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Head, Neck and Nervous System Block > HNNS Practicals > Flashcards

HNNS Practicals Flashcards

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1
Q

[Dissection]
Which muscle forms the inferior boundary of the mandibular triangle?

A

Digastric muscle

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2
Q

[Dissection]
Hypoglossal nerve gives motor innervation to most of the muscles of the tongue EXCEPT for one. Which muscle of the tongue is NOT supplied by hypoglossal nerve?
A. Genioglossus
B. Hyoglossus
C. Intrinsic tongue muscles
D. Palatoglossus
E. Styloglossus

A

D

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3
Q

[Dissection]
Which nerve innervates mylohyoid muscle?
A. Ansa cervicalis
B. C1 spinal nerve
C. Mandibular branch of facial nerve (CN VII)
D. Mandibular nerve (CN V3)

A

D

Ansa cervicalis
- superior root (C1) + inferior root (C2-3)
- innervate omohyoid, sternohyoid & sternothyroid muscles

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4
Q

[Dissection]
Which nerve accompanies with the superior laryngeal artery?
A. External branch of superior laryngeal nerve
B. Internal branch of superior laryngeal nerve
C. Recurrent laryngeal nerve

A

B

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5
Q

[Dissection]
A patient complains of numbness in the anterior cervical triangle after trauma. Which nerve is most likely damaged?
A. Greater auricular nerve
B. Lesser occipital nerve
C. Supraclavicular nerve
D. Transverse cervical nerve

A

D

Greater auricular n.: skin behind auricle and on parotid gland

Lesser occipital n.: scalp behind auricle

Supraclavicular n.: skin over clavicle and the shoulder

Transverse cervical n.: turn around posterior border of SCM => skin of anterior cervical triangle

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6
Q

[Dissection]
A patient presents to a clinic with a swelling on the neck. Upon evaluation, the patient is diagnosed with an infection within the carotid sheath due to an untreated throat infection. Which of the following structures are most likely damaged?
A. Internal carotid artery and recurrent laryngeal nerve
B. Internal jugular vein and vagus nerve
C. External carotid artery and ansa cervicalis
D. Sympathetic trunk and common carotid artery
E. Vagus nerve and middle cervical ganglion

A

B

Carotid sheath: IJV, vagus nerve, CCA, ICA

Recurrent laryngeal n.: tracheoesophageal groove

Sympathetic trunk (with superior & middle cervical ganglia): posterior to carotid sheath

Ansa cervicalis: superficial to / in carotid sheath

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7
Q

[Dissection]
A patient with thyroid cancer undergoes a total thyroidectomy. Postoperatively, the patient presents with hoarseness and dysphonia. Which nerve is most likely damaged during the surgery?
A. Glossopharyngeal nerve
B. Hypoglossal nerve
C. Recurrent laryngeal nerve
D. Superior laryngeal nerve

A

C

Recurrent laryngeal nerve:
- posterior to thyroid gland
- damage causes ipsilateral paralysis of all muscles of larynx (except cricothyroid muscle innervated by superior laryngeal nerve)

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8
Q

[Dissection]
Which structure passes through mandibular foramen?

A

Inferior alveolar nerve, artery & vein

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9
Q

[Dissection]
Which structure lies on the surface of sublingual fossa?

A

Sublingual gland

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10
Q

[Dissection]
Which structure attaches to mylohyoid line?

A

Mylohyoid
Part of superior constrictor muscle of pharynx

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11
Q

[Neuroanatomy Practical]
Structures above the fornix are … while those below are …

A

Telencephalic
Diencephalic

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12
Q

[Neuroanatomy]
After a stroke, patients usually suffer dysfunctions from generating language.
What is the name of the area responsible for language production?

A

Broca’s area

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13
Q

[Neuroanatomy practical]
After a stroke, patients usually suffer dysfunctions from generating language.
Discuss which anatomical gyrus forms the affected language area.

A

Inferior frontal gyrus, usually left hemisphere

Brodmann 44, 45

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14
Q

[Neuroanatomy practical]
Which type of information is processed in transverse temporal gyri?

