrees also highlight the differences between epidermis, dermis, and hypodermis (subcutaneous tissue). rule of nines for body surface area for typical adults (head and arms 9% each, legs 18%, torso 18% in front and 18% in back, genitalia 1%) can offer a quick guide to the extensiveness of the burn.

Answer 301

Damage is limited to superficial part of epidermis, produces pink or light red and is tenderspares hair follicles and sweat glands aka partial-thickness. involves free nerve endingss

Answer 302

Damage extends through epidermis into superfifical part of dermis, except for their most suprficial parts, sweat glands and hair follicles are not damaged and can provide source of replacement cells for basal layer of epidermis is red, weeping, blistering, and painful. involves free nerve endings and vascularity

Answer 303

Entire epidermies, dermis, and underlying muscle are damage minor degree of healing may occur at edges, open ulcerated portions pretty white or charred. nerve sensation drops, down to muscle and subcutaneous tissue, fried nerves, veins showing through, tight w/ no easticicty in skin and muscles.

Answer 304

highly penetrating beam of X-rays transilluminates patient, showing tissues of differing densities of mass within body as images of differing densities of light and dark. tissue or organ relatively dense in mass like contact bone absorbs than a less densy such as spongy bone (radiolucent) . w/ dense tissue producing trnasparent oarea as less reach (radiopague). PA (posterior to anterior) anteroposterior (AP). use barium sulfate or iodine to study tubular like bowels or vessels.

Answer 305

images of body that resemble transverse anatomical sections w/ a beam of X-ray pass through body as tube and detector rotate around body in transverse plane w/ differing amount of radiation absorbed depending upon fat, bone, and water a computer compiles and generates 2-D nd 3-D images can enhance to see hollow viscera or blood vessels after taking contrast. faster, cheper, easily available, 3D, boney feuatures compared to MRI poor tissue definition in comparison

Answer 306

visulaization of superficial or deep structures in body by recording pulses of ultraonic waves reflecting of tissue. The images can be viewed in real time to demonstrate the motion of structures and flow within blood vessels shows as movie or images. noninvasive best way to see fetus and embryo growth.

Answer 307

MRI shows images of the body similar to those produced by CT, but they are better for tissue differentiation, reconstruct the tissues in any plane, even arbitrary oblique planes. The person is placed in a scanner with a strong magnetic field, and the body is pulsed with radio waves. Signals subsequently emitted from the patient’s tissues are stored in a computer and may be reconstructed in 2-D or 3-D images. The appearance of tissues on the generated images can be varied by controlling how radiofrequency pulses are sent and received. Scanners can be gated or paced to visualize mov- ing structures, such as the heart and blood flow, in real time. strong magnets align hydrogen's free protons radio wave deflects proton high resolution cant have metal implants or foreign bones cant do bone

Answer 308

PET scanning uses cyclotron-produced isotopes of extremely short half-life that emit positrons. PET scanning is used to eval- uate the physiological functions of organs such as the brain on a dynamic basis. Areas of increased brain activity will show selec- tive uptake of the injected isotope. finds structures w/ a higher metabolic rate such as malignant tumors and inflammatory lesions

Answer 309

most commonly arise on sun-damaged skin of head, neck, and dorsal arms and hand and can maetastasize. more mature cells resembling spinous layer precurosor from actinic keratoses. arise rapidly can have crateriform center, smooth but firm border can become quite large metastaais to scalp, lips, and ears. may be ulcerated firmer edges

Answer 310

most common cancer in world. rearely spread can destory local tissues causing morbidity to eye, nose, or brain immature cells similar to epidermis pink patch that does not heal, amy have focal scaling, or translucent pearly apperance focal pigmentation dermoscopy shows arbonizing vessels, focal pigment globules, and other patterns. less firm edges

Answer 311

in the stratum basale) may become melanomas with radial and then vertical growth phases, highlighting the interest in marking both visual size and rate of growth of the skin lesion as well as demonstrating the clinical prognostic feature of the depth of the melanoma upon excision. Notice changes in border and diametr above it, but the spread went down before up and is three dimensional spreading once it gets into papillary layer hits lymphatic. sun-exposed or sun-protected skin evolution, rapid change, or assymetry, blue/black

Answer 312

Bedsores common complications in patients confined to beds or wheelchairs. Form when soft tissue is compressed betwee bony eminence and bed/wheelchair. Debilitated patients cant feel discomfort more than half sacral girdle. Stage I: changes in skin temperature, consistency, or sensation, persistent redness, intact skin changes; stage II: primal-thickness/partial skin loss, similar to abrasion w/ shallow crater or blisters stage down to dermis III: full thickness skin loss w/ subcutaneous tissue damage and deep crater such as ulcer reaching subcutaneous Stage IV: full thickness skin loss w/ necrosis or damage to muscle, bone or adjacent structures. (decubiti L. “laying down”) are based on sustained pressure and shear on spots with decreased patient movement and positioining, typically over a bony prominence. If pressure exceeds the capillary filling pressure (~32 mm Hg), then blood flow into the soft tissues can be compromised. Pressure looses vascularity no sustained pressure on capillaries for long period. As with burns, there can be stages, that highlight the depth of damage.

Answer 313

excessive thoracic kyphosis aka humpback, dowager hump abnormal increase in thoracic curvature curving posterioly result from erosion of anteiror part of one or more vertebrae erosion and collapse cause loss of height as a result of osteoporosis because of disruption of calcium deposition and resorption or from poor posture

Answer 314

" lordosis hollow back anterior rotation of pelvis producing abnormal increase in lumbar curvature vertebral column becomes more convex anteriorly. associated w/ weakened trunk musculature of anterolateral abdominal wall develop in women in late pregnancy or obesity

Answer 315

characterized by abnormal lateral curvature accompanied by rotatio of vertebrae w/ spinous process turning toward cavity of abnormal curvature common in pubertal girls because of assymettric weakness of back muscle, failure of half of vertebra to develop, and different in legnth of lower limbs cause ex. genetic, trauma, idiopathic, occurs in adolescent girls and boys

Answer 316

herpes zoster a viral disease of spinal ganglia, acute neuralgia dermatomally distributed skin lesison. herpes virus invades a spinal ganglion and transported along axon to skin of cranial or spinal nerve root, where produces an infection that causes a sharp burning pain in dermatome supplied by involved nerve. ex. red and vesicular eruptions appear

Answer 317

failure of vertebral arch to fuse in deelopment, especially seen in lumbar region w/ variety of deformities. whole formed by layers. distal end, last to fuse is first to mess up. development based to problem caused in last step if it happened earlier no live birth. lack of formal clsoer of spinal vertebrae nerouv,s bone, and skin. Most common congenital anomaly of vertebral column in which lamina (embryonic neural arches) of L5 and/or S1 fail to develop normally and fuse. 1/4 of people, concealed by skin but indicated by tuft of hair most not having back problems. W/ severe cystica one or more vertebral arches may almost completely fail to develop. Associated w/ herniation of meninges and/or spinal cord w/ neurological symptoms like paralysis of limbs and disturbance in bladder and bowel control. Linked to low folic acid ingestion during the first trimester neural tube remains too close to surface w/ sclerotome cells do not migrate over tube forming neural arch of vertebra at L5 or S1 w/ neurological findings/ meninges and CSF protrude as cyst (meningococcal) or meninges and cord itself (meningomyelocele)

Answer 318

T1 and T12 are most commonly fractured noncervical vertebrae not commonly dislocated. Dislocation of cervical vertebrae common in neck injuries and don’t always damage spinal cord, can slip back in place or

Answer 319

degenerative changes or defect in vertebral pars between L5-S1Fractures of interarticular parts of vertebral laminate of L5 wearing collar . Results from failure of centrum of L5 to unite adequately w/ neural arches during development may result in pressure on spinal nerves of cauda equina as they enter sacrum causing back and lower limb pain reducing anteroposteior diameter . Congenital defect or acquired stress fracture of lamina presents w/ no slippage of adjacent articulating vertebrae. Scottie dog w/ collar

Answer 320

Spondylolysis (L5) progression of spondylolysis defect is bilateral and completely dislocated, causing vertebral body to be displaced anteirorly head disconnected. y result in forward dplacement of L5 vertebral body relative to sacrum. Bilateral defect (complete dislocation, or luxaition) resulting in anterior displacement of L5 body and transverse process. Posterior fragment remains in proper alignment or dog w/ broken neck creating low back or limb pain.

Answer 321

can often be the basis for kyphotic angulation in older women. Increased kyphosis by itself did not have an independent association for fracture, although it could be a marker for prevalent fractures. Common metabolic bone disease often detected during routine radiographic studies. Results from net demineralization of bones caused by disruption of nrmal balance of calcium depositor and resorption. Quality is reduced and atrophy of skeletal tissue occurs. Most affects are neck of femur, bodies of vertebra, metacarpals, and radius weakened brittle easy to fracture.compression fractures cause continuous acute or intermittent (chronic) back pain from midthoracic to midlumbar region, fracture of proximal femur humerus, ribs, or distal radius. Risk of history hormones, bad lifestyle,

Answer 322

Pedicure fracture of axis, can be stabilized, if survived w/ or w/out spinal cord damage.

Answer 323

Burst fracture of atlas C1 caused by a blow to top of head

Answer 324

type I stable, type II unstable, type III extend into body reunite when immobilized

Answer 325

whiplash injury hyperextend anterior longitudinal ligament stretched or torn. (flexion-extension syndrome) is a common general term for injury, usually from hyperextension, to the cervical region, as in a "rear-ender." Minor whiplash presents with muscle (e.g., sternocleidomastoid, longus colli m.) and ligament strains, but severe whiplash with spinal cord compression is serious. The lower cervical vertebrae include very mobile joints, and so are prone to dislocation. A bilateral dislocation runs the risk of spinal cord disruption. Otherwise, pinched spinal nerves may result from forced/rebound neck flexion/extension. Hyperextension most likely to injure posterior part of vertebrae arches and processes w/ severe hyperextension in diving injuries may pinch posterior arch of c1 vertebra between occipital and C2 braking at one or both grooves for vertebral arteries. Anterior longitudinal ligament and adjeacent annulus fibrosis may rupture. Cranium, C1, and c2 separated for axial skeleton, and spinal cord is severed. Relaxed head thrown backward, or hyperextended as accelerated forward w/ recoil of neck into flexion can tear muscles, ligament, bone and nerves

Answer 326

(narrowing of the lumbar vertebral foramina) can either be congenital or acquired. Compression of the nerve roots of the cauda equina may require surgical laminectomy decompression. Sitting and leaning forward for pain relief is characteristic of lumbar stenosis, as that position helps to stretch taut structures like a hypertrophic ligamentum flavum and so allow more space in the vertebral foramen for the roots. Stenosis of lumbar vertebral foramen alone causes compression of one or more of spinal nerve roots occupying vertebral canal. Treatment Amy consist of decompress I’ve laminectomy. May be hereditary making them more vulnerable to age related degenerative changes like IV disc protrusion, further compromises size of vertebral canal along w/ arthritic proliferation and ligamentous degeneration lumbar spinal nerves increase in size as vertebral column descends, IV foramina decease in size.

