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Sam's Neuro > Week of 4/10? > Flashcards

Week of 4/10? Flashcards

1
Q

Draw a picture of the Pharyngeal structures (including pharynx, laryngopharynx, pharyngoconstrictor x3, lat pharyngeal wall [and its gaps], and stylopharyngeus)

A
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2
Q

Which set of tonsils are the ones we see [when doing oropharyngeal exam)? Which ones can we not see?

A

We See Palatine

Can’t see the Tubal tonsils

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3
Q

What important oriface is blocked by the tubal tonsils? What function does the orifice have?

A

Pharyngotympanic tube orifice

Important for equalizing ear pressure!

If these tubal tonsils swell –>blocks the orifice –> get increased pressure and PAIN

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4
Q

Are there lingual tonsils?

A

?maybe? check notes.

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5
Q

What is the blind ending of the laryngopharynx called? Where does it sit?

A

The piriform recess?

SIts in front of the neurovascular bundle

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6
Q

Where does the superior pharyngoconstrictor (SPC)?

A

pharyngobasilar fascia

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7
Q

Wheres does the mid pharyngoconstrictor (MPC) attach? What does it overlap?

A

attaches to hyoid

overlaps the SPC

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8
Q

Wheres does the Inf pharyngoconstrictor attach (IPC)? What does it overlap?

A

it attaches to thyroid

Overlaps the MPC

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9
Q

What CN (cranial nerve) innervates all of the PC’s (sup, mid, inf)? Now be specific

A

CN X
-pharyngeal branch of CN X
-recurrent laryngeal branch of CN X?
-ext laryngeal branch of CN X?

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10
Q

How do the PC’s contract? (what kind of pattern)

A

Sequentially!
(almost like peristalsis)

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11
Q

What are the purpose of the lateral pharnygeal wall gaps?
How many gaps are there?

A

allow structure

4 gaps

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12
Q

What are the important structures/things in the LPW gap 1?

A

levator palatini
auditory tube
ascending palatine Artery

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13
Q

What are the important structures/things in the LPW gap 2?

A

stylopharyngeus
CN IX
stylohyoid ligament

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14
Q

What are the important structures/things in the LPW gap 3?

A

Internal laryngeal Nerve
Superior laryngeal Artery & Vein

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15
Q

What are the important structures/things in the LPW gap 4?

A

Recurrent laryngeal nerve
Inf Laryngeal Artery

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16
Q

What is unique about the innervation of the stylopharyngeus?

A

Its the only internal pharyngeal muscle that is innervated by CN IX

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17
Q

Where does the CN IX arise from (whihc arch)

A

4th pharyngeal arch

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18
Q

What are all the other internal pharyngeal muscles innervated by?
Which one is the exception to this?

A

CN X

The exception: stylopharyngeus is CN IX

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19
Q

What vessel brings blood to all the pharyngeal muscles/structures?
What drains them?

A

External carotid

drained by the inferior aveolar vein

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20
Q

What nerve provides motor function for the pharyngeal structures?
-exception 1?
-exception 2?

A

All motor supply is from CN X EXCEPT:
1) tensor veli palatini gets it from CN V
2) stylopharyngeus is from CN IX

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21
Q

What nerve supplies sensory function to pharyngeal muscles?
except?

A

Sensory is IX

except for the inferior laryngopharynx, which gets sensory from CN X

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22
Q

Where do the sympathetic fibers of the pharyngeal muscles come from?

A

the superior cervical ganglion

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23
Q

What lymph node(s) drain the pharyngeal structures?

A

Deep cervical LN’s

EXCEPT: the tonsils are drained by the jugulodigastric LN

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24
Q

What are people with allergic rhinitis 3x more likely to develop then the [regular] population?

A

Asthma

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25
Q

What is medicamentosa?

A

A harry potter spell

JK! It’s ppl who use nasal decongestants and essentially get addicted to them

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26
Q

What is the physiology of medicamentosa?

A

Decongestants decrease venous plexus [vasoconstrict it?] –>when the drug wears off, you get rebound congestion

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27
Q

How long is it okay to use nasal decongestants?

A

3 days before damage begins to occur

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28
Q

How do you treat medicamentosa? 2 ways?

A

Weaning process; can take 17-41 days

OR

Surgery

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29
Q

What histoloigic changes do nasal decongestants cause?

A

-obstinate vasodilation
-inflammation edema
-cilia loss
-goblet cell hyperplasia

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30
Q

What CN is responsible for smell?

Anatomically how does it do so?

A

CN 1!!!
-it has 50 fascicles (tiny branches?) that go through the cribiform plate

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31
Q

WHat is the important gland involved in our sense of smell? How does it work?

A

Bowmans Gland
-it dissolves odorant to bind [to cribiform plate?] and to wash away the odorant

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32
Q

What is Naegleria fowleri? aka N fowleri
WHo/where would be most likely to get N fowleri?

A

An Amoeba!!
-accesses nasal cavities through cribiform plate & eat neurons in the brain causing PAM (Primary Amebic Meningoencephalitis)
-95% deadly

-most commonly affects males (dumb & dunk heads in water) in the south (ameoba likes warm water)

terror moment: you can get it from tap water or neti pots as well

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33
Q

What is the histology of the Tonsilar RIng?