A

Auditory information

Primary auditory cortex (area 41, 42, 22)

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15
Q

[Neuroanatomy practical]
Which anatomical gyrus forms primary somatosensory cortex?

A

Postcentral gyrus of parietal lobe

Brodmann areas 3, 1, 2
Process tactile information

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16
Q

[Neuroanatomy practical]
Which anatomical gyrus forms primary motor cortex?

A

Precentral gyrus of frontal lobe

Brodmann area 4
Voluntary movements

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17
Q

[Neuroanatomy practical]
Which lobe of cerebrum forms primary visual cortex?

A

Occipital lobe

Brodmann area 17
Visual information

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18
Q

[Neuroanatomy practical]
What is the function of Brodmann area 6?

A

Premotor cortex - plan movements

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19
Q

[Neuroanatomy practical]
Name 3 association areas and their functions.

A
  1. Prefrontal cortex
    - complex behaviour, decision-making, personality
  2. Parietal association cortex
    - integrate sensory information to form a single perception
  3. Temporal association cortex
    - recognition of objects and faces, memory
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20
Q

[Neuroanatomy practical]
The spinal cord is a cylindrical structure, greyish-white in colour.
Name the anatomical space in which the spinal cord travels.

A

Vertebral canal

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21
Q

[Neuroanatomy practical]
Name three membranes which protect the spinal cord.

A
  1. Dura mater
  2. Arachnoid mater
  3. Pia mater
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22
Q

[Neuroanatomy practical]
In which meningeal space is the cerebrospinal fluid found?

A

Subarachnoid space

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23
Q

[Neuroanatomy practical]
The spinal cord is segmental. How many segments form the spinal cord?

A

31 segments

Cervical: C1-C8
Thoracic: T1-T12
Lumbar: L1-L5
Sacral: S1-S5
Coccygeal: Co1

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24
Q

[Neuroanatomy practical]
What is the name of the last part of the spinal cord?