Answer 327

A tear or a weak spot in the anulus can lead to a protruded disc that can compress on spinal nerve roots that extend through the intervertebral foramen between two vertebrae, especially as the anulus weakens with age. Sciatica or lumbar radiculopathy with herniated nucleus pulposus or other impingement can create different deficit patterns. Protrusion of gelatinous nucleus purposes into or through annulus fibrosis is well-recognized cause of low back and low limb pain. If degeneration of posterior longitudinal ligament and wearing of annulus fibrosis occurred, nucleus purposes may herniate ino vertebral canal and compress spinal cord or nerve roots of spinal nerves in cauda equina. Occur posterolaterall, where annulus is thin and lacks support fromosterior o anterior longitudinal ligaments. Posterolateral herniation more likely to be symptomatic because of proximityof spinal nerve roots. Localized back pain of herniated disc from pressure on longitudinal ligaments and periphery of annulus fibrosis and local inflammation from chemical irritation by substances from ruptured nucleu pposus. Chronic pain from roots being compressed based on dermatome area. Common in lumbar region L4-L5, L5-S1 or nerve roots compressed by ossification of IV foramen on nerve roots. Sciatica- pain in lower back and hip and radiating down back of thigh into leg, by herniated lumbar IV disc osteopaths compressing L5 or S1. Nerve Roos passing to IV foramen immediately and farther below pass directly across area of herniation. In cervical as often as lumbar w/ exit superior to vertebra resulting in pain in neck, shoulder, arm and hand. Repeated compresssin- relaxation cycle of intervertebral discs lead to peripheral tears of annulus fiibrosus allow for extrusion and hernaiaton of more gelatinous nucleus pulposus common w/ age because of dehydration. In posterolateral direction doesnt commonly happen compressing spinal cord. Common in C5-C6 and C6-C7 shoulder and upper limb pain, L4-L5 and L5-S1 lumbar more common w/ pain in sacroiliac joint, hip, posterior thigh, and leg.

Answer 328

Sources of pain can be: fibroskeletal structures: periosteum, ligaments, nd anuli fibrosis of IV discs; meninges- covering of spinal cord; synovial joints- capsules of zygapophysial joints; muscles- intrinsic muscle of back; nervous tissue- spinal nerves or nerve roots exiting IV foramina. First two innervated by meninges of spinal and next to are posterior rami (articular and muck are) w/ pain from compression or irritation of spinal nerves is referred pain from cutaneous or subcutaneous or localized pain. Localized lower back pain- muscular, joint, or fibroskeletal. Muscular pain0 cramping spasms producing ischemia from guarding. Zygohyseal joint pain- w/ aging osteoporosis or arthritis /rheumatoid. Sharp pain from fracture periostea in origin, dislocation from ligaments, acute localized pain IV disc herniation from psterolateral annulus fibrosis and impingement on posterior longitudinal ligament. Lower back pain- invertebral disc rupture and herniation, nerve inflammation or compression, degenerative to vertebral facet joints, sacroiliac joint and ligament, metabolic bone disease, psychosocial factors, abdominal aneurysm, metastatic cancer, and my facial disorders

Answer 329

Involves some degree of stretching or microscopic tearing of uncle fibers. Muscles are producing movements of lumbar IV joints such as erector spinae. If weight not properly balanced on vertebral column strain is exerted on muscles and is most common cause. Back muscles go into spasm after an injury or in response to inflammation ex. Ligaments. Spasm is sudden involuntary contraction of one or more muscle groups resulting in cramps, pain, and interference w/ function, producing involuntary movements and distortion of vertebral column.

Answer 330

associated with trigger points secondary to taut bands of muscle. Note the role of signaling from the sensory muscle spindle fibers and subsequent increased muscle fiber contraction. Pain associated w/ muscle or adjacent fascia may be felt at a signal point or multiple active sending signal to CNS. Trauma, muscle overuse, poor posture, and disease may precipitate. May be tender to palpation and initiate muscle spasm-pain cycle. Can trigger neck: levator scapulae, splenius capitus, trapezius, sternocleidomastoid; shoulder: infraspinatus, supraspinantus, and rhomboid; lower back: Quadra Turkish lumborum, gluteus medis, tensor fasciae latte; thigh: biceps femoris, vastus lateralis, adductor longisimus; leg: gastrocnemius, soles

Answer 331

Fractures, dislocations, and fracture-dislocations interfere w/ blood supply to spinal cord for spinal and medullary arteries cn lead to muscle weakness and paralysis. Suffer circulatory impairment if segmental medullary arteries, great anterior segmental medulary artery are narrowed by OAD. With ruptured aneurysms, clamped arteries or occlusion can lose all sensation and voluntary movement inferior to level of impaired blood supply to spinal cord (paraplegia) secondary to death of neurons in pro of spinal cord supplied by anterior spinal artery. When dropped BP for 3-6 min. Blood supply to these retries reduced or stopped.

Answer 332

Obtain sample of CSF from lumbar cistern, lumbar puncture needle, fitted w/ styles, inserted into subarachnoid space. typical target for lumbar puncture is L3-L4, L4-L5; the cauda equina is located in that region, as the spinal cord terminates in the L1 range, so less risk of spinal cord damage. lower dose needed, one-time injection with more rapid onset. Given the nerve roots of the cauda equina in the CSF, they can “float away” as the needle is advanced. Lumbar spinal puncture performed w/ patient leaning forward or lying on side w/ back flexed. Flexion of vertebral column facilitates inserting of needle by spreading laminate and spinous processes apart, stretching ligament flavor. Needle inserted in midline between spinous process of L3 and L4 or L4 and L5 reduced danger of damaging spinal cord.

Answer 333

Anesthesic agent injected into extradural (epidural) spaceopportunity to place a catheter and deliver a continuous medication supply. using same position as lumbar puncture of being held in flexion open up between spinous processes and laminae of adjacent vertebrae needle can be advanced. Anesthetic has direct effect on spinal nerve roots of cauda equina after exit from rural sac loses sensation inferior to level of block or injected into extradural space in SoCal canal through sacral hiatus or through posterior sacral foramina (trans-sacral epidural anesthesia) distance agent as needs (number of nerves affected) depends on amount injected nd psoion assumed by patient.

Answer 334

able to palpate site of external occipital proteuberanceSurface anatomy able to palpate along spine feeling spinous processes. Cervical in Nuchal groove 2-C6, C3-C5 deeply placed below nuchal ligmanet, c7 is prominent palpate supraspinous ligement surrouding Thoracic. Transverse process of thoracic vertebrae palpated on either side of spinous process in thoracic, Supraspinous ligament blends w/ unchallenged ligament T5-T11 making them difficult to palpate.. lumbar palpated in posterior median furrow line joining highest points of iliac crests through tip of L4 spinous process. Dimples overlying posterior superior iliac spines. S2 process lies at middle of line drawn between posterior superior iliac spines found in dimples inferior extend of subarachnoid space. Median crest of sacrum palpated in midline inferior to L5 spinous process, sacral hiatus palpated at inferior end of sacrum in superior part of intergluteal cleft between buttocks. Coccyx in anal canal and apex above anus. sacral triangle formed by lines joining posterior superior iliac spines and superior part of intergluteal cleft, common area of pain from low back sprains. Midline of erect back, posterior median furrow overlying tips of spinous processes of vertebrae continuous w/ unchallenged groove ending in flattened triangle covering sacrum. Erector spinae muscles produce prominent vertical bulges on each side of furrow. Upper limbs elevated scapulae move laterally on thoracic wall rhomboid and there’s major visible.

Answer 335

1 degree (kyphoses) concave anteriorly primary curvatures developing in fetal period retained through life as consequence of height between anteiror and psoterior parts

Answer 336

2 degrees (lordoses) concave posteriorly secondary curvatures obvious in infancy maintained by differences in thickness between anterior and posterior aprts

Answer 337

very good for high-contrast structures such as bone allowing contrast resolution..

Answer 338

radiopaqu contrast study that allows visualization of spinal cord and spinal nerve roots. Contrast material is injected into spinal subarachnoid space showing extent of subarachnoid space and its extensions around spinal nerve roots within rural sheaths largely replaced by MRI

Answer 339

Differentiates between white and gray matter of brain and spinal cord. Improved radiological assessment of fractures of vertebra determining degree of compression of spinal cord. Dense vertebrae are white, IV discs have higher density than surrounding adipose in extradural space and CSF in subarachnoid space.

Answer 340

Like CT, computer imaging don’t use X-ray. High quality images of vertebral column, spinal cord, and CSF. MRI clearly demonstrates components of IV discs and shows relationship to vertebral bodies and longitudinal ligaments. Herniation of nucleus purposes and relationship to spinal nerve roots defined. Evaluate IV disc disorders

Answer 341

The convexity of the calvaria (skullcap) distributes and thereby minimizes the effects of a blow to it. However, hard blows to the head in thin areas are likely to produce depressed fractures in which a fragment of bone is depressed inward, compressing and/or injuring the brain. In a contrecoup (counterblow) fracture, the fracture occurs on the opposite side of the cranium rather than at the point of impact. Fracture of the pterion can be life threatening because it overlies the frontal (anterior) branches of the middle menin- geal vessels, which lie in grooves on the internal aspect of the lateral wall of the calvaria. Pterioin- big supplies to meninges is meninges love artery right underneath is w/ a really thin spot causing bleed creating epidural hematoma can cause leaks of CSF or blood A hard blow to the side of the head may fracture the thin bones forming the pterion, rupturing the frontal branches deep to the pterion. The resulting epi- dural hematoma exerts pressure on the underlying cerebral cor- tex. Untreated middle meningeal artery hemorrhage may cause death in a few hours. can describe the type and location of injury, e.g., depressed fractures from a hard blow to a thinner region. Worry about stuff leaking out. With respect to fractures at the pterion, we will focus on the middle meningeal artery and the risk of epidural hematoma when we open up the braincase with neuroanatomy.

