Week 1 - Skull, Fascia and Posterior Triangle

Question 1

What are the two points of movement in the skull ?

Answer 1

Temporomandibular joint and atlanto-occpitial joint.

Question 2

How are flat bones formed and distinguished ?

Answer 2

Intramembranous ossification.
Distinguished by embryological origin.

Question 3

How are irregular bones formed and distinguished ?

Answer 3

Endochondral ossification. Distinguished by embryological origin.

Question 4

How are pneumatised bones distinguished ?

Answer 4

Presence of air spaces (air cells or sinuses).

Question 5

What is the function of pneumatised bones in the skull ?

Answer 5

Reduce weight and add resonance to voice.

Question 6

What are four examples of pneumatised bones in the skull ?

Answer 6

Frontal.
Temporal.
Sphenoid.
Ethmoid.

Question 7

What is the difference between neurocranium and viscerocranium ?

Answer 7

Neurocranium - bony case of brain.
Viscerocranium - anterior part of cranium.

Question 8

What does the neurocranium consist of ?

Answer 8

Cranial meninges.
Calvaria.
Cranial base.

Question 9

What does the viscerocranium consist of ?

Answer 9

Oral cavity.
Nasal cavity.
Most of orbit.

Question 10

What bones are separate to the skull ?

Answer 10

Mandible.
Three ossicles of ear.

Question 11

What are the three ossicles of the ear ?

Answer 11

Malleus.
Incus.
Stapes.

Question 12

What are the bones of the neurocranium ?

Answer 12

8 bones -
Frontal.
Occipital.
Sphenoid.
Ethmoid.
Parietal (x2).
Temporal (x2).

Question 13

What are the bones of viscerocranium ?

Answer 13

Ethmoid.
Vomer.
Mandible.
Palatine (x2).
Lacrimal (x2).
Nasal (x2).
Zygomatic (x2).
Inferior nasal concha (x2).
Maxilla (x2).

Question 14

What does superior and inferior temporal lines do ?

Answer 14

Provide attachment for temporalis and temporal fascia.

Question 15

What is the superior border of temporal fossa ?

Answer 15

Superior temporal line.

Question 16

What is the posterior border of temporal fossa ?

Answer 16

Inferior temporal line.

Question 17

What is the anterior border of temporal fossa ?

Answer 17

Frontal process of zygomatic bone.
Zygomatic process of frontal bone.

Question 18

What is the inferior border of temporal fossa ?

Answer 18

Infratemporal fossa crest deep to zygomatic arch.

Question 19

What lies at the floor of temporal fossa ?

Answer 19

Pterion.

Question 20

Craniometric points - what is the vertex ?

Answer 20

Superior point of neurocranium centred in middle of cranium (if cranium is orientated in Frankfort horizontal plane).

Question 21

Craniometric points - what is bregma ?

Answer 21

Junction between sagittal and coronal sutures.

Question 22

Craniometric points - what is lambda ?

Answer 22

Junction between sagittal and lambdoid sutures.

Question 23

Craniometric points - what is inion ?

Answer 23

Most prominent external protuberance of occipital bone.

Question 24

Craniometric points - what is asterion ?

Answer 24

Star-shaped junction between occipital, parietal and temporal bones.

Question 25

Craniometric points - what is nasion ?

Answer 25

Junction between frontonasal and internasal sutures join.

Question 26

Craniometric points - what is glabella ?

Answer 26

Most prominent hairless protuberance of frontal bone between two brows.

Question 27

Craniometric points - what is pterion ? And why is it significant ?

Answer 27

Junction between sphenoid, squamous part of temporal, frontal and parietal bones. Structurally weakest part of the skull with significant arteries running in proximity.

Question 28

What are wormian bones ?

Answer 28

Small islands of bone seen in cranial sutures.

Question 29

When does frontal suture begin to and finally close ?

Answer 29

Starts at 2 years old. Complete by 8 years old.