A

Conus medullaris

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25
[Neuroanatomy practical] Observe the posterior median sulcus. What is the name of its counterpart on the front?
Anterior median fissure
26
[Neuroanatomy practical] How is the filum terminale formed?
Continuation of pia mater From tip of conus medullaris to coccyx * Meningeal layer of dura and subarachnoid space ends at S2
27
[Neuroanatomy practical] What is the common name for a bundle of spinal nerve rootlets that arise from conus medullaris?
Cauda equina
28
[Neuroanatomy practical] What is held inside central canal?
Cerebrospinal fluid
29
[Neuroanatomy practical] How many branches does a typical spinal nerve have?
4 1. Ventral ramus 2. Dorsal ramus 3. Meningeal branch 4. Communicating rami (to sympathetic trunk)
30
[Neuroanatomy practical] Why can we observe a widened area at C4-T1 level of spinal cord?
Cervical enlargement Increased volume of motor neurons in ventral horn Anterior rami of spinal nerves -> brachial plexus -> upper limbs
31
[Neuroanatomy practical] Why can we observe a widened area at T11-L1 level of spinal cord?
Lumbar enlargement Anterior rami of spinal nerves -> lumbosacral plexus -> lower limbs
32
[Neuroanatomy practical] Compare the sizes of anterior, posterior and lateral horns of spinal cord. Explain the difference in size
Anterior > posterior > lateral Anterior horn: - motor neurons - enlarged in cervical and lumbar regions Posterior horn: - sensory neurons - relatively constant size Lateral horn: - ANS neurons - Only found in T1-L2 (sympathetic) & S2-S4 (parasympathetic)
33
[Neuroanatomy practical] What is the approximate circulating volume of CSF?
150 mL
34
[Neuroanatomy practical] What is the approximate daily production volume of CSF?
500 mL
35
[Neuroanatomy practical] What produces CSF?
Ependymal cells in choroid plexus in ventricles
36
[Neuroanatomy practical] Describe the functions of CSF.
1. Buoyancy 2. Protection: shock absorber 3. Regulation of intracranial pressure by altering CSF volume 4. Homeostasis (pH, electrolyte, temperature) 5. Clearance of metabolic waste: glymphatic system (glia + lymph) -> CSF -> blood Brain Protection Relies Heavily on CSF
37
[Neuroanatomy practical] What is the clinical importance of CSF analysis?
1. Appearance - turbid: infection - blood-stained: subarachnoid haemorrhage - xanthochromic (clear yellow): breakdown products of blood (e.g. after subarachnoid haemorrhage) 2. Glucose - Normal: 2/3 of blood - Often lowered in infections 3. Protein - Minimal normally - Often elevated in infections, inflammation and demyelinating diseases 4. Cell counts - Normal: no RBC, WBC <5/mm^3 5. Electrolytes - Normal: less Ca2+ and K+, more Cl-
38
[Neuroanatomy anatomy] Where can you perform lumbar puncture?
Subarachnoid space at L3-L5 For diagnosis / regional anesthesia L4: iliac crest
39
[Neuroanatomy practical] Which anatomical structures form the walls of lateral ventricle?
1. Anterior wall - Superior: foramen of Monro - Inferior: optic chiasm 2. Posterior wall - Superior: Suprapineal recess - Inferior: cerebral aqueduct 3. 2X Lateral walls - Medial aspects of thalamus and hypothalamus
40
[Neuroanatomy practical] Which structure continues the fourth ventricle in spinal cord?
Central canal
41
[Neuroanatomy practical] Follow the blood flow from internal jugular vein to the heart.
Internal jugular vein -> join subclavian vein to form brachiocephalic vein L & R brachiocephalic veins join to form superior vena cava -> right atrium
42
[Neuroanatomy practical] Cavernous sinus drains into internal jugular vein via …
Inferior petrosal sinus
43
[Neuroanatomy practical] What tissue lines the lumen of the dural venous sinuses?
Endothelium The lumen is the space between periosteal and meningeal layers of dura mater
44
[Neuroanatomy practical] What is the main function of arachnoid villi (granulations)?
CSF reabsorption into blood
45
[Neuroanatomy practical] What are emissary veins?
Valveless veins that connect extracranial with intracranial veins
46
[Neuroanatomy practical] In which space are cerebral veins found?
Subarachnoid space
47
[Neuroanatomy practical] What are the tributaries of great cerebral vein (of Galen)?
Paired internal cerebral veins Paired basal cerebral veins (of Rosenthal)
48
[Neuroanatomy practical] Into which sinus does great cerebral vein drain into?
Straight sinus (with inferior sagittal sinus)
49
[Neuroanatomy practical] Venous drainage ensures that blood volume in the brain is not excessive since sinuses are housed in non-expandable bony structures and will not place the brain under pressure. A blood clot in the cavernous sinus (cavernous sinus thrombosis) can place pressure on the cranial nerves. Which cranial nerves may be affected?