Answer 342

presents with a distinct fracture line. calvarial fractures, the most frequent type, usually occur at the point of im- pact, but fracture lines often radiate away from it in two or more directions. If the area of the calvaria is thick at the site of impact, the bone usually bends inward without frac- turing; however, a fracture may occur some distance from the site of direct trauma where the calvaria is thinner.

Answer 343

presents with multiple fragments (depressed if driven inward; can compress or tear the underlying dura mater). the bone is broken into several pieces

Answer 344

fracture along a suture line

Answer 345

fracture of the base of the skull. although less common than other skull fractures, run the risk of CSF leak, e.g., rhinorrhea, otorrhea. involve the bones forming the cranial base (e.g., occipital bone around the foramen magnum, temporal and/or sphenoid bones, or the roof of the orbit). As a result of the fracture, cerebrospinal fluid (CSF) may leak into the nose (CSF rhinorrhea) and ear (CSF otorrhea), and cranial nerve and blood vessel injury may occur, depending on the site of the fracture.

Answer 346

Any fracture that communicates with a lacerated scalp, a paranasal sinus, or the middle ear is termed a compound fracture. Compound depressed fractures must be treated surgically

Answer 347

Trauma to the zygomatic bone (cheekbone) can disrupt the zygomatic complex and its articulations with the frontal, maxillary, temporal, sphenoid, and palatine bones. can affect the orbit as well as the cheek causing assymetry bruising w/ excess loose connective tissue around eyes be able to notice swelling and bruising in eyes. Often, fractures involve suture lines with the frontal and maxillary bones, resulting in displacement inferiorly, medially, and posteriorly. The typical clinical presentation is illustrated. Ipsilateral ocular and visual changes may include diplopia (an upper outer gaze) and hyphema (blood in the anterior chamber of the eye), which requires immediate clinical attention. A massive zygomaticomaxillary complex fracture or a direct blow to the front of the orbit (e.g., by baseball or fist) may cause a rapid increase in intraorbital pressure resulting in a blow-out fracture of the thin orbital floor. In severe comminuted fractures of the orbital floor, the orbital soft tissues may herniate into the underlying maxillary paranasal sinus. Clinical signs include diplopia, infraorbital nerve paresthesia, enophthalmos, edema, and ecchymosis.

Answer 348

easily breakable blown and affecting sinus in inferior direction eye sunken into maxillary sinus. Globe surrounded by fat in socket can have rupture things depending upon how hard or direct. When blows are powerful enough and the impact is directly on the bony rim, the resulting fractures usually occur at the sutures between the bones forming the orbital margin. Because of the thinness of the medial and infe- rior walls of the orbit, a blow to the eye may fracture the orbital walls while the margin remains intact. Indirect traumatic injury that displaces the orbital walls is called a “blowout” fracture. Fractures of the medial wall may involve the ethmoidal and sphe- noidal sinuses, whereas fractures in the inferior wall may involve the maxillary sinus and may entrap the inferior rectus muscle, limiting upward gaze. Although the superior wall is stronger than the medial and inferior walls, it is thin enough to be translucent and may be readily penetrated. Thus, a sharp object may pass through it into the frontal lobe of the brain. Orbital fractures often result in intra-orbital bleeding, which exerts pressure on the eyeball, causing exophthalmos (protrusion of the eyeball).

Answer 349

Midface fractures (of the maxilla, nasoorbital complex, and zygomatic bones): Facial fractures (Le Fort types I, II, and III) result from frontal blows, such as motor vehicle accidents (MVAs). There is a high association with intracranial damage and CSF leaks.Le Fort I: horizontal detachment of the maxilla at the level of the nasal floor. tooth being seperated from upper maxilla Le Fort II: fracture across orbital floor and nasal bridge (pyramidal fracture) pyramidal fracture that includes both maxillae and nasal bones, medial portions of both maxillary antra, infraorbital rims, orbits, and orbital floors. Le Fort III: fracture across frontozygomatic suture line, entire orbit and nasal bridge craniofacial seperationg includes Le Fort II and a fracture of both zygomatic bones; may cause airway problems, nasolacrimal apparatus obstruction, and cerebrospinal fluid leakage.

Answer 350

he loose connective tissue layer is the dan- ger area of the scalp because pus or blood spreads easily in it. Infection in this layer can also pass into the cranial cavity through emissary veins, which pass through the calvaria and reach intracranial structures such as the meninges. An infection cannot pass into the neck because the occipital belly of the occipitofrontalis muscle attaches to the occipital bone and mastoid parts of the temporal bones. Neither can the infection spread laterally beyond the zygomatic arches because the epicranial aponeurosis is continu- ous with the temporal fascia that attaches to these arches. An infection or fluid (e.g., pus or blood) can enter the eyelids and the root of the nose because the frontal belly of the occipitofrontalis muscle inserts into the skin and subcutaneous tissue and does not attach to the bone. Consequently, “black eyes” can result from an injury to the scalp or forehead. Ecchymo- ses, or purple patches, develop as a result of extravasa- tion of blood into the subcutaneous tissue and skin of the eyelids and surrounding regions.

Answer 351

1. Preauricular—in front of the ear2. Posterior auricular—superficial to the mastoid process3. Occipital—at the base of the skull posteriorly 4. Tonsillar—at the angle of the mandible 5. Submandibular—midway between the angle and the tip of the mandible. These nodes are usually smaller and smoother than the lobulated subman- dibular gland against which they lie. A pulsating “tonsillar node” is really the carotid artery. A small hard tender “ton- sillar node” high and deep between the mandible and the sternocleidomastoid is probably a styloid process. 6. Submental—in the midline a few centi- meters behind the tip of the mandible. 7. Superficial cervical—superficial to the sternocleidomastoid. 8. Posterior cervical—along the anterior edge of the trapezius. 9. Deep cervical chain—deep to the ster- nocleidomastoid and often inaccessible to examination. Hook your thumb and fingers around either side of the sterno- cleidomastoid muscle to find them. 10. Supraclavicular—deep in the angle formed by the clavicle and the sterno- cleidomastoid1. Preauricular—in front of the ear 2. Posterior auricular—superficial to the mastoid process Most superficial tissues of the neck are drained by lymphatic vessels that enter the superficial cervical lymph nodes, which are located along the course of the EJV (Fig. 8.26A). Lymph from these nodes drains into inferior deep cervical lymph nodes (Fig. 8.26B,C). The specific group of inferior deep cervical nodes involved here descends across the lateral cervical region with the spinal accessory nerve (CN XI). Most lymph from the six to eight nodes then drains into the supraclavicular lymph nodes, which accompany the trans- verse cervical artery. The main group of deep cervical nodes forms a chain along the IJV, mostly under cover of the SCM.Other deep cervical nodes include the prelaryngeal, pretracheal, paratracheal, and retropharyngeal nodes (Fig. 8.26C). Efferent lymphatic vessels from the deep cervi- cal nodes join to form the jugular lymphatic trunks, which usually join the thoracic duct on the left side. On the right side, the vessels enter the junction of the internal jugular and subclavian veins (right venous angle) directly or via a short right lymphatic duct.

Answer 352

Squamous cell carcinoma (cancer) of the lip usually involves the lower lip (Fig. B7.5). Overexposure to sunshine and irritation from pipe smoking over many years are contributing factors. Cancer cells from the central part of the lower lip, the floor of the mouth, and apex of the tongue spread to the submental lymph nodes, whereas cancer cells from lateral parts of the lower lip drain to the submandibular lymph nodes.

Answer 353

Malignant tumors in the posterior part of the tongue metastasize to the superior deep cervical lymph nodes on both sides. In contrast, tumors in the apex and anterolateral parts usually do not metastasize to the inferior deep cervical nodes until late in the disease. Because the deep nodes are closely related to the IJVs, metas- tases from the carcinoma may spread to the submental and submandibular regions and along the IJVs into the neck.

Answer 354

Trigeminal neuralgia (tic douloureux) is a sensory disorder of the sensory root of CN V characterized by sudden attacks of excruciat-ing, lightning-like jabs of facial pain. A paroxysm (sudden sharp pain) can last for 15 minutes or more. The max- illary nerve (CN V2) is most frequently involved; then the mandibular nerve (CN V3); and, least frequently, the ophthalmic nerve (CN V1). The pain often is initiated by touching a sensitive trigger zone of the skin. The cause of trigeminal neuralgia is unknown; how- ever, some investigators believe that most affected peo- ple have an anomalous blood vessel that compresses the sensory root of CN V. When the aberrant artery is moved away from the root, the symptoms usually disappear. Other researchers believe the condition is caused by pathological processes affecting neurons of the trigemi- nal ganglion. In some cases, it is necessary to section the sensory root for relief of trigeminal neuralgia. cuased by touching the drafts of cool air producing facial tic

Answer 355

Lesions of the entire trigeminal nerve cause wide- spread anesthesia involving the Corresponding anterior half of the scalp, Face, except for an area overlying the angle of the mandible, Cornea and conjunctiva, Mucous membranes of the nose and paranasal sinuses, mouth, and anterior part of the tongue. Paralysis of the muscles of mastication also occurs.