Question 30

When does mandibular symphysis occur ?

Answer 30

At 2 years old.

Question 31

What is a metric suture ?

Answer 31

Where frontal suture fails to close.

Question 32

What is a fontanelle and their function ?

Answer 32

Fibrous membranes which separate cranial bones. Facilitates cranial growth and aids in child birth.

Question 33

Name the two clinically relevant fontanelles, their shape and when they close ?

Answer 33

Anterior fontanelle - diamond shaped, 18 months. Posterior fontanelle - triangular shaped, no longer palpable by 2 years old.

Question 34

What are the superior and inferior boundaries of the neck ?

Answer 34

Superior - inferior aspect of the mandible and cranial base. Inferior - clavicle, manubrium, acromion of scapula, C7 (posteriorly).

Question 35

What are the three compartments of the neck ?

Answer 35

Visceral, vascular, vertebral.

Question 36

What does the visceral compartment of neck contain ?

Answer 36

Digestive system, respiratory system, trachea, endocrine gland i.e. thyroid and parathyroid gland.

Question 37

What does the vascular compartment of the neck contain ?

Answer 37

Carotid sheath and contents - vagus nerve, IJV and CCA.

Question 38

What does the vertebral compartment of the neck contain ?

Answer 38

Cervical vertebrae, spinal cord, muscles and cervical nerves.

Question 39

What is the function of fascia ?

Answer 39

Containment and protection for muscles/viscera. Conduit for neuromuscular structures. Movement for internal structures.

Question 40

What are the three layers of fascia ?

Answer 40

Investing layer, pre-trachael, pre-vertebral deep fascia.

Question 41

What does the investing fascia enclose anteriorly ?

Answer 41

SCM, trapezius, parotid and submandibular glands, can include infra-hyoid muscles.

Question 42

What are the superior attachments of investing fascia ?

Answer 42

Superior nuchal line of occipital bone. Mastoid processes of temporal bones. Zygomatic arches. Inferior border of mandible.

Question 43

What are the inferior attachments of investing fascia ?

Answer 43

Spine of scapula. Acromion. Clavicle. Manubrium.

Question 44

What is the anterior attachment of investing fascia ?

Answer 44

Hyoid bone.

Question 45

What is the posterior attachments of investing fascia ?

Answer 45

Ligamentum nuchae. Periosteum of C7 spinous process.

Question 46

What is ligamentum nuchae ?

Answer 46

Fibrous septum between muscles on each side of the neck.

Question 47

What does pre-tracheal fascia enclose ?

Answer 47

Visceral - trachea, oesophagus, thyroid. Muscular - infrahyoid muscles.

Question 48

What vessels pierce the pre-tracheal fascia ?

Answer 48

Thyroid vessels.

Question 49

What vessels pierce the investing fascia ?

Answer 49

External and anterior jugular veins and cervical plexus.

Question 50

What does pre-vertebral fascia enclose ?

Answer 50

Vertebral column and pre and post vertebral muscles i.e. scalenes and longus.

Question 51

What pierces the pre-vertebral fascia ?

Answer 51

Cutaneous branches of cervical plexus.

Question 52

What is enclosed by the carotid sheath ?

Answer 52

IJV, ICA, CNX.

Question 53

What are the boundaries of the carotid sheath ?

Answer 53

Aortic arch to jugular foramen.

Question 54

What nervous structure lies on the surface of the carotid sheath ?

Answer 54

Ansa cervicalis.

Question 55

What are the boundaries of the posterior triangle ?

Answer 55

Posterior surface of SCM, posterior 1/3 of clavicle and anterior surface of trapezius.

Question 56

What are the 3 main regions of the posterior triangle ?

Answer 56

Sternocleidomastoid region. Posterior cervical region. Lateral cervical region.

Question 57

How is the lateral cervical region subdivided ?