A

crypts w/ respiratory epithelium = [up arrow] up location = pharyngeal tonsil

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34
Q

What is the histology of the palatine tonsils? (different then most?)

A

stratified squamous epithelium

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35
Q

What type of muscle makes up the oropharynx?

A

skeletal muscle

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36
Q

What is the histology of the epiglottis?

A

stratified squamous & elastic cartilage

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37
Q

What is the histology of the true vocal cords?

A

stratified squamous and NO glands

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38
Q

False vocal cord histology?

A

skeletal muscle, resp epithelium AND goblet cells

(opposite of what you would think because they are actually superior to true vocal cords, and thus farther away from trachea and resp organs that have similar histo)

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39
Q

What nerve is used for balance & orientation?
Which CN is it part of?

A

Vestibular Nerve

Which is part of CN 8 (vestibulocochlear nerve)

40
Q

Tell me what happens at each stage of ear embryologic development:
-week 4?
-week 6?
-week 7?
-week 8?

A

-week 4: otic placode forms
-week 6: cochlear duct forms
-week 7: spiral organ of corti forms (which turns mechanical signals into nerve signals)
-week 8: get full 2.5 circles of inner ear/cochlea

41
Q

What is the ductus reunions?

A

connection btw saccule and cochlear duct

42
Q

what do the outer and inner ridges of the cochlear duct form, respectively?

A

outer ridge forms hair cells

inner makes the tectorial membrane

43
Q

What is sensorineural deafness?

A

abnormal hair cells or abnormal auditory nerve conduction

44
Q

What conditions are associated with sensorineural deafness?

A

herpes
drugs
down syndrome
prematurity

45
Q

What pharyngeal arches are involved in forming the inner ear including canal?
what does each arch form specifically & which CN is associated with each arch?

A

the 1st and 2nd pharyngeal arches

1st: middle ear, auditory tube, malleus, incus, tendor Tympanion –> (CN V)

2nd: stapes & stapedius muscle –> CN VII

46
Q

What embryologic [sub]structure forms all the ossicles?

A

neural crest

47
Q

What is the histology of mastoid air cells and what are their significance?

A

endoderm epithelium dissolves bone to make sinuses

48
Q

What happens if there is no meatal plug regression during inner ear formation?

A

congenital deafness

49
Q

What do external ear malformations indicate? (embryologically what happened to cause this)

A

neural crest defects

50
Q

Conductive hearing loss, what is it?

A

something that stops sounds from getting through the outer or middle ear. This type of hearing loss can often be treated with medicine or surgery.

51
Q

What are some causes of conductive hearing loss? or some conditions related to it

A

COnditions:
-ankylosis (fixed stapes)
-treacher collins
-down syndrome

Other causes:
-foreign object
-ruptured ear drum
-ear wax build up
-allergies
-fluid etc

52
Q

What type of hearing loss do ppl with downs syndrome have?

A

Trick question! They can have either/both sensorineural or conductive hearing loss

53
Q

Discuss the Lesser Petrosal Nerve
-which CN is it part of?
-what types of fibers does it carry? and to where?

A

-continuation of CN IX
-carries preganglionic parasympathetic
-carries them to the otic ganglion & parotid gland

maybe related to GVEP (can’t tell, see notes)

54
Q

What does the chorda tympany SVA do?

A

responsible for taste to anterior 2/3 of tongue

55
Q

What does chorda tympany GVE-P do?

A

carries parasympathetic to submandibular and sublingual salivary glands

56
Q

What odd symptom/deficit can be a consequence of ear surgery?
bonus if you can tell me why

A

you can have loss of taste

Probably due to injury [of the chorda tympany SVA] as its transmitted through the petrotympanic fissure

57
Q

WHat can chronic otitis media lead to?

A

inflammation of the jaw bone, aka mastoiditis

58
Q

What is the internal ears major organ?

A

vestibulocochlear organ

59
Q

What CN is related to the vestibulocochlear organ

A

CN VIII (vestibulocochlear nerve)

60
Q

what do the utricle and saccule of inner ear do?

A

proprioception; vertical and horizontal orientation

61
Q

What are the three scala of the vestibulocochlear organ

A

scala vesitbuli (top)
scala media (middle)
scala tympani (bottom)

62
Q

What is Meneires disease/what causes it?

A

defective endolymph flow or absorption

Symptoms/signs:
-one sided?
-vertigo
-hearing loss
-tinnitus
-aural fullness/congestion

63
Q

Which parts of the kinetic labyrinth are involved in movement perception and which direction of movement?

A

ampula & crista

deal with rotational movement

64
Q

What parts of the linear labyrinth are involved in movement perception and how?

A

otoliths (sensory apparatus is maculae?)

feel acceleration

65
Q

Describe how rotation is is perceived

A

rotation is registered on contralateral side in the opposite canal

ex: head turn to L = cupula on L moves anterior and R moves posterior

66
Q

Describe the cilia on hair cells and how they are involved in perceiving movement in the inner ear?

