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Gross, Block 2
Gross -- Block 2
| Question | Answer |
|---|---|
| What is sensory innervation of scalp behind the ear? | Lesser occipital nerve and greater occipital nerve (C2) |
| Of what bone are the superior and middle conchae a part? | The ethmoid |
| T or F: ALL venous sinuses of the dura drain into the sigmoid sinus. | False. The inferior petrosal sinus drains into the jugular vein. |
| What exits the foramen cecum of the anterior fossa? | the nasal emissary vein |
| What exits the anterior and posterior ethmoid foramina in the anterior fossa? | vessels and nerves of ethmoid |
| What exits the optic canals in the middle fossa? | CN II and the opthalmic artery |
| What exits the superior orbital fissure? | CN III, IV, VI. Also V-1. Opthalmic veins, sympathetic fibers. |
| What exits the foramen rotundum? | CN V-2. |
| What exits the foramen ovale? | CN V-3, accessory meningeal artery. |
| What exits the foramen spinosum? | Middle meningeal artery and vein. Meningeal branch of V-3. |
| What six lymph node groups make up the pericervical ring? | Occipital, retroauricular, parotid, buccal, submandibular, and submental. |
| Where do the pericervical nodes drain to? | The deep cervical nodes |
| Superficial vs deep cervical nodes | Superficial lay along external jugular, whereas deep cervical lay along internal jugular. |
| 2 important groups of nodes | Jugulodigastric and jugulo-omohyoid |
| What is the jugulodigastric node group concerned with? | It's part of the superior deep cervical nodes and drains the palatine tonsil and the nasopharynx. |
| What is the jugulo-omohyoid group of nodes concerned with? | It's part of the inferior deep cervical nodes, and drains the tongue. |
| What drains the anterior 2/3 of the tongue? | The submental and submandibular nodes, usually, although they may go directly to deep cervical (jugulo-omohyoid) nodes |
| What drains the posterior 1/3 of the tongue? | The deep cervical nodes directly. |
| What lymph nodes drain the teeth? | Maxillary teeth: buccal nodes. Mandibular teeth: posteriorly through mandibular canal to deep cervical nodes. |
| What drains the anterior part of the nasal cavity? | Submandibular nodes |
| What drains the posterior nasal cavity? | directly to deep cervical chain or indirectly via parotid and retropharyngeal nodes |
| What lymph nodes drain the pharynx and esophagus? | Retropharyngeal, paratracheal, or directly to deep cervical |
| Lymph drainage of larynx and trachea? | Above vocal folds: directly to deep cervical. Below vocal folds: pretracheal and paratracheal or directly to deep cervical |
| How many baby teeth do you have? | 20 (central incisor, lateral incisor, canine, first premolar, second premolar). |
| How many grownup teeth? | 32 (medial incisor, lateral incisor, canine, 2 premolars, 3 molars)/ |
| What does the styloglossus do? | Retracts and elevates the tongue |
| What does hyoglossus do? | Flattens the tongue |
| What does genioglossus do? | protrudes the tongue |
| What is general sensory to anterior 2/3 of tongue? | Lingual nerve (from V3) |
| What gives general sensory to post. 1/3 tongue? | lingual branch of CN IX |
| What gives taste to ant. 2/3 tongue? | chorda tympani (from facial) |
| what gives taste to post. 1/3 tongue? | lingual branch of CN IX |
| Blood supply to tongue | Mostly lingual artery, with contributions from tonsillar and ascending pharyngeal artery. |
| What emerges from the greater palatine foramen? | greater palatine nerve (from V2) and greater and lesser palatine artery |
| What comes out of the lesser palatine foramen? | lesser palatine nerve |
| What comes out of the incisive fossa? | nasopalatine nerves through incisive foramen from nasal septum to incisive fossa |
| What nerve is sensory to parotid? | great auricular nerve (cervical plexus), auriculotemporal nerve (V3) |
| What nerve is parasymp. to parotid? | CN IX -->otic ganglion --> postsynaptic fibers via auriculotemporal nerve |
| What nerve is sympathetic to parotid? | Cervical sympathetic ganglion --> external carotid nerve plexus --> parotid |
| What structures are there in the parotid, superficial to deep? | CN VII, retromandibular vein, external carotid. Also have parotid lymph nodes all over. |
| What is arterial supply of submandibular and sublingual glands? | submental and sublingual arteries, which are branches of the lingual and facial arteries respectively |
| How are the submandibular and sublingual glands innervated? | Presynaptic, parasympathetic nerve fibers are conveyed from CN VII to the lingual nerve via CHORDA TYMPANI. Get postsynaptic fibers from submandibular ganglion. |