Answer 57

Occipital and subclavian triangle via inferior belly of omohyoid.

Question 58

What nerves, muscles and blood vessels are associated with the sternocleidomastoid region of the posterior triangle ?

Answer 58

SCM, great auricular and transverse cervical nerves, superior part of EJV.

Question 59

What nerves and muscles are associated with the posterior cervical region ?

Answer 59

Trapezius, cutaneous branches of posterior rami of cervical spinal nerves.

Question 60

What is the origin of the sternocleidomastoid ?

Answer 60

Sternal head - manubrium via rounded tendon. Clavicular head - superior of middle third of the clavicle.

Question 61

What is the insertion of the sternocleidomastoid ?

Answer 61

Lateral of mastoid process and superior nuchal line.

Question 62

What is the motor innervation to the sternocleidomastoid ?

Answer 62

CNXI (accessory cranial nerve).

Question 63

What is the sensory innervation to the sternocleidomastoid ?

Answer 63

C2 and C3.

Question 64

What is the action of SCM when functioning bilaterally ?

Answer 64

Extension of the neck and head upwards from AO joint.

Question 65

What is the action of SCM when functioning unilaterally ?

Answer 65

Flex neck laterally i.e. ear to shoulder.

Question 66

What is the origin of the trapezius ?

Answer 66

Superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of C7 to T12.

Question 67

What is the insertion of the trapezius ?

Answer 67

Lateral third of clavicle, acromion, spine of scapula.

Question 68

What is the insertion of the trapezius ?

Answer 68

Lateral third of clavicle, acromion, spine of scapula.

Question 69

What is the innervation of the trapezius ?

Answer 69

CNXI (accessory cranial nerve).

Question 70

What is the action of the trapezius ?

Answer 70

Movement of scapula.

Question 71

In relation to the pre-vertebral fascia, where do the muscular and cutaneous branches of the cervical plexus lie ?

Answer 71

Muscular - deep to PV fascia. Cutaneous - superficial to PV fascia.

Question 72

What are the two key muscular branches of the cervical plexus ?

Answer 72

Phrenic nerve - C3, C4, C5. Ansa cervicalis - C1, C2, C3.

Question 73

What are the four key cutaneous branches of the cervical plexus ?

Answer 73

Lesser occipital - C2. Great auricular - C2 and C3. Transverse cervical - C2 and C3. Supraclavicular nerves - C3 and C4.

Question 74

What does ansa cervicalis supply ?

Answer 74

Pre-vertebral and vertebral muscles i.e. anterior, middle and posterior scalenes and infrahyoid muscles (with exception of thyrohyoid - innervated by independent branches of C2).

Question 75

What does the external jugular vein drain into ?

Answer 75

Subclavian vein.

Question 76

What is the function of the anterior jugular vein ? And where does it drain into ?

Answer 76

Drain anterior neck. Drains into EJV then subclavian.

Question 77

What 4 blood vessels are associated with the posterior triangle ?

Answer 77

EJV, AJV, IJV and transverse cervical artery.

Question 78

What main blood vessel runs deep to SCM ?

Answer 78

IJV.

Question 79

What 3 structures cross the sternocleidomastoid ?

Answer 79

EJV, greater auricular nerve, transverse cervical nerve.

Question 80

What does the greater auricular nerve innervate ?

Answer 80

Cutaneous - skin over parotid, mastoid process, temporal bone and auricle of the ear.

Question 81

What does the transverse cervical nerve innervate ?

Answer 81

Cutaneous - anterolateral neck (chin to sternal notch and clavicle).

Question 82

What is the function of the brachial plexus ?

Answer 82

Motor and sensory supply to upper limb.

Question 83

Where is the brachial plexus located ?

Answer 83

Between anterior and middle scalene beneath the clavicle - runs with subclavian artery.

Question 84

The brachial plexus is associated with what spinal nerves ?

Answer 84

Ventral rami of C5-T1.