A

All hair cells have top linked stereocilia & kinocilium

Kinocilium are aligned in the same direction
-when you move in one direction it causes hyperpolarization in one canal, and depolarization in the opposite

67
Q

What are the main vestibular functions of CN VIII and where are those parts of CN VIII that do each function (name 3)

A

1) eye movements compensate for head movement
-done by efferents of CN8 that control EOM

2) adjust posture to head position
-cerebellar and spinal cord portions of cn VIII

3) mediate awareness of movement
-the portion of CN 8 that runs from thalamus to cortex

68
Q

What element/electrolyte is unique in endolypmh?

A

It has higher K+, which leads to K+ influx into cells

69
Q

Name the major sound organ (think easy)

A

COchlea!!

70
Q

What separates the scala?

A

osseus spiral lamina

71
Q

What is reissners membrane?

A

separates endolymph and perilymph

72
Q

Where is the organ of corti [attached]? What is it made up of?

A

Attached to the basilar membrane

It is 3000 fibers!! different lengths hear different frequencies

73
Q

What fibers of the organ of corti hear low frequency and where are they located?

A

Long fibers hear low frequency and are at the apex of the OoC

74
Q

What fibers of the organ of corti hear high frequency and where are they located?

A

short fibers hear high frequency and are at the base of OoC

75
Q

Why do hair cells need a bath?

A

Bath of perilymph

if they didn’t get this the neurons wouldn’t work right due to high K+ in endolympph (so gotta wash this away, just as memory aid to remember)

76
Q

inner hair cells do what?

A

auditory transduction

77
Q

outer hair cells do what?

A

fine tuning

78
Q

After K+ in the endolymph has been driven into cells, what happens next? WHat Neurotransmitter is released [usually]?

A

Ca+ influx happens with depolarization –> glutamate (NT) –> goes to vestibular Nerve

79
Q

What is VOR? What triggers it and how does the signal travel/where?

A

Horizontal head move triggers VOR –> ascending medial long fasciculus (MLF) –> bilateral CN motor center –> EOM

(note, this can also be triggered by some vertical movements as well)

80
Q

What is Nystagmus

A

slow VOR motion that then jerks back other direction quickly
The nystagmus is named for the quick jerk direction

81
Q

COWS…
What is it? and give examples

A

Cold Opposite, Warm Same

SO cold water in R ear, eyes track R, then jerk left

Warm in R ear, eyes track left then jerk right

82
Q

Where are the otoliths? What do they do?

A

Otoliths are in statoconic membrane, when they move they displace hair cells

saccular otoliths –> vertical
utricle –> horizontal

83
Q

what is otoconia

A

calcium carbonate cryystal

84
Q

What is the vestibulocolic reflex?
Where is it primarily located?

A

Reflex responsible for stabilizing head as it moves and coordinates EOM with it

located in MVST (descending MLF) –> bilateral innervations –> cervical area targets

85
Q

What is the vestibulospinal reflex?
Where does it primarily lie/located?

A

Controls body posture

LVST –> ipsilateral innervation –> to cerebellar partner

86
Q

Where does the vestibulocerebellar tract run/synapse? Tricky, 2 parts

A

vestibular cerebellar tract –> one path to synapse in vestibular nucleus
–> 2nd path skips that nucleus and goes straight to scarpas ganglion

87
Q

How does alcohol trigger vertigo?

which way will your nystagmus go if you are drunk vs sobering up?

A

Etoh changes enodlymph density

Drunk nystagmus: R beating
Sobering up: L beating

88
Q

What causes BPPV? what is the mechanism of bppv

A

detached otoliths move into semicircular canals

can be from aging or trauma (that detaches otoliths)

89
Q

HOw do we treat BPPV

A

Movements: to get the otolith to come out of semi circular canals (like dix hallpike maneuver and others)

Otherwise the otolith will dissolve on its own

90
Q

What artery would be involved in an ischemic stroke that causes problems with the VOR, VCR, and/or VSR?

A

PICA thrombus

91
Q

You have an ischemic stroke that causes problems with the VOR, VCR, and/or VSR

describe each lesion/deficit or what you will see

A

VOR –> resting nystagmus will be opposite of lesion (left jerk = R sided lesion [in PICA])

VCR –> head tilts toward the lesion

VSR –> fall toward the side with the lesion

92
Q

sensory trigeminal damage: where is it located? what does it cause?

A

damage to ipsilateral noci

disrupts thermosense

93
Q

You have a lesion/stroke that causes contralateral loss of pain & temperature in trunk and limbs? Where did the lesion/injury occur/affect?

A

spinothalamic

94
Q

What happens if the nucleus ambiguous sustains damage/injury?

A

Depends on location:
1)injury to spympathetic pathway –> horners syndrome (ptois and anhydrosis on which side?
2)injury to spinocerebellar disruption –> ipsilateral ataxia

95
Q

What is ROmberg sign? where has there been an injury?

A

Closed eyes and swaying, or even falling

vestibulocerrebellar injury

Sam's Neuro (4 decks)

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