Flashcards in Neuro 1 Deck (157):
What are the contents of the superifical posterior triangle
Deep posterior triangle?
Traps and SCM
External jugular vein
Spinal nerves: Accessory, dorsal scapular, nerve to levator scapularis
What is in Zone 1?
cupola of lung
carotid, vertebral and subclavian
viscera (larynx, pharynx, )
recurrent laryngeal n
What is the division between nasopharynx and oropharynx/
Oral cavity and oropharynx?
What tonsils are in the nasopharynx?
What are teh lateral boundaries of the oropharynx?
What tonsils are here?
Palatoglossal and palatopharyngeal arches
What are the 3 elevator muscles of the pharynx?
What are innervations?
Palato/Salpingo --> Vagus
Stylopharyngeus --> glossopharyngeal n.
What cranial nerves are afffected by dysarthria
XII & IX
Pt presents with syncope, double vision, numbness/weakness in handsfeet, slurred speech and N/V. You have the nurse check the BP in both arms. why?
Trying to distinguish from
Posterior brain claudication due to vertebral artery occulsion
and subclavian steal syndrome.
SS has different BPs
What does the parotid duct run with?
Buccal nerve (of sensory branch of V3) and the transverse facial artery from the superficial temporal artery
What is the danger area of scalp? Why?
4th layer of scalp.
Pus spreads to emissary veins into intracranial sinuses
What level does the vertebral artery and cricoid cartliage enter transverse foramen?
What are Erb's point nerves?
Lesser occipital, greater auricular, transverse cervical, supraclaviculars.
Also brachial plexus C5-C6 = waiters tip hand
What is the relationship of the facial artery and vein to the submandibular gland?
Facial a/v go around it.
What is the inferio border of the root of neck? what does it contain?
Cupola of lung, thoracic duct, eso, trachea
What happens if you have a lesion of
IX = loss of gag, loss of posterior 1/3 tongue, pharynx sensation
X = dysphagia, dysphonia, dyspnea, loss of gag/cough reflex
XI = can't shrug or rotate head
XII = tongue deviates toward affected side
Gag: IX to X
Cough: superior laryngeal nerve to inferior laryngeal nerve
What can cause Vernet's syndrome?
Basilar skull fracture, base of skull fracture, battles sign, CN IX, X, XI
What can cause Collet Sicard syndrome?
Retroparotid space penetrating injury
IX X XI XII
A pt presents with ptosis (anisocria), pupillary constriction, anhidrosis. He has a PMH of strokes, and a tumor in his upper right lung. He complains of migraines and cluster headache.
loss of sympathetic innervation due to partial or complete transection of spinal cord
Which carotid is more prone to aneurysm
internal because higher pressure.
Hypoperufsion: blood shunted from anterior to posterior
What is Central cord syndrome?
Necorsis of central spinal cord due to anterior spinal arery sucking. branches off vertebral artery
How do plastic surgeons do face lifts?
They lift the SMAS - subqutaneous muscluoaponeurotic system, to put the lift in it
What is the fxn and innervation of
anterior belly of digastric
Posterior belly of digastric?
Mylohyoid: Depress mandible,
N. to mylohyoid from V3
Geniohyoid: C1 via hypogossal nerve
Nerve to mylohyoid from V3
P. Digastric: Facial nerve
Stylohyoid - facial VII
Facial nerve functions and nuclei?
Glossopharyngeal fxns and nuclei?
Facial expression, eye lid closing - motor nucleus
Stapes - Pontine Principal Sensory Nucleus
Salivation/Lacrimation - Superior salivatory nucleus
Anterior 2/3 tongue - Nucleus solitarius
- Carotid: tractus solitarius middle
- P 1/3 tongue sensation: spinal trigem
- P 1/3 tongue taste: Tractus solitarius rostral
- Stylopharyngeus: Nucleus ambiguus
- Parotid gland: inferior salivatory nucleus
- aortic arch: Tractus solitarius
- Meninges senesation: Trigeminal spinal
- Larynx: Nucleus ambiguus
- Gi: dorsal vagal motor
Name the foramina of the nerves
Cribiform plate: I
Optic canal: II
Superior Orbital fissure: III, IV, V1, VI
Foramen Rotundum: V2
Foramen Ovale: V3
Foramen spinosum: MMA
Internal Auditory Meatus: VII, VIII
Jugular Foramen: IX X XI, jugular
Problems with Vagus
Porblems with facial
Uvula deviates away,
Loss of gag
Loss of voice
What are the arches that bind the oropharynx?
glossopharyngeal and palatopharyngeal
In what stage do pharyngeal Constrictors contract?