Answer 356

the affected facial muscles do not function, so that the affected portion of the patient's face appears to sag. A common cause of Bell palsy is inflammation of the facial nerve near the stylomastoid foramen. With Bell palsy, concern over loss of function, including: orbicularis oculi m.: closes eyes, so with loss of blinking, concern with corneal ulceration., orbicularis oris m.: closes and purses lips, so with loss, drooling and difficulty in mastication, buccinator m.: compresses cheek; the major cheek muscle, aids during food chewing, and with loss, accumulation of food in the cheeks, so difficulty in mastication.injury to the facial nerve (CN VII) or its branches produces paralysis of some or all the facial muscles on the affected side (Bell palsy). Acute, unilateral idiopathic facial palsy is the most common cause of facial muscle weakness and cranial neuropathy. Facial nerve palsy also may be caused by herpes simplex virus (HSV) infection. The affected areas sag and facial expression is distorted. The loss of tonus of the orbicularis oculi causes the inferior eyelid to evert (fall away from the surface of the eyeball). As a result, the lacrimal fluid is not spread over the cornea, preventing adequate lubrication, hydration, and flushing of the cornea. This makes the cornea vulnerable to ulceration. If the injury weakens or paralyzes the buccinator and orbicularis oris, food will accumulate in the oral vestibule during chewing, usually requiring continual removal with a finger. When the sphincters or dilators of the mouth are affected, displace- ment of the mouth (drooping of the corner) is produced by gravity and contraction of unopposed contralateral facial muscles, resulting in food and saliva dribbling out of the side of the mouth. Weakened lip muscles affect speech. Affected people cannot whistle or blow a wind instrument effectively. They frequently dab their eyes and mouth with a handker- chief to wipe the fluid (tears and saliva), which runs from the drooping eyelid and mouth. 1. Intracranial and/or internal auditory meatus. All symptoms of 2, 3, and 4, plus deafness due to involvement of vestibulocochlear nerve (CN VIII). 2. Geniculate ganglion All symptoms of 3 and 4, plus pain behind ear. Herpes of tympanum and of external auditory meatus may occur. 3. Facial canalAll symptoms of 4, plus loss of taste in anterior tongue and decreased salivation on affected side due to chorda tympani involvement. Hyperacusis due to effect on nerve branch to stapedius muscle. 4. Below stylomastoid foramen (parotid gland tumor, trauma) Facial paralysis (mouth draws to opposite side; on affected side, patient unable to close eye or wrinkle forehead; food collects between teeth and cheek due to paralysis of buccinator muscle).

Answer 357

There are three pairs of major salivary glands, with the parotid gland (duct crusies over maseter innervated by glossopharyngeal can cause motor deficit to 7 but not innervated by) and submandibular gland easily accessible by dissection (Platysma and skin off duct is under tongue). Note that exocrine glands such as these often have a distinctive appearance with multiple connective tissue septae (partitions) in their tissue. Saliva has important moistening and digestive functions. Connective tissue septa dividing up glandular tissue chewed bubble gum salivary glands. Sialoliths- salivary gland stones creating bad breaths (hallotosis) can be painful especially common in long submandibular duct . Conditions affecting the salivary gland may impact a number of local nerves. For example, surgery on the parotid gland can impact branches of facial nerve (CN VII) that extends from it. Sensation/inflammation from parotid gland tissue can refer to the TMJ region because of involvement of branches of trigeminal nerve (CN V). The long submandibular duct (Wharton duct) is at higher risk of salivary stones (sialoliths) than other ducts. The parotid gland may become infected by infectious agents that pass through the bloodstream, as occurs in mumps, an acute communicable viral disease. Infection of the gland causes inflammation (parotidi- tis) of the gland. Severe pain occurs because the tough parotid sheath, innervated by the great auricular nerve , becomes tightly stretched by swelling. The pain may be aggra- vated during chewing because the enlarged gland is wrapped around the posterior border of the ramus of the mandible and is compressed against the mastoid process when the mouth is opened. The mumps virus also may cause inflammation of the parotid duct, producing redness of the parotid papilla, where the parotid duct opens into the mouth opposite the second maxillary molar tooth. Because the pain produced by mumps may be confused with a toothache, redness of the papilla is often an early sign that the disease involves the gland and not a tooth. Parotid gland disease often causes pain in the auricle, external acoustic meatus, temporal region, and TMJ because the auriculotemporal nerve, from which the parotid gland receives sensory fibers, also supplies sensory fibers to the skin over the temporal fossa and auricle.

Answer 358

An alveolar nerve block—commonly used by den- tists when repairing mandibular teeth—anesthetizes the inferior alveolar nerve, a branch of CN V3. The anesthetic agent is injected around the mandibular foramen, the opening into the mandibular canal on the medial aspect of the ramus of the mandible. This canal gives passage to the inferior alveolar nerve, artery, and vein. When this nerve block is successful, all mandibular teeth are anesthetized to the median plane. The skin and mucous membrane of the lower lip, the labial alveolar mucosa and gingiva, and the skin of the chin are also anesthetized because they are supplied by the mental branch of this nerve.

Answer 359

Decay of the hard tissues of a tooth results in the formation of dental caries (cavities). Invasion of the pulp cavity of the tooth by a carious lesion (cavity) results in infection and irritation of the tissues in the cavity. This condition causes an inflammatory process (pulpitis). Because the pulp cavity is a rigid space, the swollen pulpal tissues cause pain (toothache). Improper oral hygiene results in food deposits in tooth and gingival crevices, which may cause inflam- mation of the gingivae (gingivitis). If untreated, the disease spreads to other supporting structures (e.g., alveolar bone), producing periodontitis, which results in inflammation of the gingivae. It may result in absorption of alveolar bone and gingival recession that exposes the sensitive cement of the teeth.

Answer 360

Elevation (close mouth)- Temporalis, masseter, and medial pterygoid. depression (opens mouth)-Lateral pterygoid and suprahyoid and infrahyoid musclesa. protrustion- Lateral pterygoid, masseter, and medial pterygoid. retrusion- Temporalis (posterior oblique and near horizontal fibers) and masseter. lateral movements (grinding and chewing)- Temporalis of same side, pterygoids of opposite side, and masseter

Answer 361

During yawning or taking a large bite, excessive contraction of the lateral pterygoids may cause the heads of the mandibles to dislocate anteriorly, by passing anterior to the articular tubercles. In this position, the mandible remains depressed and the person may not be able to close the mouth. Most com- monly, a sideways blow to the chin when the mouth is open dislocates the TMJ on the side that received the blow. Fracture(s) of the mandible may be accompanied by disloca- tion of the TMJ. Because of the close relationship of the facial and auriculotemporal nerves to the TMJ, care must be taken during surgical procedures to preserve both the branches of the facial nerve overlying it and the articu- lar branches of the auriculotemporal nerve that enter the posterior part of the joint. Injury to articular branches of the auriculotemporal nerve supplying the TMJ—associated with traumatic dislocation and rupture of the joint cap- sule and lateral ligament—leads to laxity and instability of the TMJ.

Answer 362

Names:Oh, Oh, Oh, To Touch And Feel Virgin Girls’ Vagina and Hymen. Sensory vs. motor: Some Say Marry Money, But My Brother Says Big Butts Matter More. Functions: 1 Hears; 2 sees; 3, 4 & 6 roll the eyeballs around; 5 Feels and Chews; 7 Smiles, Spits, Tastes, and Tears; 8 Hears and Balance; 9 & 10 Gag; 11 Shurgs the Shoulders; 12 Sticks the tongue out. Cranial nerves innervate ipsilaterally(except for CN IV, trochlearn., which crosses over soon after exiting the midbrain), and so, if damaged, represent ipsilaterallesions(except for trochlearnerve as mentioned above).

Answer 363

Note that the nasal septum has bony components from the ethmoid bone and the vomer bone, along with septal cartilage. If sufficiently deviated, e.g., congenitally or by trauma, it could compromise air flow through a nasal passage. Easily fractured deviated septum of entranceway to turbimate, kesselneck plexus in midline septum or arteries 90% of nosebleed in anterior localized nasal trauma can lead to bleed Because of the prominence of the nose, fractures of the nasal bones are common facial fractures in au- tomobile accidents and sports (unless face guards are worn). Fractures usually result in deformation of the nose, particularly when a lateral force is applied by someone’s elbow, for example. Epistaxis (nosebleed) usually occurs. In severe fractures, disruption of the bones and cartilages results in displacement of the nose. When the injury results from a direct blow, the cribriform plate of the ethmoid bone may also fracture, often accompanied by CSF rhinorrhea (leaking of CSF through the nose)

Answer 364

Nosebleed (epistaxis) commonly occurs on the nasal septum at the Kiesselbach plexus (area), where a number of arteries anastomose there, and the mucosa there is prone to drying or trauma due to rhinotillexis (which is…) A nosebleed, or epistaxis, is a common occurrence and often involves the richly vascularized region of the vestibule and the anteroinferior aspect of the nasal septum (Kiesselbach’s area). Nosebleeds usually result from trauma to the septal branch of the superior labial artery from the facial artery. bleeding is from an area in the anterior third of the nose (Kiesselbach area). Epistaxis is also associated with infections and hypertension. Spurting of blood from the nose results from rupture of arteries. Mild epistaxis may also result from nose picking, which tears veins in the vestibule of the nose.

Answer 365

The nasal mucosa becomes swollen and inflamed (rhinitis) during severe upper respiratory infections and allergic reactions (e.g., hay fever). Swelling of the mucosa occurs readily because of its vascularity and glan- dular nature. Infections of the nasal cavities may spread to the: Anterior cranial fossa through the cribriform plate, Nasopharynx and retropharyngeal soft tissues, Middle ear through the pharyngotympanic tube (auditory tube), which connects the tympanic cavity and nasopharynx, Paranasalsinuses, Lacrimal apparatus and conjunctiva

Answer 366

The superior location of maxillary sinus drainage indicates that if the normal mucociliary clearance is obstructed, e.g., from inflammation following a viral infection, the maxillary sinus can fill with secretions. Maxillary sinuses hard because Ostend or opening at toppseudostratified columnar lots of mucus waving mucus moving stuff out of sinus mucoscikkary ofnsinus must be up and out so w/ infection or closing down of superior opening things don’t drain well causing sinusitis Maxillary sinus right below eye vulnerable spot for fractures. The maxillary sinuses are the most commonly infected, probably because their ostia are com- monly small and are located high on their supero-medial walls. When the mucous membrane of the sinus is congested, the maxillary ostia are often obstructed. Because of the high location of the ostia, when the head is erect, it is impossible for the sinuses to drain until they are full. Because the ostia of the right and left sinuses lie on the medial sides (i.e., are directed toward each other), when lying on one’s side, only the upper sinus (e.g., the right sinus if lying on the left side) drains. A cold or allergy involving both sinuses can result in nights of rolling from side-to-side in an attempt to keep the sinuses drained. A maxillary sinus can be cannulated and drained by passing a cannula from the nares through the maxillary ostium into the sinus. The close proximity of the three maxillary molar teeth to the floor of the maxillary sinus poses potentially serious problems. During removal of a molar tooth, a fracture of a root may occur. If proper retrieval methods are not used, a piece of the root may be driven superiorly into the maxillary sinus. A communication may be created between the oral cav- ity and the maxillary sinus as a result, and an infection may occur.