CN III -> ptosis CN IV -> vertical diplopia CN VI (most common) -> horizontal diplopia CN V1 CN V2 -> loss of sensation in forehead and cheeks
50
[Neuroanatomy practical] Describe the position of caudate nucleus in relation to lateral ventricle.
Caudate nucleus is lateral to lateral ventricle
51
[Neuroanatomy practical] Name 3 major areas of white matter in the brain.
1. Internal capsule 2. External capsule (separates claustrum from putamen) 3. Anterior commissure (connects 2 cerebral hemispheres)
52
[Neuroanatomy] Name 5 major basal ganglia structures.
1. Caudate nucleus 2. Putamen 3. Globus pallidus 4. Subthalamic nuclei 5. Substantia nigra
53
[AR/VR] What are the structures that pass through the substance of the parotid gland?
From deep to superficial (AVN) 1. External carotid artery 2. Retromandibular vein 3. Facial nerve (divides superficial & deep lobes)
54
[AR/VR] What are the 4 muscles of mastication and their actions on the mandible?
1. Medial pterygoid: elevation, protrusion 2. Lateral pterygoid: depression, protrusion 3. Temporalis: elevation, retraction 4. Masseter: elevation, retraction
55
[AR/VR] The sphenopalatine foramen gives passage to …
Sphenopalatine artery (terminal branch of maxillary artery) Nasopalatine nerve (which goes down and passes through incisive foramen) Nasal branches of PPG
56
[AR/VR] How to locate sphenopalatine foramen in nasal cavity?
Posterior to superior meatus on lateral wall
57
[AR/VR] What structures form the nasal septum?
Septal cartilage Perpendicular plate of ethmoid bone Vomer
58
[AR/VR] Name the 4 contributors to the Kiesselbach’s area.
1. Sphenopalatine artery 2. Greater palatine artery (terminal branch of maxillary artery): goes down via greater palatine foramen, along hard palate, then up via incisive foramen 3. Septal branches of anterior & posterior ethmoidal arteries (from ophthalmic artery) 4. Septal branch of superior labial artery (from facial artery)
59
[AR/VR] Pituitary gland is located in …, a part of … bone.
Sella turcica Sphenoid
60
[AR/VR] What are three passages into the orbit closely related to sphenoid bone?
Superior orbital fissure Inferior orbital fissure Optic canal
61
[AR/VR] Which surface(s) of sphenoid bone help to form temporal fossa?
Greater wing
62
[AR/VR] Which surface(s) of sphenoid bone help to form infratemporal fossa?
Infratemporal surface of greater wing Lateral pterygoid plate
63
[AR/VR] Which surface(s) of sphenoid bone help to form middle cranial fossa?
Greater wing Anterior clinoid process Sella turcica
64
[AR/VR] Which surface(s) of sphenoid bone help to form anterior cranial fossa?
Lesser wing
65
[AR/VR] Which surface(s) of sphenoid bone help to form nasal cavity?
Body Sphenoidal sinus Medial pterygoid plate
66
[AR/VR] Name the contents of pterygopalatine fossa.
1. Maxillary nerve (branches: zygomatic, ganglionic, alveolar, meningeal) 2. PPG 3. 3rd part of maxillary artery and accompanying veins
67
[AR/VR] Which nerve passes through foramen rotundum?
CN V2
68
[AR/VR] Transphenoidal surgery is used to remove tumours of pituitary gland. Describe the path of endoscope and/or surgical instruments after insertion into nasal cavity.
Nasal cavity -> along nasal septum -> sphenoid sinus inside body of sphenoid bone -> sella turcica -> pituitary gland
69
[AR/VR] What are the four parasympathetic ganglia in head?
CN III -> ciliary ganglion CN VII -> pterygopalatine ganglion, submandibular ganglion CN IX -> otic ganglion
70
[AR/VR] How is lobotomy performed?
Insert needle transorbitally -> sever the connections between prefrontal cortex and thalamus
71
[AR/VR] Describe the contents of the greater palatine canal.
Greater & lesser palatine nerves & arteries
72
[AR/VR] Name the boundaries of the pterygopalatine fossa.
1. Anterior: maxilla 2. Posterior: pterygoid plate of sphenoid bone 3. Medial: perpendicular plate of palatine bone 4. Roof: infratemporal surface of greater wing of sphenoid bone 5. Floor: pyramidal process of palatine bone
73
[Surgical cadaveric dissection] In thyroidectomy, the posterior part of each lobe is usually preserved to protect …
Recurrent laryngeal nerve Superior laryngeal nerve Parathyroid gland
74
[Surgical cadaveric dissection] Name the layers cut through during parotidectomy.
Skin -> subcutaneous fascia -> (platysma) -> parotid fascia (investing layer of deep cervical fascia) -> superficial lobe
75