When does the vagus stimulate the levator veli palatini?
If you want to numb the internal laryngeal n, where do you stick needle?
Posterior recess of pharynx
Position of larynx in neonate?
What is inferior to vocal folds?
A. Laryngeal vestibule
B. Infraglottic cavity
C. Laryngal ventricle
Laryngeal Vestibule: Between laryngeal inlet and vestibular folds,
Laryngeal vntricle: recess from middle part of laryngeal cavity between vestibular folds and vocal folds
What is the largyngeal aditus?
Opening from pharynx to larynx
What are the importnat branches of V3?
Nerve to myelohyoid
What innervates teh cricothyroid muscle?
extnerla branch of superior laryngeal
A pt presents with dysarthria. What nerves?
XII & IX, X
Facial and glossopharyngeal, vagus
What is the consequence s of inferior laryngeal nerve injury?
Superior laryngeal nerve?
Stuck closed, vocal fold cannot adduct to form voice
What drains into the IJV?
Superior ophthalmic and sphenoparietal sinus-->
Cavernous sinuses --> Superior and inferior petrosal sinuses.
Inferior petrosal --> IJV;
Superior petrosal --> Sigmoid sinuses
COnfluence --> Transverse sinus --> Sigmoid sinus
Through what structure does CSF drain?
What is the importance of pterygoid plexus?
Can drain maxillary v or facial.
Pumps venous blood when you move your mouth or yawn
What are the 4 branches of the superficial temporal artery?
Name the lymph of the face and scalp?
Pt presents with syncope and double vision, numbness/weaknesses in hands feet, slurred speech, N/V
Vertebral basilar insufficiency
due to vetebral artery occlusion
What is the innervation of the parotid gland?
Greater auricular nerve from C2-C3
Parasympathetic from otic ganglion, tympanic n, lesser petrosal nerve, auriculotemporal V3 nerve, and external carotid sympathetic.
Danger area of scalp?
4th - loose areolar scalp;
infection in subaponeurotic space spreads to emissary veins and collects pus
How to check for Bell's?
Smile, raise eyebrows, squeez eyes shut, open mouth, puff out cheeks
What happens in an UMN injury?
Stroke, contralateral lower half of faces loses innervation
LMN: Bell's palsy, full half face.
A pt presents with excruiciating attacks of pain on their face. Dx?
What are the steps in nostril syntehsis?
Frontonasal prominence --> nasal placodes --> Nasal pits --> Nostrils and cavities
How does the nasal septum form?
Septum: medial nasal prominence fuse with palatine prominence
Philtrum: maxillary prominences grow over the frontonasal prominence.
How does the primary palate form?
- Fusion of medial nasal prominences
- Premaxillary part of maxilla that contains incisors.
- palatine shelves grow out, lateral to tongue. Tongue drops = together now.
- Bone extends from maxilla & palatine
How do you get cleft palate?
Failure of palatine shelves to fuse
- failure of maxillary and medial nasal procesess to fuse
The sphenoid bone is described as what type of cranium?
Sphenoid: cartilaginous neurocranium
What develops via endochondral ossification?
Endochondral = cartilagionous
Intramembranous = membranous
A pt is born with orbital and frontal bones misaligned. Dx and mx?
frontal suture (Metopic), closed too soon.
A pt is born with a very tall head. Dx?
Coronal suture messed up
30% of cases
A pt is born with asymmetrical forehead
Sagittal suture'50% of cases
What is the boundary between ectoderm and endderm in teh palate?
Ectodermal derviatives of face?
Endodermal derivatives of face?
Ectoderm: epithelium of lips, gums, enamel, oral portion of tongue
Epithelium of pharyngeal portion of tonuge, palatine fossa and below.
Describe tongue development?
1st PA --> Median lingual swlling --> anterior 2/3 tongue
3rd PA --> overgrow 2nd arch ---> posterior 1/3 tongue.
4th PA --> Epiglottis and stuff.
What are the muscles of the tongue derviced from?
What are the muscles of the tongue?
Occipital myoblasts from paraxial mesoderm
hyoglossus, genioglossus, styloglossus
Innervation of tongue?
Anterior 2/3 tongue
Sensation = Trigeminal V3, lingual branch
Motor= XII, hypoglossus
Taste = VII, facial
Sensation and Taste:
sensation = vagus
A patient presents with her child. They are having difficulties breast feeding. the tongue looks normal, but tied..