| What is neurofibromatosis Type II? | get posterior fossa tumors, including neuroma |
| Where are extracranial tumors usually found? | infratemporal fossa (carotid body tumors, etc). Approach anterior and inferior. |
| What forms the roof of the nasal cavity? | Nasal bone, nasal spine of frontal bone, cribriform plate of ethmoid, body of sphenoid. |
| What forms the floor of the nasal cavity? | the palate |
| What forms the medial wall of the nasal cavity? | Nasal septum |
| What forms the lateral wall of the nasal cavity? | maxilla, perpendicular plate of palatine bone, ethmoid bone, cartilages |
| What are the middle and superior conchae made of? | ethmoid |
| What is the limen nasi? | Divides nasal cavity into nasal vestibule and nasal cavity proper |
| What happens if you break the cribriform plate? | causes CSF to leak into nose |
| What is the sphenoethmoidal recess? What contains it? | Narrow space above the superior concha. Has opening of SPHENOID SINUS. |
| What opens into the superior meatus? Whereabouts? | Posterior ethmoidal sinuses. Open into the anterior end of the meatus. |
| What opens into the middle meatus? | Ethmoidal infundibulum (frontal sinus opening), semilunar hiatus (maxillary sinus opening), ethmoid bulla |
| What's in the ethmoid bulla? | Middle ethmoidal air cells. |
| What opens into the inferior meatus? Wherabouts? | Nasolacrimal duct. Anterior end of meatus. |
| What is the olfactory region of the nasal cavity? | Superior concha. Contains CN I. |
| What is the frontonasal duct? | It's where the frontal sinuses open into the middle meatus via the ethmoidal infundibulum. |
| Where is the ostium of the maxillary sinus? | In the semilunar hiatus, in the middle meatus. |
| Where do the anterior ethmoidal air cells open into? | Middle meatus, via ethmoidal infundibulum. |
| Where do middle ethmoidal air cells open into? | Directly into middle meatus. |
| Where do posterior ethmoidal air cells open into? | Directly into superior meatus. |
| Where do general sensory and parasympathetic innervations for the nasal cavity come from? | The pterygopalatine ganglion, which is intimately related to the maxillary nerve (V2). |
| What is the region over the septum and anterior part of hard palate innervated by? | Nasopalatine nerve (from pterygopalatine ganglion, V2). |
| What innervates the posterior part of the nasal cavity? | Superior and inferior POSTERIOR LATERAL NASAL BRANCHES OF V2. |
| What is the very anterior part of the nasal cavity innervated by? | V1 |
| What are the lateral communications of the pterygopalatine fossa? | Pterygomaxillary fissue, into infratemporal fossa |
| What's the medial commuication of the pterygopalatine fossa? | Through sphenopalatine foramen, into nasal cavity (posterior part) |
| What's the anterior communication of the pterygopalatine fossa? | through the inferior orbital fissure |
| What's the posterior-lateral communication of the pterygopalatine fossa? | Foramun rotundum |
| What's the postero-medial communication of the pterygopalatine fossa? | Pterygoid canal into foramen lacerum |
| What's the inferior communication of the pterygopalatine fossa? | Greater and lesser palatine canals into oral cavity. |
| What artery goes through the pterygopalatine fossa? | 3rd part of maxillary artery (branch off external carotid) |
| What branches off the maxillary artery in the pterygopalatine fossa? | Posterior superior alveolar artery (leaves via pterygomaxillary fissure), infraorbital artery, descending palatine |
| What is the posterior superior alveolar artery? What does it supply? | Branch of maxillary, goes through infratemportal fossa to go to posterior superior alveolar foramen, supplies posterior maxillary teeth |
| What is the infraorbital artery? what does it supply? | goes via infraorbital fissure to infraorbital groove, infraorbital canal, infraorbital foramen. Supplies anterior maxillary teeth and lower eyelid, nose, upper lip. |
| What is the descending palatine artery? What does it do? | It divides into greater and lesser palatine arteries to hard and soft palate, respectively. |
| What is the sphenopalatine artery? what does it do? | branch off maxillary a. Goes through sphenopalatine foramen to nasal cavity. Branches into posterior lateral nasal branches. Goes to paranasal sinuses. |
| What nerve goes through the pterygopalatine fossa? | Maxillary nerve (V3). Branches into zygomatic and pterygopalatine nerves. |
| What is the Vidian nerve? Where does it go and what does it do? | Vidian nerve = nerve of the pterygoid canal, carrying parasympathetic and sympathetic fibers from greater petrosal nerve (CN VII). Goes to pterygopalatine ganglion. |
| Is the pterygopalatine ganglion parasympathetic? | yes |