Answer 367

Rhinosinusitis is an inflammation of the paranasal sinuses (usually the ethmoid and maxillary sinuses) and the nasal cavity. Physical examination of the paranasal sinuses is usually sufficient to make the diagnosis, although a CT of the sinus may help in difficult cases.

Answer 368

Otitis externa is an inflammation of the external acoustic meatus. The infection often develops in swimmers who do not dry their meatus after swimming and/or use ear drops, but it may also be the result of a bacterial infection of the skin lining the meatus. The affected individual complains of itching and pain in the external ear. Pulling the auricle or applying pressure on the tragus increases the pain. Pain in response to tugging on the auricle indicates a likely infection of the external acoustic meatus, or otitis externa. The most common bacterial cause of otitis externa is Pseudomonas aeruginosa (Gram negative rod that is environmentally hardy).environmental infection from outside swimmers ear pseudomonas … gram negative environmental hardy. Eustachian smaller lumen less angle, get URI inflammation of mucosa in Eustachian tube no longer draining environment for pathogens1 streptococcus pneumonia gram positive lancet shaped- major cause of pneumonia meningitis lives in head and neck given opportunity can create infection 2- homofloxen influenza- head and neck inflammation with vaccine not as invasive in epiglottis not B see type around head and neck ear infection 3- moracelic heteracchus- not as aggressive but head and neck swoops in when compromised or secondary pneumonia can result in Deafness- hearing loss

Answer 369

is an infection in the middle ear caused by viral or bacterial pathogens. Streptococcus pneumoniae (Gram positive diplococcus) is a common head and neck organism that can be the cause, as well as two other common head and neck pathogens, Haemophilus influenzae (Gram negative rod) and Moraxella catarrhalis (Gram negative diplococcus). The decreased diameter and angle of the pediatric auditory tube accounts for the comparatively high rates of otitis media in children. An earache and a bulging red tympanic membrane may indicate pus or fluid in the middle ear, a sign of otitis media. Infection of the middle ear is often secondary to upper respiratory infections. Inflammation and swelling of the mucous membrane lining the tympanic cavity may cause partial or complete blockage of the pharyngotympanic tube. The tympanic membrane becomes red and bulges, and the person may complain of “ear popping.” An amber-colored bloody fluid may be observed through the tympanic membrane. If untreated, otitis media may produce impaired hearing as the result of scarring of the auditory ossicles, limiting their ability to move in response to sound. common in children younger than 15 years because the auditory tube is short and relatively horizontal at this age, which limits drainage by gravity and provides a route for infection from the nasopharynx. When viewed with an otoscope, the normal translucent appearance of the tympanic membrane is gone, the eardrum is erythematous and bulging, and the cone of light is absent

Answer 370

There are two kinds of deafness: conductive deafness, involving the external or middle ear (e.g., otitis media, inflammation in the middle ear), and sensorineural deafness, which results from disease in the cochlea or in the path- way from the cochlea to the brain CN 8. Pattern deafness change over time Infection- conductive hearing loss over time because of repeated infections in tympanic membrane or ossicles. Air conduction because ear is designed for it and uses it. Good ear is gonna hear better but bad here would hear conductive or bone sound better because able to feel it not hear it

Answer 371

As the brain grows, so does the neurocranium, by bone deposition along suture lines. If this process is interrupted (for unknown reasons or because of genetic factors), the cranium may compensate by depositing more bone along other sutures. If the sagittal suture closes prematurely, scalppocephaly- growth in width is altered, so growth occurs lengthwise and leads to a long, narrow cranium; brachycephaly- coronal and lambdoid suture closure results in a short, wide cranium. The disorder occurs in about 1 in 2000 births and is more common in men than in women. Premature fusion of sutures can lead to craniosynostosis, with patterns varying by the suture(s) that were fused. Plagiocephaly or asymmetrical skull distortion can be seen in babies for other reasons, e.g., positional.

Answer 372

have large Sagittarius ridge in the middle

Answer 373

due to coronal craniosynotosishave big growth of bones on either side of head

Answer 374

no centered area assymetrical

Answer 375

Cleft lip is a congenital facial abnormality caused by failure of fusion between the maxillary process with the medial nasal process. Failure of these the palate fusion points leads to a cleft palate. Because the face and oral cavity develop largely by midline fusion of various prominences, incomplete or failed fusion can lead to cleft formation (lips and palate) or anomalous features (ankyloglossia, torus formations). The etiology is multifactorial, but genetics appears to play some role. unilateral- one side, unliateral of primary palate- complete involving lip and alveolar ridge; bilateral cleft; ankylogossia- restricted tongue movment from short lingual frenulum; torus palatine- bone deposition on plate; complete cleft of secondary paalate and unilateral cleft of primary palate. Can include partial or full separation of bone nasal and micaillary process in face c9me together. Can affect feeding latching on any generating enough pressure for nursing

Answer 376

Most anomalies of the pharyngeal apparatus involve fistulas, cysts, or ectopic glandular tissue. Some common anomalies and their sources from the associated pharyngeal pouch or wall

Answer 377

The investing layer of deep cervical fascia helps prevent the spread of abscesses (a collection of pus). If an infection occurs between theinvesting layer of deep cervical fascia and the muscular part of the pretracheal fascia surrounding the infrahyoid muscles, the infection usually does not spread beyond the superior edge of the manubrium. If, however, the infection occurs between the investing fascia and the vis- ceral part of the pretracheal fascia, it can spread into the thoracic cavity anterior to the pericardium. Pus from an abscess posterior to the prevertebral layer of deep cervical fascia may extend laterally in the neck and form a swelling posterior to the SCM. The pus may perforate the prevertebral layer of deep cervical fascia and enter the retropharyngeal space, produc- ing a bulge in the pharynx (retropharyngeal abscess). This swelling may cause difficulty in swallowing (dysphagia) and speaking (dysarthria). Similarly, air from a ruptured trachea, bronchus, or esophagus (pneumomediastinum) may pass superiorly in the neck.

Answer 378

injuries in zone I and III obstruct the airway and havethe greatest risk for morbidity (complications after sur- gical procedures and other treatments) and mortality (a fatal outcome) because injured structures are difficult to visualize and repair and vascular damage is difficult to control. Injuries in zone II are most common; however ,morbidity and mortality are lower because physicians can control vascular damage by direct pressure and surgeons can visualize and treat injured structures more easily than they can in zones I and III.

Answer 379

root of neck extending from clavicle to manubrium to inferior broder of cricoid cartilage. including cervical pleurae, apices of lungs, thyroid and parathyroid glands, trachea, esopha- gus, common carotid arteries, jugular veins, thyroid artery and the cervical region of the vertebral column.

Answer 380

extends from the cricoid cartilage to the angles of the mandible. Structures at risk are the superior poles of the thyroid gland, thyroid and cricoid cartilages, larynx, laryngopharynx, carotid arteries, jugular veins, esopha- gus, and cervical region of the vertebral column.

Answer 381

occurs superiorly from the angles of the mandible. Structures at risk are the salivary glands, oral and nasal cavities, oropharynx, and nasopharynx

Answer 382

Congenital torticollis (wryneck) is often the result of congenital fibrosis or a difficult breech delivery that results in SCM damage. As a result, the head is tilted and the chin elevated. contraction of the cervical muscles that produces twisting of the neck and slanting of the head. most common type of congenital torti-collis (wry neck) results from a fibrous tissue tumor (L. fibroma- tosis colli) that develops in the SCM before or shortly after birth. Occasionally, the SCM is injured when an infant’s head is pulled excessively during a difficult birth, tearing its fibers (muscular tor- ticollis). This tearing results in a hematoma that may develop into a fibrous mass entrapping a branch of the spinal accessory nerve (CN XI), thus denervating part of the SCM. Surgical release of a partially fibrotic SCM from its distal attachments to the manu- brium and clavicle may be necessary. Cervical dystonia (abnormal tonicity of the cervical muscles), commonly known as spasmodic torticollis, usually begins in adult-hood. It may involve any bilateral combination of lateral neck mus- cles, especially the SCM and trapezius.

Answer 383

Central lines are often placed via the right subclavian vein. Right side is a lot easier start at the head save left for HD catheters because heart is rotated to the right versus interacting w/ the possible aorta on the left. The internal jugular vein, if lacerated, may be prone to air embolism. right or left subclavian vein often provides a point of entry into the venous system for cen- tral line placement. Central lines are inserted to administer parenteral (venous nutritional) flu- ids and medications and to measure central venous pres- sure. The pleura and/or the subclavian artery are at risk of puncture during this procedure. Alternative sites of central venous line placement are the IJV and femoral vein.

Answer 384

During a thyroidectomy (e.g., excision of a malignant thyroid gland), the parathyroid glands are in danger of being inadvertently damaged or removed. These glands are safe during subtotal thyroidectomy because the most posterior part of the thyroid gland usually is preserved. Vari- ability in the position of the parathyroid glands, especially the inferior ones, puts them in danger of being removed during surgery on the thyroid gland. If the parathyroid glands are inadvertently removed during surgery, the patient suffers from tetany, a severe convulsive disorder. The generalized convulsive muscle spasms result from a fall in blood calcium levels. Hor- mone replacement therapy is required.