What if it was bifid?
Wha tis the germ layer for dental sac and what does it do?
Mesenchyme --> PDL, cementum
If the chorda tympani was lesioned, what would be affected?
Where doe the chorda tympani join the lingual nerve?
What happens if only the lingual nerve is lesioned?
loss of taste from anterior 2/3s tongue and decrease in saliva production bc asubmandibular and sublingual glands would not be innervated.
In the infratemporal fossa
Loss of senseation from A2/3 tongue
Tumor in jugular foramen, what nerves are located here? What sx would be present?
IX, X, XI = losso f gag reflex
A uvula deviates to the right, what nerve is affected? Why does this happen?
Levator veli palatini pulls it to the other side.
You test to see if a pt is brain dead by cotton swabbing their eye ball. The eyelid twitches. (Blink Reflex) What nerves are being tested?
Then you shine light in their eye, causing a corneal reflex. What nerve?
Afferent: V1 Nasociliary
Efferent VII: Zygomatic
Motor: Oculomotor does constriction
BILATERAL BC of posterior commissure
A pt is can't go to the Foo Fighters concerts anymore bc he is insensitive to loud noises. WHat nerve?
Pt presents with hoarseness?
Hoarseness: Recurrent Laryngeal
Monotone: inferior laryngeal nerve - (includes recurrent laryngeal)
Pt presents with constricted right pupil that does not respond to light. Everything else, including his left eye, is normal. Where is the lesion?
Constricted = cannot dilate.
Dilation occurs in sympathetic response.
Superior Cervical ganglion is affected.
What are the functions of the chorda tympani?
Chorda Tympani: Submandibular and sublingual glands, taste to A2/3 tongue (via facial)
deep petrosal: Sympathetic to blod vessels and mucous glands
Lesser petrosal: Parasympathetic to parotid
Greater petrosal: parasympathetic to lacrimal gland
A patient presents with right corner of mouth dropping, unable toclose his right eye and food collection in his irght oral vestibule, history reveals a recent otitis media surgery. What nerve?
You can get loss of taste from which 2 nerves?
Facial via chorda tympani (anterior)
What nerve runs along the intenral carotid artery near the cavernous sinus?
What muscles can protrude the side of jaw?
Medial, Lateral pterygoid and masseter
If a pt is experiencing watery saliva, what nervous system is stimulating that?
What are the muscles of the tongue and how are the innervated?
Most by hypoglossal:
Nasociliary V1 afferent --> zyogmatic branch VII efferent
Sensory afferent: optic I
Motor: Oculomotor III
Edinger westphal nucleus*
Pt presents with diplopia, decreased vision, acuity, and loss of pupillary reflex, saying they were hit by a baseball. you notice the eye also has an upward gaze. Dx? Mx?
blow out fracture
Fracture of lower = entrapment of inferior rectus
fracture of higher = superior rectal and superior rbital, so lower gaze. Orbital plate broken
A pt presents with CSF rhinorrhea, nasal disfigurement, and a periorbital edema after an MVA. Dx?
Type 2 LeForte fractrue
Arches 1& 2 form anterior 2/3. Senesation from V3, taste CN VII
3rd and 4th from posterior 1/3
How do you tell from an oculomotor nerve lesion from Horners?
if the ptosis corrects itself by looking up
Which cranial nerve is involved in the elevation of pharynx/larynx?
IX bc stylopharyngeous is the only elevator of pharynx/larynx
but also Palatopharyngeus muscle and salpingopharyngeuous muscle by the Vagus.
What muscle groups does the oculomotor innervate?
Dilators of pupil (Sphincter pupillae), eyelid (levator palpebrae), extraocular m
What muscle retracts and depresses the tongue?
Hyoglossus, hypoglossal XII
A pt may develop venous sinus thrombosis if they have what pre-existing condition?
A pt has loss of taste and baroreceptor reflex after damage to a brain stem nucleus, which fibers send stuff back to nucleus?
VII, IX, X
What goes back to the nucleus ambiguus?
IX, X, XI,
9 11 was an inside job!
AFter a tonsillectomy, a girl gets ear pain, nerve?
glossopharyngeal bc gloospharyngeal does sensation of pharynx, auditory tube.
What tonsil is next to the pharyngotympanic tube?
What embryologically does this tube come from?