| Where do postsynaptic parasympathetic fibers of the pterygopalatine ganglion go? | Innervate lacrimal gland, minor salivary and mucous glands |
| What's the worst kind of nosebleed? | Rupture of the sphenopalatine artery |
| What is Kiesselbach's area? | It's in the anterior part of nasal septum where there's a rich vascular anastomosis. Lots of nosebleeds. |
| Where are the 2 functionally important cartilage articulations in the larynx? | Between cricoid and thyroid (tension of vocal ligament) and between cricoid and arytenoid (size of rima glottidis as well as vocal ligament tension). |
| What is the "conus elasticus"? | Vocal ligament + cricothyroid membrane |
| Why is the vestibule of the larynx important clinically? | It's the area above your false vocal cords. If you stimulate it, its mucose is richly innervated so you get a violent cough reflex. |
| What action of the vocal folds widens the rima glottidis? | abduction of the vocal folds |
| What narrows the rima glottidis? | adduction of the vocal folds |
| What is the only muscle capable of opening the rima glottidis? | The POSTERIOR CRICOARYTENOID. (abducts vocal folds). |
| What two nerves innervate the larynx? | superior laryngeal and inferior laryngeal (off the recurrent laryngeal) |
| What gives sensory innervation to the mucosa ABOVE the vocal folds? | internal laryngeal nerve |
| What gives sensory innervation to the mucosa BELOW the vocal folds? | inferior laryngeal nerve (off recurrent) |
| What gives motor innervation to the intrinsic muscles of the larynx? | The recurrent laryngeal (not cricothyroid, which is supplied by external laryngeal) |
| What is the action of the thyroepiglotticus? | closes the inlet |
| what's the action of the aryepiglotticus? | closes the inlet |
| What's the action of the oblique arytenoid? | closes the inlet |
| What's the action of the thyroarytenoid? | relaxes the vocal folds |
| What's the action of the posterior cricoarytenoid? | ABDUCTION of vocal folds |
| What's the action of the lateral cricoarytenoid and the transverse arytenoid? | adduct the vocal folds |
| What's the action of the cricothyroid? | stretchs and tenses the vocal folds |
| what's the action of the vocalis? | tenses the vocal ligament regionally |
| What happens if you damage the external laryngeal nerve? | Cricothyroid is paralyzed, so can't stretch the vocal ligament on one side. Get hoarse voice. |
| What happens if you cut the recurrent laryngeal nerve? | Bad. Unilaterally, get weird voice. Bilaterally, emergency, respir. distress. |
| What supplies blood to the larynx? | Superior and inferior thyroid arteries. |
| During heavy respiration, are the vocal ligaments abducted or adducted? | Abducted |
| Why is the pharyngeal recess important? | Most nasopharyngeal cancers start there. |
| What is the major artery that supplies the palatine tonsil? | Facial artery. |
| What can be found in the palatine tonsillar fossa? | CN IX (glossopharyngeal) |
| What are the superior and inferior borders of the laryngopharynx? | Superiorly, the top of the epiglottis. Inferiorly, inferior border of cricoid cartilage at C6 level. |
| What two nerves are deep to the mucosa of the piriform recess? | Internal and recurrent laryngeal. |
| What passes through the 1st gap (above the superior constrictor) | auditory tube |
| What goes through the 2nd gap (between superior and middle constrictors)? | Stylopharyngeus and CN IX (glossopharyngeal) |
| Where does the middle pharyngeal constrictor attach? | Arises from hyoid, meets itself at the pharyngeal raphe |
| What passes through the 3rd gap between the middle and inferior constrictors? | The internal laryngeal nerve and superior laryngeal artery. |
| What passes through the gap inferior to the inferior constrictor? | The recurrent laryngeal nerve and the inferior laryngeal artery. |
| What innervates the pharynx? | Pharyngeal plexus from IX, X, sympathetic fibers. |
| What gives MOTOR innervation to the pharynx? | CN X (vagus) via the pharyngeal plexus, except for tensor veli palatini and stylopharyngeus |
| What gives SENSORY innervation to the pharynx? | CN IX (glossopharyngeal), except for nasopharynx mucosa which is V2. |
| How do you test CN IX and X? | gag reflex, movement of soft palate |
| What gives blood to the oropharynx? | Lingual artery and tonsillar branch of the facial artery. |
| What gives blood to the nasopharynx? | branches of the external carotid. |
| What gives blood to the laryngopharynx? | Branches of the ascending pharyngeal artery, which arises from external carotid artery close to the bifurcation. |
| What is the outer 1/3 of the external acoustic meatus made of? Inner 2/3? | Elastic cartilage, bone. |