[Dissection] Which nerve gives motor innervation to the buccinator muscle? A. Facial nerve (CNVII) B. Ophthalmic branch of mandibular nerve (CN V1) C. Maxillary branch of mandibular nerve (CN V2) D. Mandibular branch of mandibular nerve (CN V3)
A Buccal branch of CN VII
76
[Dissection] Which nerves transmit the nerve fibers that innervates the parotid gland?
Parasympathetic: lesser petrosal nerve Inferior salivatory nucleus -> Tympanic branch of glossopharyngeal nerve (CN IX) -> Lesser petrosal nerve -> Otic ganglion Sensory: auriculotemporal nerve (CN V3: mandibular) Sympathetic: internal carotid plexus (from superior cervical ganglion) X facial nerve IT has Lesser Options Anywhere
77
[Dissection] In the event of facial artery bleeding, where should direct pressure be applied to achieve hemostasis? A. On the frontal bone B. On the inferior margin of the body of the mandible C. On the nasal bone D. On the ramus of mandible
B Facial artery - ascend deep to post. belly of digastric & stylohyoid in neck - cross body of mandible anterior to masseter - palpation: inferior margin of body of mandible, anterior border of masseter
78
[Dissection] A patient accidentally cut the scalp when shaving the head. The scalp wound appears modest but bleeds profusely. In what layer of the scalp do the severed vessels reside? A. Skin B. Dense subcutaneous connective tissue C. Occipitofrontalis and aponeurosis D. Loose connective tissue E. Periosteum of the skull
B Contains nerves and vessels
79
[Dissection] Which layer of the scalp does traumatic scalping occur? A. Skin B. Dense subcutaneous connective tissue C. Occipitofrontalis and aponeurosis D. Loose connective tissue E. Periosteum of the skull
D Allow upper 3 layers to move freely as a unit Spread of infections via emissary (epiploic) veins to intracranial venous sinuses
80
[Dissection] When does the anterior and posterior fontanelle close?
Anterior fontanelle (larger): usually by 12-18 months of age Posterior fontanelle: usually by 2-3 months of age
81
[Dissection] Observe the two types of movements that occur at the temporomandibular joint. Match the synovial cavity with correct movement of mandible. A. Inferior synovial cavity - depression and elevation of mandible B. Inferior synovial cavity - protrusion and retraction of head of mandible C. Superior synovial cavity - depression and elevation of mandible D. Superior synovial cavity - depression and elevation of mandible
A Separated by fibrous articular disc Superior synovial cavity: protrusion (to articular tubercle) and retraction (into mandibular fossa) of mandibular head Inferior synovial cavity: hinge-like depression and elevation of mandible
82
[Dissection] Which artery and nerve can be exposed after removing temporalis?
Deep temporal nerve (CN V3) Deep temporal artery (2nd part of maxillary artery)
83
[Old PP] Actions of lateral pterygoid
Depress and protrude the mandible
84
[Dissection] Describe the location of the second part of maxillary artery. Name three branches.
Superficial / deep to lateral pterygoid Deep temporal artery Pterygoid artery Buccal artery
85
[Dissection] Describe the location of the first part of maxillary artery. Name two branches.
Posterior to neck of mandible. 1. Middle meningeal artery 2. Inferior alveolar artery
86
[Dissection] Location and 3 branches of 3rd part of maxillary artery
Entering pterygomaxillary fissure & pterygopalatine fossa 1. Infraorbital artery (entering inferior orbital fissure) 2. Posterior superior alveolar artery (entering pterygomaxillary fissure) 3. Terminal branches: Sphenopalatine artery, Descending palatine artery (entering pterygopalatine fossa)
87
[Neuroanatomy practical] List 5 cortical areas in Limbic system.
Cingulate gyrus Parahippocampal gyrus Hippocampal formation = hippocampus + dentate gyrus + subiculum Subcallosal area Paraterminal gyrus
88
[Neuroanatomy practical] List 3 subcortical nuclei in Limbic system.
Mamillary body Anterior nucleus of thalamus Amygdala Septal nuclei
89
[Neuroanatomy practical] List 5 connections in Limbic system.
Fornix Fimbria Mammillothalamic tract Stria terminalis (efferent pathway from amygdala) Indusium griseum
90
[Neuroanatomy practical] Describe the pathway of the Papez circuit.
Hippocampus -> fimbria (of hippocampus) -> fornix -> mammillary body -> mammillothalamic tract -> anterior nucleus of thalamus -> posterior cingulate gyrus (cingulum) -> parahippocampal gyrus -> entorhinal cortex -> hippocampus (repeat)
91
[Neuroanatomy practical] State a consequence of fornix lesion.
Anterograde amnesia

Head, Neck and Nervous System Block (4 decks)

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