The pharyngeal tonsil
First pharyngeal pouch / tubotympanic recesss
What are the palatine tonsils supplied by?
Tonsillar branch of facial
Inner surface of tympanic membrane innervation?
Outer: V, VII, X ; V3 mostly
triad of accomodation,
When you're trying to look at something closeup
- Cnvergence of gaze
- pupillary constriction
- thicken lens
happens when eye constricts trying to focus on a near object
WHat are you at risk for in a cricothyroidotomy?
pyramidal lobe or remnant of thyroglossal duct
What does the superior thyroid artery run with?
Inferior thyroid artery?
superior: external branch of SLN
inferior: Recurrent Laryngeal
Retropharyngeal space is between..?
buccopharyngeal and alar layer of prevertebral fascia
For the muscles of facial expression, what branch of facial artery do each of them get?
Frontalis - temporal n, raise eybrows
Orbicularis oculi - zygomatic, close eye
zygomaticus major - smile, zygomatic
orbicularis oris - pucket lips, buccal n
platysma - flaring of neck -cervical n
What innervates the tensor veli palatini?
What is the hiatus semilunaris?
Where do your tears go if there's an excess?
opening for maxilary sinus in the middle nsasl concha
frontal drains here via frontal recess
Nasolacrimal = inferior nasal concha
Relationships of sphenoid sinus?
Superior = pituitary
Lateral - internal carotid, V1, cavernous sinus
Posterior = pons, basilar
inferior = nasopharynx
Relationship of maxillary
Superior = orbit, infraorbital neurovascular bundle
Inferior= teeth, paplatine
posterior = pterygopalatine fossa
What innervates the leavtor palpebrae superioris?
III = complete ptosis
What is the lateral pelprebral ligament?
Attaches to zygomatic bone
What is traumatic optic neuropathy?
Intercanalicular portion of optic nerve ischemic from orbital fracture
How to anesethetize infraorbital area?
Go through upper gums
What is the periorbita?
Continuous with endosteal dura
Chief sensory nerve to orbit?
Nasociliary n, anterior posterior ethmoidal n, long ciliary n,
What nerves go to the palate?
All from V2
Greater palatine nerve: Gingivae, mucous embrane, glands of hard palate
Nasopalatine; mucous membran, anterior hard palate
Lesser palatine nerves: Soft palate
Which Parasympathetic pathway has 2 cranial nerves associated with it?
Lacrimal gland. Pterygopalatine ganglion
What type of epithelium does the labial, alveolar, ventral tongue, and soft palate have?
Which ones have keratinized?
Non keratinized Simple Stratified squamous
dorsal tongue, hard palate, gingiva.
What innervates Tensor tympani?
V2 or V3
Think, Bose TOO loud. V2 and VII
What is the crista ampullaris?
Organ of rotation. Located at bottom of each semicircular canal
Also fxns as angular acceleration and deceleration
Path of sound waves?
ossicles --> round window --> scala vestibli --> organ of corti in scala media --> scala tympani --> round window --> E tube
higher frequency, closer to round window
A pt presents with recurrent attacks of tinnitus, hearing loss, vertigo, feeling of rpesur ein ear and sensitivity to noise. Dx? Cx? Mx?
Cx: Ballooning of cochlear duct, utricle and saccule
Mx: Excess endolymph from overproduction or blockage of endlymph
Pt presents with Loss of senseation of posterior tongue, paralysis of vocal cords, and ipsilateral trap/SCM weakness. Dx?
What if they also had trouble protruding their tongue?
Vernet's. IX, X, XI
Collet Sicard. Ix, X, XI, XII
You will have loss of corneal reflex if which CN's are injured?
IX & X
Insertion and Origin of stapedius? Innervation?
Posterior wall to posterior crura of stapes?
First arch Cartilage, muscles, and nerves
Mandible, Maxilla, ZygoMatic, Meckel cartilage, Malleus, Incus SphenoMandibular lig
Mastication; Masseter, Medial and pterygoids, Mylohyoid A digastric,
Nerves: V2, V3
2nd arch Cartilage, muscles, nerves
Stapes, Styloid, leSSer horn, Stylohyoid lig
Stapedius, Stylohyoid, PlatySma posterior belly of digastric
3rd arch cartilage, muscles, nerves?
greater horn of hyoid
4th arch cartilage, muscle, nerves,
4 - X superior laryngeal
6 - X recurrent laryngeal
Arytenoids, Cuneiform, Corniculate, Cricoid, Thyroid
Pharyngeal constrictors & cricothyroid
6th Intrinsic muscles except cricothyroid.