| Vascular supply to the auricle? | Via superficial temporal and posterior auricular branches, which are both off of the external carotid. External canal also gets blood from deep auricular artery, off of maxillary a. |
| Venous drainage of the auricle? | Superficial temporal, posterior auricular, and mastoid emissary veins. |
| Venous drainage of the external meatus? | branches of the maxillary and external jugular veins, and pterygoid venous plexus. |
| Where should you incise the tympanic membrane during meringotomy? why? | Posteroinferiorly, to avoid injury to chorda tympani and the handle of the malleus. Also, bottom half is less vascular. |
| Where does the stapedius attach? | To the head of the stapes. |
| Where does tensor tympani attach? | To the manubrium of the malleus. |
| Roof of the middle ear | Tegmen tympani, above which is the middle cranial fossa. |
| Floor of the middle ear | plate of bone separating it from the bulb of the jugular. |
| What is the anterior wall of the middle ear? | bone separating cavity from internal carotid. 2 openings: one to auditory tube, 1 to canal for tensor tympani. |
| posterior wall of tympanic cavity? | separates it from mastoid air cells. Have aditus ad antrum opening into mastoid air cells. Beneath aditus, have PYRAMID projection which connects to tendon of stapedius. |
| What is the lateral wall of the tympanic cavity? | Tympanic membrane |
| What's in the medial wall of the tympanic cavity? | Promontory (formed partly by cochlea underneath). Separates oval window and round window. |
| Where does the tensor tympani attach? | On a bony shelf in the promontory. Pulley, called "processus cocheariformis". |
| What innervates tensor tympani? | CN V3 |
| What innervates stapedius? | CN VII (facial) |
| What gives sensory innervation for the lining of the tympanic cavity? | Tympanic plexus, formed from tympanic nerve from CN IX. Plexus also gives rise to lesser petrosal nerve. |
| What is the path of the chorda tympani? | it passes through the tympanic cavity bewteen incus and malleus and leaves via petrotympanic fissure. |
| Blood supply to middle ear | Anterior tympanic artery (off mexillary artery) for anterior part, stylomastoid artery off of posterior auricular artery for posterior part and mastoid air cells. |
| What part of the auditory tube is osseus? Which is cartilaginous? | posterior 1/3 is osseus, anterior 2/3 is cartilaginous |
| How many openings are there into the vestibule of the inner ear? | 5. Crus commune (anterior + posterior canals), oval window, round window, cochlea, and lateral ampulla |
| What is the spiral lamina? | It splits the cochlear canal into vestibular and tympanic components: scala vestibuli and scala tympani. |
| Where do scala vestibuli and tympani communicate? | At apex of spiral, through helicotrema. |
| Nerve supply to the inner ear. | CN VIII (vestibulocochlear). Vestibular nerve branch- --> utricle, saccule, semicircular ducts. Cochlear nerve --> cochlear duct. |
| What enters the internal acoustic meatus at the upper left quadrant? | CN VII. |
| What about the lower left quadrant? | CN VIII, cochlear division. |
| Upper right quadrant? | superior vsetibular division of CN VIII |
| Lower right quadrant? | Inferior vestibular divison of CN VIII. |
| what is Meniere syndrome? | Caused by blockage of cochlear aqueduct, increase in endolymph volume. Causes hearing loss and vertigo. |
| What is acoustic neuroma? What happens? | Slow growing Schwann cell tumor at base of brain where CN VII and CN VIII emerge. Generally damages vestibular part of CN VIII first, even though hearing loss is first sign. |
| Vascular supply of the inner ear. | Labyrinthine vessels off labyrinthine artery from AICA or from basilar artery. |
| Where does the labyrinthine vein drain into? | The superior petrosal sinus or the transverse sinus. |
| What is the orbital septum? | Thin membrane connecting tarsal plates with the periosteum at rim of orbit. |
| What happens to the face if the cervical trunk is interrupted? | Horner's syndrome: ptosis, constricted pupil,eye sinking, redness, dryness, hot face. |
| What is the plica semilunaris? | Semiluar fold, lateral to lacrimal caruncle. |
| How do you test SR? | look superiolaterally |
| How do you test IR? | look inferolaterally |
| How do you test SO? | look inferomedially |
| How do you test IO? | look superomedially |
| Where do CN III, IV, and VI enter the orbit? | Superior orbital fissure. |
| What provides sensory innervation to orbit? | CN V1 |
| What does the lacrimal nerve do? | Autonomic innervation to lacrimal gland, sensory to conjunctiva and upper lid |
| What is Meckel's cave? | where the trigeminal ganglion is |
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