Answer 385

Graves’ disease is the most common cause of hyperthyroidism in patients younger than 40. Excess synthesis and release of thyroid hormone (T3 and T4) result in thyrotoxicosis, which upregulates tissue metabolism and leads to symptoms, indicating increased metabolism. autoimmune disease w/ antibodies joint TSH receptors getting constantly turned off thyroid. Besides Graves’ disease, hyperthyroidism can be caused by benign growth of the thyroid gland, benign growth of the anterior pituitary gland, thyroiditis, the ingestion of excessive amounts of thyroid hormones and iodine, and tumors of the ovaries. symptoms: perspiration, facial flushing, loss of weight, palpable lymph nodes, SOB, breast enlargment (even in male), warm-velvety skin, muscle wasting, rapid pulse (palpitation, tachycardia), nervousness, excitability, restlessness, emotional instability, insomnia, increased appetite, diarrhea, tremor, clubbing, muscular weakness. Eyes have fat surrounding to provide cushion and if have immune cells and inflammation have fat and eyeball w/ fat and connective tissue swelling pushing eyes out.

Answer 386

Primary hypothyroidism is a disease in which the thyroid gland produces inadequate amounts of thyroid hormone to meet the body’s needs.Antibodies targeting and destroying thyroid cells w/ skin yellowing doughy. ECM- no turnover in hypothyroidism materials build up creating dietary pigments getting yellow skin doughyness. Thyroid-stimulating hormone (TSH) levels are elevated. In addition to the autoimmune form of the disease, hypothyroidism also may occur from thyroidectomy and radiation-related damage. symptoms: hair dry and brittle, Lethargy, memory impairment, slow cerebration (psychoses may occur), edema of face and eyelids, sensation of coldness, diminished perspiration, skin coarse, dry, scaling, cold (follicular keratosis), yellowish (carotenmia), swollen face and tongue (considered to be from accumulation of extracellular matrix materials like glycosaminoglycans from decreased breakdown) and slow speech, deep coarse voice, heart enlarged poor heart sounds and precordial pain occasionally hypertension, prolonged reflexes

Answer 387

Hoarseness can be caused by any condition that results in improper vibration or coaptation of the vocal folds. including inflammation, lesions, and carcinoma of vocal folds and larygneal fractures, Altered activity of the vocal cords can present as hoarseness. Swelling of loose connective tissue laryngitis of pictures creates hoarseness. Thin spot rhinototisis- recurrent laryngeal w/ whole area innervated by vagus vulnerable and thinnest spot in area . Vestibular folds- create cough reflx

Answer 388

A foreign object, such as a piece of steak, may ac- cidentally aspirate through the laryngeal inlet into the vestibule of the larynx, where it becomes trapped superior to the vestibular folds. Note that the rima glottidis between the vocal folds is the narrowest part of the airway, and would often be the “sticking point” for aspiration. The vestibular folds would be highly innervated and could trigger a coughing response, or could lead to laryngeal muscle spasm and rima glottidis closure if a foreign body lands there. Otherwise, the Heimlich maneuver can use lung air to help dislodge whatever is in the larynx. When a foreign object enters the vestibule, the laryngeal muscles go into spasm, tensing the vocal folds. The rima glottidis closes and no air enters the tra- chea. Asphyxiation occurs, and the person will die in approxi- mately 5 minutes from lack of oxygen if the obstruction is not removed. Emergency therapy must be given to open the airway. Foreign bodies entering the pharynx may become lodged in the piriform fossae. If the object (e.g., a chicken bone) is sharp, it may pierce the mucous membrane and injure the internal laryngeal nerve. The su- perior laryngeal nerve and its internal laryngeal branch are also vulnerable to injury if the instrument used to remove the foreign body accidentally pierces the mucous membrane. Injury to these nerves may result in anesthesia of the laryngeal mucous membrane as far inferiorly as the vocal folds. Young children swallow various objects, most of which reach the stomach and subsequently pass through the alimentary tract without difficulty. In some cases, the foreign body stops at the inferior end of the laryngopharynx, its narrowest part. A medical image such as a radiograph or a CT scan will reveal the presence of a radiopaque foreign body. Foreign bodies in the pharynx are often removed under direct vision through a pharyngoscope.

Answer 389

A transverse incision through the skin of the neck and anterior wall of the trachea (tracheostomy) establishes an airway in patients with upper airway obstruction or respiratory failure. A tracheostomy can generate long-term access to the airway. Note that infrahyoid muscles and the thyroid isthmus are both considerations to move. The placement in the cartilaginous C rings 2-4 of the trachea can lessen the chance of stenosis compared to if the (encircling) cricoid cartilage were involved. Too large an endotracheal tube cuff can erode through the posterior wall of the trachea to the esophagus. The infrahyoid muscles are retracted laterally, and the isthmus of the thyroid gland is either divided or retracted superiorly. An opening is made in the trachea between the first and second tracheal rings or through the 2nd through 4th rings. A tracheostomy tube is then inserted into the trachea and secured. Stoma- two finger lengths above the sternal notch aiming three rings below the sternonothc have to move the sternohiloid and sternothyroid away. C rings surrounding circuit cartilage C rings w/ esophagus right behind it directly don’t want erosion between two forming tracheal esophageal fistula. Don’t put it in cricoid cartilage that w/ any swelling there is the extra area to swell outward done put in cricoid because would block airway w/ swelling

Answer 390

When all other methods of establishing an airway have been exhausted or determined to be unsuitable, an incision can be made through the skin and the underlying cricothyroid membrane to gain access to the trachea. inferior to rima glottidis. The site of the incision can be judged by locating the thyroid notch and sliding your finger inferiorly until the space between the thyroid and cricoid cartilages is palpated (about one fingerbreadth inferior to the thyroid notch). If the patient has a midline pyramidal lobe arising from the thyroid gland, this procedure may lacerate that tissue and cause significant bleeding.

Answer 391

Laryngoscopy is the procedure used to examine the interior of the larynx. The larynx may be examined visually by indirect laryngoscopy using a laryngeal mirror, or it may be viewed by direct laryngoscopy using a tubu- lar endoscopic instrument, a laryngoscope. The vestibular and vocal folds can be observed. something that all health professionals should be aware of, as it is based on tobacco and alcohol use, and hence there is the possibility of prevention through lifestyle alterations. Most of these cancers can be easily visualized, e.g., oral exam or laryngoscope, and with possible effects on movement of the vocal cords.

Answer 392

Inflammation of the pharyngeal tonsils (adenoids) is called adenoiditis. removal of the adenoids (pharyngeal tonsils). On top of soft palate near nasopharyngeal and turbinate can block off nose w/ mouth breathing. 10 is motor in pharynx, and 9 is sensory in pharynx vulnerable back there. This condition can obstruct the passage of air from the nasal cavities through the choanae into the nasopharynx, making mouth breathing nec- essary. Infection from the enlarged pharyngeal tonsils may also spread to the tubal tonsils, causing swelling and closure of the pharyngotympanic tubes. Impairment of hearing may result from nasal obstruction and blockage of the pharyngo- tympanic tubes. Infection spreading from the nasopharynx to the middle ear causes otitis media (middle ear infection), which may produce temporary or permanent hearing loss

Answer 393

Tonsillectomy removal of the palatine tonsils after repeated infections; CN IX is along side the tonsillar artery. Can cause SOB, tight fit as lymphoid tissue w/ mouse survalence highly vascular. Folds of muscle of palatine pillars. is per- formed by dissecting the tonsil from the tonsillar sinus or by a guillotine or snare operation. Each procedure involves removal of the tonsil and the fascial sheet covering the tonsillar sinus. Because of the rich blood supply of the tonsil, bleeding commonly arises from the large exter- nal palatine vein or less commonly from the tonsillar artery or other arterial twigs. The glossopharyngeal nerve accompanies the tonsillar artery on the lateral wall of the pharynx and is vulnerable to injury because this wall is thin. The internal carotid artery is especially vulnerable when it is tortuous as it lies directly lateral to the tonsil

Answer 394

SCM region and divides the neck into anterior and lateral cervical regions. EJV runs vertically across the SCM toward the angle of the mandible. The Jugular notch in the manubrium is the fossa between the sternal heads of the SCM. The lesser supraclavicular fossa, between the sternal and clavicular heads of the SCM, overlies the inferior end of the IJV. Deep to the superior half of the SCM is the cervical plexus, and deep to the inferior half of the SCM are the IJV, common carotid artery, and vagus nerve in the carotid sheath. anterior border of the trapezius defines the posterior cervical region. Just inferior to the belly of the omohyoid is the greater su- praclavicular fossa, the depression overlying the omoclavicular triangle. The subclavian arterial pulsations can be palpated here in most people.The occipital triangle contains the spinal accessory nerve (CN XI). Its course can be approximated by a line that intersects the junction of the superior and middle thirds of the posterior border of the SCM and the junction of the middle and lower thirds of the anterior border of the trapezius. The submandibular gland nearly fills the submandibular triangle, which is palpable as a soft mass inferior to body of mandible. The U-shaped hyoid bone lies superior to the thyroid cartilage at the level of the C4 and C5 vertebrae (Fig. SA8.2). The la- ryngeal prominence is produced by the fused laminae of the thyroid cartilage, which meet in the median plane. The cricoid cartilage can be felt inferior to the laryngeal prominence. It lies at the level of the C6 vertebra. The cartilaginous tracheal rings are palpable in the inferior part of the neck. The second through fourth rings cannot be felt because the isthmus of the thyroid, connecting its right and left lobes, covers them. The first tra- cheal ring is just superior to the isthmus.specially when the tongue is pushed against the maxillary incisor teeth. The submandibular lymph nodes lie superficial to the gland and, if enlarged, can be palpated by moving the fingers from the angle of the mandible along its inferior border. enlarged submen- tal lymph nodes can be palpated in the submental triangle. The carotid arterial system is located in the carotid triangle. The carotid sheath can be mapped out by a line joining the ster- noclavicular joint to a point midway between the mastoid process and the angle of the mandible

Answer 395

Upright radiography of the sinuses can be used to evaluate air- fluid levels in purulent sinusitis. Soft tissue radiography of the neck (different radiographic technique than cervical spine radi- ography) is used to look for enlargement of the ad- enoids and to examine the contour of the airway in croup (viral infection of the subglottic trachea). In cases of suspected acute epiglottitis (life-threatening bacterial infection of the epiglot- tis), the rapid identification of an enlarged epiglottis, which can be gained from a single lateral soft tissue neck radiograph, can lead to lifesaving protection of a compromised airway. Bright white: metal. White: bone Gray: tissue, water Black: air

Answer 396

are used to diagnose inflammatory paranasal sinus disease, severe facial fractures, and cross-sectional images of the neck. CT is acquired in the axial plane, and the dataset can then be used to reconstruct images in the sagit- tal and coronal planes. CT scans are superior to radiographs because they reveal radiodensity differences among and within soft tissues (e.g., in salivary glands). CT angiograms enable re- construction of the arteries in 3-D

Answer 397

MRI studies of the neck are superior to CT studies for showing detail in soft tissues, but they pro- vide little information about bones.

