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Flashcards in Head and neck Deck (42):
1

Where does the internal jugular vein drain?

Subclavian vein

2

What are the main sites of access for central venous lines?

Internal jugular vein or subclavian vein

3

What are central venous lines used for?

Monitoring central venous pressure in right atrium
Administration of irritant drugs
Intravenous feeding

4

What are the complications of insertion of central venous lines?

Arterial puncture leading to haematoma and potential airway obstruction
Pneumothorax
Nerve damage
Air embolism
Thrombosis
Misplacement
Infection

5

What defines posterior triangle of neck?

Anterior margin of trapezius
Posterior margin of sternocleidomastoid
Middle third of clavicle

6

What traverses the posterior triangle of neck?

Accessory nerve (CN XI)

7

Where the accessory nerve exit the skull?

The jugular foramen

8

What does the accessory nerve do and how would you test its function?

It innervates the trapezius and sternocleidomastoid and you would test its function by asking patient to shrug shoulders or turn head against pressure

9

What does the condyle of the mandible do during opening and closing of the mouth?

It articulates with mandibular fossa of temporal bone in a hinge action

10

What does the condyle of the mandible do during protrusion and retraction of mandible?

Glides forward to articulate on articular tubercle. Protraction mainly due to action of lateral pterygoids while retraction achieved using posterior temporalis
You can palpate temporalis and masseter during these movements

11

Why is the masseter easier to palpate than temporalis?

Masseter is superficial and large whereas temporalis is fan-shaped, thin and covered by temporal fascia

12

In each quadrant of the teeth what is there?

Incisors 2
Canines 1
Premolars 2
Molars 3

13

What is the full number of teeth in a typical permanent set?

32

14

What is the number of teeth in a complete deciduous set?

20

15

When do the first deciduous teeth usually erupt?

6-8 months

16

When is the deciduous set usually complete?

20-24 months

17

What are the approximate starting and completion ages for permanent set?

6 years to early twenties

18

What can be examined in mouth by using a torch and tongue depressor?

Submandibular salivary ducts
Genioglossus muscle
Sublingual salivary glands
Papilla of parotid duct
Tongue -> Filiform papilla, line of button like circumvallate papillae

19

Which nerves supply general sensation and taste to the anterior and posterior parts of the tongue?

Anterior 2/3: Sensation- Mandibular Taste- Facial VII
Posterior 1/3: Sensation and taste- IX

20

Why are tonsils clinically important?

May become inflamed and need surgical removal

21

What is the great sensory nerve of the face?

Trigeminal- it supplies general sensation through three divisions:
Ophthalmic
Maxillary
Mandibular

22

What does the opthalmic division supply?

Skin from the top of the head to the upper eyelids and a strip down the median line of the nose. It supplies sensation to very sensitive conjunctiva covering the anterior surface of the eye and much of the nasal mucosa and frontal sinus

23

What does the maxillary division supply?

Skin of anterior temple and middle part of face as far down as corners of mouth. In addition it supplies the upper teeth, lip, gums and roof of mouth

24

What does the mandibular division supply?

Strip of skin running from middle part of the temple then anterior to the ear and down to the chin. In addition, it supplies the lower teeth, gums and lip, lining of cheeks, floor of the mouth and buccal part of the tongue

25

How do you test the three different sections of the trigeminal nerve individually?

Pin-prick test to determine sensation in three divisions and ask patient to clench teeth to test motor component

26

What does the facial nerve supply?

Motor fibres to facial muscles
Taste sensation to the anterior 2/3 of the tongue and parasympathetic (secretomotor) nerves to lacrimal and salivary glands

27

How would you test a patients facial nerve function?

Ask patient to look at ceiling, screw up eyes or show their teeth

28

How do you test for the facial nerve innervation to the lacrimal and salivary glands?

Loss of tear or saliva production

29

What does the glossopharyngeal nerve innervate?

It is the main sensory nerve of the posterior 1/3 of the tongue and oropharynx.

30

What does stimulation of glossopharyngeal nerve cause?

Reflex of expulsive effort called gagging

31

What is the simplest test of the glossopharyngeal nerve?

Eliciting a gag reflex

32

What is the only motor nerve of the tongue?

The hypoglossal nerve

33

How do you test the function of the hypoglossal nerve?

Ask the patient to stick out their tongue

34

What will happen if the hypoglossal nerve is injured on one side only?

Tongue will deviate towards side of lesion

35

What else might you observe in long standing injury to a hypoglossal nerve?

Atrophy of the tongue on side of lesion

36

What structures should you be able to identify in the neck?

Thyroid cartilage
Cricoid cartilage
Thyroid gland
Hyoid bone

37

What happens to structures in the neck during swallowing?

Larynx is elevated during swallowing and with retroflexion of epiglottis over laryngeal inlet this helps to stop any food getting into the airway

38

Where would you perform a cricothyroidotomy?

Via the circothyroid membrane, which lies in the space between the thyroid cartilage (laryngeal prominence adam's apple and the cricoid cartilage, on the anterior aspect of the neck

39

What is hypotropia?

When eye look down

40

What is hypertropia?

Eye looks up

41

What is exotropia?

Eye turns out

42

What is esotropia?

Eye turns in