Head, neck and spine Flashcards
(32 cards)
What are the contents of the following foramen: • Cribriform plate • Optic canal • Superior orbital fissure • Foramen rotundum • Foramen ovale • Foramen spinosum • Carotid canal • Internal acoustic meatus • Jugular foramen • Hypoglossal canal • Foramen magnum • Stylomastoid foramen
- Cribriform plate - Olfactory nerve (I)
- Optic canal - Optic nerve (II), opthalmic artery
- Superior orbital fissure - Oculomotor nerve (III), Trochlear nerve (IV), Trigeminal nerve (opthalmic branch V1), Abducens nerve (VI)
- Foramen rotundum - Trigeminal nerve (maxillary branch V2)
- Foramen ovale - Trigeminal nerve (mandibular branch V3)
- Foramen spinosum - Middle meningeal artery
- Carotid canal - Internal carotid artery
- Internal acoustic meatus - Facial nerve (VII) [entry], Vestibulocochlear nerve (VIII), labyrinthine artery
- Jugular foramen - Glossopharyngeal nerve (IX), Vagus nerve (X), Accessory nerve (XI), sigmoid sinus (become internal jugular vein)
- Hypoglossal canal - Hypoglossal nerve (XII)
- Foramen magnum - spinal fibres of accessory nerve (XI), medulla, vertebral arteries, anterior + posterior spinal arteries
- Stylomastoid foramen - Facial nerve (VII) [exit]
Demonstrate the surface landmarks of C7, T3, T7, L2 and L4 vertebrae
- C7 - vertebra prominens
- T3 - medial part of scapula spine
- T7 - inferior angle of the scapula
- L2 - subcostal plane
- L4 - top of iliac crest
Describe the range of motion of the different regions of the vertebral column
Flexion/extension (forwards/backward) • Cervix - large range • Upper thorax - no range • Lower thorax - very limited range • Lumbo-sacrum - large range
Lateral flexion • Cervix - large range • Upper thorax - limited range • Lower thorax - large range • Lumbo-sacrum - limited range
Rotation • Cervix - large range • Upper thorax - very limited range • Lower thorax - large range • Lumbo-sacrum - no range
Describe the anatomical basis for the range of motion of the different regions of the vertebral column
Cervix (C1-7)
• Atlanto-occipital joint and atlanto-axial joint allow full range of motion
Upper thorax (T1-7) • Movement restricted by ribs • Flexion/extension prevented due to long articular processes
Lower thorax (T7-12) • Ribs are floating • Movement less restricted
Lumbo-sacrum (L1-S4)
• Vertebral processes are optimised for flexion/extension
• Articulations with each vertebra prevent rotation since they’re vertical
Demonstrate the technique for palpation of the cervical lymph nodes
- Tell patient you will check for any lumps in the neck
- Ask if they feel pain or discomfort
- Palpate from behind patient
- Move fingers along in circular motions and don’t lift off
1) Submental
2) Submandibular
3) Anterior cervical
4) Supraclavicular
5) Posterior cervical
6) Pre-auricular
7) Post-auricular
8) Occipital
Locate the hyoid bone, thyroid and cricoid cartilages, lateral mass of the atlas and
spinous process of C7
- Laryngeal prominence is part of the thyroid cartilage
- Hyoid bone is above the thyroid cartilage
- Cricoid cartilage is below the thyroid cartilage
- Lateral mass of atlas (C1) palpated in space below the ear, behind mandible
- C7 - vertebra prominens
Demonstrate the boundaries of the anterior triangle of the neck and
recall its contents
Boundaries
• midline of neck
• mandible (inferior border)
• SCM (anterior border)
Contents
• hyoid bone
• common carotid artery
• internal jugular vein
• supra-hyoid muscles (stylohyoid, digastric, mylohyoid, geniohyoid)
• infrahyoid muscles (omohyoid, sternohyoid, thyrohyoid, sternothyroid)
Demonstrate the boundaries of the posterior triangle of the neck and
recall its contents
Boundaries
• trapezius (anterior border)
• middle 1/3 of clavicle
• SCM (posterior border)
Contents • external jugular vein • subclavian vein • subclavian artery • brachial plexus trunks • phrenic nerve • vagus nerve • spinal accessory nerve
Demonstrate the surface landmarks for insertion of a central line into the internal jugular vein
• Triangle used • Borders: - clavicular head of SCM - medial, sternal head of SCM - medial 1/3 of clavicle • Superior apex of triangle used as insertion point • Inserted at 30° angle • Directed towards ipsilateral nipple • Right sided access preferred as the right internal jugular is wider and often more superficial
Demonstrate the positions of the external and internal jugular veins and their surface landmarks
- Internal jugular vein runs parallel and lateral to the common carotid artery
- External jugular vein runs from the angle of the mandible to the middle of the clavicle
Where can the carotid pulse be found?
- Anterior border of SCM
* Level of superior border of laryngeal prominence
Test the motor function of the accessory nerve
- SCM contraction - ask patient to look over opposite shoulder, and resist turning with your hand
- Upper fibres of trapezius - shrug shoulders
Test the sensory function of the 3 divisions of the trigeminal nerve (V)
• Ask patient to close their eyes
• Stimulate 3 areas with a blunt pin and ask patient to say “yes” each time they feel it
- V1 = opthalmic
- V2 = maxillary
- V3 = mandibular
• Touch right and left of each area before moving onto the next area
• Ask whether it felt the same on both sides
Test the motor function of the (mandibular division of the) trigeminal nerve (V)
- Tell the patient you will feel their muscle of chewing
* Palpate the masseter and temporalis and ask to clench jaw
Test the motor function of the facial nerve
Ask patient to pull various facial expressions and resist them • Temporal - raise eyebrows • Zygomatic - squeeze eyes shut • Buccal - smile • Mandibular - puff out cheeks • Cervical - grimace
(check for asymmetry on both sides)
Recall testing the glossopharyngeal nerve (IX)
- Ask patient to open their mouth
- Say it will be uncomfortable
- Use a tongue depressor to touch the back of the throat and evoke a gag reflex
What mediates the sensory and motor limb of the gag reflex?
- Sensory - glossopharyngeal (IX) nerve providing sensation to the oropharynx and posterior 1/3 of the tongue
- Motor - vagus (X)
Test the motor function of the vagus nerve
- Ask patient to open their mouth and say “ahh”
- Observe elevation of the uvula and see if there is any deviation from the midline
- Deviation would be away from lesioned side
Test the motor function of the hypoglossal nerve
- Ask patient to stick their tongue out
- Look for deviation from the midline
- Deviation would be towards lesioned side
How many teeth are there in a full set in an adult?
32 (28 without wisdom teeth)
What are the different teeth in one quadrant of an adult?
- 2 incisors
- 1 canine
- 2 premolars
- 3 molars
How many teeth do children have?
20
Locate the cervical part of the trachea, and the thyroid isthmus
Cervical part of trachea
• Begins at lower end of larynx
• C6 to C7
Thyroid isthmus
• Connects 2 lobes of the thyroid
• Below cricoid cartilage
What are the 4 paranasal air sinuses?
- Frontal
- Ethmoid
- Sphenoid
- Maxillary