Answer 398

Ultrasound: U/S with a transducer generating high frequency sound waves; safe, portable, useful for real-time imaging solid/fluid interfaces (not good for gas or bone). is also a useful imaging technique for studying soft tissues of the neck. US provides images of many abnormal conditions noninvasively, at relatively low cost, and with minimal discom- fort. It is useful for distinguishing solid from cystic masses, for example, which may be difficult to determine during physical examination. US is the major imaging modality used to evaluate morphologic changes in the thyroid gland (functional thyroid disease is evaluated by nuclear medicine procedures and with laboratory studies). Vascular imaging of arteries and veins of the neck is possible using intravascular ultrasonography. The images are produced by placing the transducer within the blood vessel. Doppler ultrasound techniques help evaluate blood flow through a vessel (e.g., for detecting stenosis [narrowing] of a carotid artery).

Answer 399

Eyelid dropping as caused by alesion in oculomotor nerve 3, which supplies somatic motor interaction to levator palpebrae superiors and sympathetic innervation to superior tarsal muscle

Answer 400

Inflammation of meibomian (tarsal) glands

Answer 401

Cyst formation in meibomian gland

Answer 402

Infection of sebaceous gland at base of eyelash follicle

Answer 403

Inflammation of eyelash margin (scaly or ulcerated)

Answer 404

Dilated, congested conjunctival vessels caused by local irritants (e.g., dust, smoke

Answer 405

Common inflammation; result of injection of conjunctival vessels caused by allergy, infection, or external irritant. is an inflammation of the conjunctiva, typically caused by bacterial or viral infection, or an allergic process. Note how different lid items can be involved, e.g., chalazion in a tarsal (meibomian) gland as a chronic cyst, or a hordeolum (sty/stye) as an acute infection in the ciliary gland, typically from Staphylococcus aureus (Gram positive coccus).

Answer 406

ainless, homogeneous red area; result of rupture of subconjunctival capillaries

Answer 407

Results from seepage of fluid between neural and pigmented layers of retina, days or even weeks after trauma to eye. Complain of flashes of light or specks floating in front of eyes

Answer 408

A number of issues can arise with diabetic retinopathy, including vitreous contraction and subsequent retinal detachment. The hyperglycemia of chronic diabetes mellitus can lead to vascular disruption from the retinal vessels. Retina disrupt photoreceptors and activity on retina, retina detachment secondary detachment, detachment visualize billowing clouds if focal plane not quite sand retina isn’t attached depending on vitroues to keep it up agains tchoroid if something were to happen might get tension get traction ask attachment as vitreous impact along the way. Vitreous start to have issues traumatically it rocked blood flow and fibrosis get traction, vascularity helping to support retina hypertension and/or deisbetes Mellifus what going on here along way, diabetes- chronically raised blood sugar lead to additional endothelium activation with simple squamous epithelium or endothelial triggering facing ongoing onslaught of high blood sugar or neovadukxarization leading to leakage or microaneurysms impact vascularity and function of photoreceptors diabetes could retinopathy, Blockage of central retina artery results in instant and toll blindness unilateral occurring in older people. Blockage of central retinal vein- enters cavernous sinus, produce blockage in one of small veins causing slow, painless loss of vision.

Answer 409

Developmentally, the eye is an outgrowth of the brain, with the dura continuous with the sclera. This means that the subarachnoid space with CSF surrounds the retinal ganglion cell axons of the optic nerve, and generating papilledema in the optic disc with increased intracranial pressure (ICP) and compression of the retinal veins and subsequent congestion. Increase in CSF pressure slows venous return from retina, causing edema of retina (fluid accumulation) edema viewed during ophthalmoscope as swelling of optic disc. When Intercranial pressure is increased, pressure compresses optic nerve and its venous return through retinal veins resulting in edema of optic disc

Answer 410

Lens’s become harder and more flattened as people age reducing focusing power of lenses.

Answer 411

Cataracts are opacities within the lens that typically occur with lens protein changes over time, and so are typically seen in older populations. Replacement with an intralocular lens typically follows ultrasonic break up (phacoemulsification), and then placement of a foldable lens through the small incision needed for the phaco probe. More generally, refractive disorders (ametropias) are situations where the light does not focus on the macula of the retina, with possible contributions from the cornea, the lens, and the axial length of the eyeball. Altered vision- nearsighted, farsighted cornea curvature for light ray bending focus on macula high concentrations of cones or color vision Lens- crystalline collection of proteins flexibility nearsighted lost Crystalline break down as get old develop cataracts clouding of lens Myopia (nearsightedness): eye functionally long . Hyperopia (farsightedness): eye functionally short Astigmatism: cornea with irregular curvatures Loss of transparency or cloudiness of lens from areas of opaqueness. Will remove lens leaving capsule of lens intact to receive synthetic intraocular lens.

Answer 412

The fluid flow of the aqueous humor from the ciliary body into the anterior chamber is essential for nutrition of avascular structures such as the posterior cornea. If the drainage of the aqueous humor is blocked, pressure builds up and glaucoma may result. If the anterior chamber becomes blocked suddenly, there is a dramatic rise in intraocular pressure with a risk for permanent visual loss within hours. Open-angle glaucoma is associated with increased intraocular pressure caused by conditions such as obstruction of the trabecular network, direct obstruction of the scleral venous sinus (canal of Schlemm), and increased venous pressure occluding the canal, but with an open angle between the cornea and iris. Acute closed-angle glaucoma is an ophthalmologic emergency associated with increased intraocular pressure and visual field deficits, and if not addressed, atrophy of the optic nerve. Retina because glaucoma big effects raised itnraoccular pressure because of open and closed angle aqueous humor, colliery body aqueous humor traveling behind iris, in front of anterior chamber drained by canal of schlem. Mesh worksporting anterior angle channel don’t drain as well developing ongoing angle opthamologic emergency pupil iris folds over blocking drainage sight pressure building up a lot faster becoming red angry and painful with rapid buildup and pressure. Slow down production of aqueous beta blocker eye drop ciliary body to slow down aqueous humor to match rate of drainage anterior still getting enough drainage, parasympathetic drops polycapineninto eye. Stretch iris taugh opennip and put tension on canal of schlem and help drain. Open glaucoma- in older open angle where its there but just not draining fast enough and slow steady rate of production unusual rate of drainage bu t still an obstruction but partial clog. Increased pressure on ganglion from nerve to brain. Ganglion highest in macular region flower ganglion talking to bigger groups of odds in periphery if squeezed and dying off in same rate show up in periphery than central Sclera Venus sinus- canal of schlem where iris and cornea come togther. Closed glaucoma- acute iris flopped over drainage site aqueous pressure builds up emergency. Optic neuropathy that can lead to visual field deficits and is often associated w/ elevated intraocular pressure. Outflow of aqueous humor through sclera venous sinus into blood circulation occur at same rate at high aqueous produced. Out low decreases significantly because outflow pathway blocked, intra-ocular pressure (IOP) builds up in anterior and posterior chambers of eye. Blindness can result from compression of inner layer of eyeball and retinal arteries if aqueous humor production is not reduced.

Answer 413

controls superior oblique, which Abducts, depresses, and rotates eyeball medially (intorsion)

Answer 414

controls inferior oblique, superior rectus, inferior rectus, medial rectus, and lateral rectus

Answer 415

Elevates, adducts, and rotates eyeball medially (intorsion)

Answer 416

Depresses, adducts, and rotates eyeball laterally (extorsion)

Answer 417

Adducts eyeball

Answer 418

“up and out”; elevate and abduct (extorsion)

Answer 419

“down and out”; depress and abduct (intorsion)

Answer 420

moves lateral rectus Abducts eyeball

Answer 421

One or more extra-ocular muscles may be para- lyzed by disease in the brainstem or by a head injury, resulting in diplopia (double vision). Paral-ysis of a muscle is apparent by the limitation of movement of the eyeball in the field of action of the muscle and by the production of two images when one attempts to use the muscle.

Answer 422

Complete oculomotor nerve palsy affects most of the ocular muscles, the levator palpebrae superioris, and the sphincter pupillae. The superior eyelid droops and cannot be raised voluntarily because of the unop- posed activity of the orbicularis oculi (supplied by the facial nerve). The pupil is also fully dilated and non- reactive because of the unopposed dilator pupillae. The pupil is fully abducted and depressed (“down and out”) because of the unopposed activity of the lateral rectus and superior oblique, respectively

Answer 423

loss of SO function, so difficulty with looking down while adducted, with a head tilt away from the affected side so that the affected eye can be “elevated". CN IV is rarely injured in isolation. The characteris- tic sign of trochlear nerve injury is diplopia (double vision) when looking down (e.g., when going downstairs). Diplopia occurs because the superior oblique nor- mally assists the inferior rectus in depressing the pupil (direct- ing the gaze downward) and is the only muscle to do so when the pupil is adducted.