What do the 1 - 4th clefts differentiate into?
1st cleft = external auditory meatus.
2nd cleft = persistent cervical sinus
A pt presents with an immobile growth on their anterior SCM. dx?
What if it was mobile?
persistent cleft cyst
thyroglossal duct cyst
1st branchial pouch?
Middle ear, eustachian tube, mastoid air cells & Endoderm of ear
2nd branchial pouch?
palatine tonsils epithelial lining
3rd branchial pouch?
Dorsal wings: Inferior parathyroids
Ventral wings: Thymus
4th branchial pouch
Dorsal: Superior paraythyroids
Ventral: Ultimobranchial and parafollicular cells
pt presents with hypocalcemia and a T cell deficiency. Dx
Chromosome 22q11 deletion - aberrant development of 3rd and 4th pouches
Neurocranium structures are derived from what germ layer?
Paraxial somatic mesoderm
What does the hypopharyngeal eminence become?
Body of hyoid
What type of epitheluim is the conjunctiva?
what does the organ of corti contain?
Tectorial membrane for stereocilia
Basilar membrane that vibrates, it's what it's sitting on
SEmicirular:- endolymph, cupola,
Utricle and saccule: otolithic membrane
what causes retinitis pigmentosa?
What molecules are ancillary inhibitors?
periferin & mutation in RPE65
What's the glutamate lik ein the dark?
high glutamate to prevent transduction repolarizaiton bc no light = no signal
What 2 molecules are for regneration of cis retinol?
Describe genetics of color blindness
red and greena re on same X chromosome = X linked
pt presents with night blindness, xerophthalmia, and bitot's spots. Dx.
What about Excess Vit A?
Vit A deficiency
liver toxicity and joint pain/ Fetal cleft palates
Macular degeneration is associated with what mutation?
VEGF mediates by inducing angiogenesis and increasing infalmmation and vascular permeability
Jaw dislocation is painful bc of what nerves?
deep temporal n
What are 5 main head muscles that the vagus motorizes?
- levator veli palatini
Maxillary sinus artery and nerve
Sphenoid sinus artery and nerve?
Superior alveolar n/a
Posterior ethmoid n/a
What type of epithelium do our tonsils have?
Palatine: tonsillar crypts
Pharyngeal: Pseudostratified epithelium
Lingual tonsil: Stratified Squamous
What does LRAT do?
LRAT esterifies all trans-retinol to all trans retinyl in RPE
RPE 65 converts all trans retinyl to 11 cis retinol
What nerve runs in hte pirifirom recess
3. In regards to the skin layers, which layer contains keratin precursors?
A. Keratin layer - flat cells that lack nuclei, full of keratin
B. Basal layer - layer of cells undergoing mitosis
C. Granular layer - contains keratohyaline granules (keratin precursors)
D. Prickle cell layer - lose ability for mitosis
2. A biopsy report for a tonsil describes it as having stratified squamous epithelium
with deep invaginations and crypts. It has a partial capsule made of dense
connective tissue and germinal centers are seen. What is the most likely
A. Palatine tonsil
B. Pharyngeal tonsil - covered with pseudostratified columnar ciliated epithelium,
C. Adenoid tonsil - another name for pharyngeal tonsil
D. Lingual tonsil - similar to palatine tonsils but has no distinct capsule
Pt presents with micrognathia, glossoptosis, cleft palate, and airway obstruction
Pierre Robin Sequence
Pt presents mandibular hyopplasia, facial abnormalities.
What arch forms the anterior ligament of malleus and sphenomandibular ligament? What specifically?
Does the mandible come from dorsal or ventral parts of primordium?
1st arch Perichondrium --> ligaments.
What arch forms the stylohyoid ligament?
2nd arch perichondrium
What muscles are General somatic efferent, and not derived from PA?
PA = 6, 7, 9 ,10
they come from myotomes
3, 4, 6, 12.
Eye muscles and tongue muscles
How do you knwo it's an acute cancer?
if it hasn't hit the Jugulofacial and jugulosubclavian jxns
What is the sympathetic pathway of sphincter eye stuff?
V1 --> nasociliary --> long ciliary --> sphincter eye
Pt can't raise eyebrows?
Can't close eyes?
flaring of neck?
temporal nerve of facial
Endosteal dura = meningeal dura
what does this cause?
Papillaedema bc CSF stays in there