Answer 424

loss of LR function, so that the affected eye has difficulty abducting across midline . When the abducent nerve (CN VI) supplying only the lateral rectus is paralyzed, the individual cannot abduct the pupil on the affected side. The pupil is fully adducted by the unopposed pull of the medial rectus. Causes medial deviation of affected eye, adducted at rest does not fully abduct due to unopposed medial rectus

Answer 425

Parasympathetic supply to the head is delivered via cranial nerves II, VII, and IX (with CN X supplying parasympathetic tone to thorax and much of abdomen). In contrast, the sympathetic tone to the head arrives from postganglionic neurons that leave the superior cervical ganglion at the top of the sympathetic trunk/chain. With respect to the eye, note that parasympathetic tone innervates pupil constrictor muscles, leading to miosis, with sympathetic tone to pupil dilator muscles, leading to mydriasis, as well as sweat glands and the superior tarsal muscle. As a result, disruption of sympathetic tone to one side of the head will result in Horner syndrome, with ipsilateral ptosis, miosis, and anhidrosis. Pre and post ganglionic to make out to periphery parasympathetic out of cranial air S2 levels, sympathetic coming out of thoracolumbar region to L2 intermediate horn into sympathetic trunk or whatever organ. 7 smiles spits tastes and tears doing salivary gland. Glossopharyngeal takes care of #9 doing parotid gland 7 goes around 9. Cranial nerve 3 eye parasympathetic focus on pupillary constrictor muscles or sympathetic tone or myosis or affect on villainy muscle spcontrilling lenses and fattening scccomadte being closer or further away contracting, fattening up or allowing nice close and focus. Sympathetic pupillary dilator muscles out on radius making them bigger Madrid’s is with sympathetic tone throughout into vertebral bodies out jaw cervical vertebral bodies to ganglion to hit sympathetic target under head, sweat glands, vasulcq r smooth muscle superior tarsal muscle closing eyes obcikuaris oculi innervated by 7 levator oalpebra supefioris innervated by ocumulotor. Smooth muscle innervstor muscle difficult to tease apart superior tarsal lift eyelid with sympathetic time. Horner syndrome- sympathetic tone to one side of head disrupting superior cervical ganglion or going to that point anhydrous is- sympathetic sweat glands. Myosis- pupillary dilator pupillary contristocr. Inside eye opthamasoccpe seeing retina or optic disk collection of ganglion cells axons connecting photocells back to resin for processing as neurons collecting get optic disc in middle of ganglion cells central vessels. Outgrowth to brain cerebrospinal fluid raised intercranial pressure get squeeze on optic nerve vascular congestion or squeeezing soon or cytoplasmic flow through axon lead to bulging of optic disk. caused by lesion of sympathetic trunk in neck resulting in: Pupillary constriction, resulting from paralysis of the dilator pupillae muscle; Ptosis (drooping of the superior eyelid), resulting from paralysis of the smooth (tarsal) muscle intermingled with striated muscle of the levator palpebrae superioris; Sinking in of the eyeball (enophthalmos), possibly caused by paralysis of smooth (orbitalis) muscle in the floor of the orbit; Vasodilation and absence of sweating on the face and neck (anhydrosis), caused by a lack of sympathetic (vaso- constrictive) nerve supply to the blood vessels and sweat glands; Flushed, warm dry skin: vasodilation of the subcutaneous arteries on the affected side caused by a lack of sympathetic vasoconstriction tone and sweat gland innervation.

Answer 426

One way to keep the visual fields straight is to remember that the retinas are looking through a lens (remember the microscope and the upside down and backwards e)? As such, the right sides of the retinas are in effect seeing the left sides of the world, and vice-versa. The retina is divided in "½" by the fovea, or central portion of the macula, generating a decussation (crossing over) of the medial fibers of the optic nerves. optic chiasm- here, the fibers from each nasal hemiretina cross and the fibers from the temporal hemiretina remain ipsilateral, e.g., the fibers of the L nasal hemiretina and R temporal hemiretina will form the R optic tract. The chiasm is located anterior to the pituitary and medial to the internal carotid arteries. optic tract: this will synapse in the lateral geniculate body (in the thalamus). optic (visual) radiations: to the occipital lobe, with parietal and temporal radiations that can lead to quadrantanopia if one or the other part of the radiation is affected. occipital lobe: of the cerebral cortex Visual pathway, right side of eyeball see left sides of world. Lower part of eyeballs see upper side of world. Optic chi ask see around pituitary gland. Ding at optic chasm and pituitary growth knock out crossing fibers causing bitemporal hemi-inopea/ with them crossing over wipe out two halves

Answer 427

Visual pathway have curved cornea to bend light going from air environment to aqueous diffraction for one medium to next from cornea and lenses onto retina where photoreceptors occur, end is crystalline protein setup fairly flexible focusing near and far. Presiopeano longer able to let it fatten Up and get close for lens

Answer 428

MR adducts, and if IR and SR are also tensed, they help to keep the eye in adduction. Then SO will start to pull the eye “down and out” (intorsion) and so will depress the eye when adducted. IO will start to pull the eye “up and out” (extorsion) and so will elevate the eye when adducted. In contrast, LR abducts, and if the obliques are allowed to contract fully (“down and out” and “up and out”), then SR can elevate the eye when abducted, and IR can depress the eye when abducted. For vertical of H, if we pull our eye in tenses superior and inferior rectus w/ inferior oblique pulling it up or superior pulling it down or. If one considers that it takes three muscles to hold the eye steady in adduction or abduction, one can then figure that in adduction: MR, SR, IR are holding the eye adducted. SO can subsequently depress as part of its initial movement and IO can elevate as part of its initial movement.In abduction, the IO is “up and out”, the SO is “down and out” and so they are holding the eye in abduction along with LR. This leaves SR to elevate and IR to depress the abducted eye.

Answer 429

The pharyngeal arches and their related structures contribute greatly to the overall formation of the head and neck. Arch: overall structure, Arch 1 (associated with CN V): two middle ear ossicles; maxilla, mandible (less directly); muscles of mastication. Arch 2 (associated with CN VII): stapes, part of hyoid, styloid process; facial expression muscles, stapedius and stylohyoid muscles, posterior belly of digastric muscle. Arch 3 (associated with CN IX): rest of hyoid bone. Arch 4 (associated with CN X): some of larynx; soft palate and pharynx muscles. Arch 6 (associated with CN X): rest of larynx; intrinsic laryngeal muscles. Notochord, pharyngeal arches (gills in fish), neural crest cells, … make up head and neck in individual. 6 pharyngeal arches one is cranial nerve 5 feels and chewed. Second arch cranial nerve 7 hyoid, arch innervated number 9 hypoglossal and blood vessel contribute to common carotid artery of external internal so glossopharyngeal crun csrotid body and sinus. 10 motor to pharynx and larynx blood vessels in 4&6 subclavian and aortic arch branch of vagus up trachea to laryngeal arteries to subclsvian or aortic arch Cartilage: support of the arch, Groove: external indentation (so from ectoderm) Pouch: internal indentation (so from endoderm. The different pharyngeal pouches contribute head and neck structures as well. Pouch 1: middle ear and eustachian tube. The pharyngeal groove will develop into the external auditory meatus. Pouch 2: palatine tonsil crypt Pouch 3: thymus, inferior parathyroids Pouch 4: superior parathyroids Pouch on inside groove on inside. Jaw first facial Eustachian tube. Pillars or fosses palatine pouches, parathyroid 3&4 w, thymus. Thyroid gland lowers from little pit st back of tongue parafollicular cells make calcitonin on back of thyroid lowering blood calcium levels opposite of parathyroid. Lung bud anteriorly off of gut pathway epiglottis comes from there as well.

Answer 430

As a reminder of the contributions of the external and middle ear to amplify sound via the stapes to the oval window of the cochleafor hearing, in contrast to the vestibular organs (saccule and utricle for linear detection, and semicircular canals for angular/rotational detection).

Answer 431

cochleae- hearing, vestibular- balance. Funneling of sound concentrating waves of sound into something generating action potential for inner earnossicles, stapes concentrated force from tympanic membrane onto beginning part of cochlea hearing process. Spiral of cochlea differential pitch discrimination, pitch discrimination based on internal structures. Issues wth sound to inner ear, within inner ear, #8 or processing. Saccule- pick up in linear acceleration, utricle- X, Y, &Z plane

Answer 432

the location of the olfactory apparatus indicates why we sniff odors, or why head trauma affecting the cribriform plate of the ethmoid bone could impact the sense of smell. Alcove to brain and projections through ethmoid cribiform plate vulnerable area for fracture CSF leakage, nasal cavity has turbinstes stirring up air instead of laminar allowing dust to settle

Answer 433

Cerebral cortex: main lobes: Frontal: motor (and prefrontal lobe with “behavior”) Temporal: hearing and memory Parietal: sensory Occipital: sight Thalamus: “way station” to/from cortex Brainstem:Midbrain: surrounds cerebral aqueduct; CN III, IV. Pons: helps to “smooth” respiration; CN V, VI, VII, (VIII). Medulla: cardiovascular and respiratory centers; CN (VIII), IX, X, XII

Answer 434

In conjugate gaze, typically the eyes work in tandem in looking at an object. This involves the nucleus of CN III (midbrain) and the nucleus of CN VI (pons) being connected by the medial longitudinal fasciculus (MLF). With damage to the MLF (e.g., multiple sclerosis and demyelination), the eyes can converge, but can not look to the other side past midline. The conjugate gaze is coordinated by the paramedian pontine reticular formation (PPRF). 6 in pons, 3 in midbrain have MLF (medial longitudinal fociculus) MS 6 & 3 don’t talk but do work together.

Answer 435

Not surprisingly, the MLF system ties into the inner ear, for vestibulo-ocular reflexes that allow visual tracking when the head is moving (CN VIII nuclei in the medulla oblongata). Nystagmus with fast and slow components, may be tested via calorics (COWS: cold opposite, warm same, referring to the fast component), as the water either stimulates (warm) or inhibits (cold) movement of the endolymphatic fluid in the horizontal semicircular duct, and whether there is: Cortical and brainstem activity (both slow and fast component appear) vs. brainstem activity (slow component only) vs. no activity (no movement), which can help to confirm brain death, suggesting lack of activity in the medulla (CN VIII), the pons (CN VI), and the midbrain (CN III) Nystagmus in inner ear- medulla cranial nerve 8 paramecium pontine. 8, 6, & 3 talk to each other vestibular part of inner ear talk to cell bodies of 6 & 3 to generate that pattern. Water in there warm water sped up semicircular canal, cold slowed it down. Brain stem cortex back on side. Coma or inner ear shut down midbrain pons medullary not see any response.

Back, Head, & Neck Flashcards

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